Patient preferences for control in medical decision making: a scenario-based approach

This study evaluated patient preferences about involvement in medical decision making and factors that might influence these preferences.

A questionnaire was used that had one general question and 10 different clinical scenarios, followed by a list of seven options that described varying degrees of patient participation in the clinical decision-making process. The participants were patients presenting to a family practice residency clinic.

Using paired t tests, patient responses to seven of 10 clinical scenarios (70%) were statistically significantly different from their responses as predicted by the general question. Six responses showed a positive relationship, ie, patients wanted to give the physician more control than they indicated by their response to the general question. Paired t tests then compared responses to each scenario with responses to every other scenario; 26 of 45 (58%) were significantly different. A factor analysis suggested groupings of scenarios. Significant differences for decision-making preferences were found among age groups and among educational levels. Cronbach's alpha, a measure of internal consistency, was calculated at .81.

Although preference for level of control in medical decision making varied by scenario, our patients most often preferred physicians to play the primary role in decision making. Patient preferences for general decision making correlated poorly with preferences in specific scenarios.