Preferred Role in Health Care Decision Making Over Time in Patients With Heart Failure: My Decision or My Doctor's Decision?

BACKGROUND

Understanding patients' preferred role in decision making can improve patient-centered care. This study aimed to determine change and the predictors of change in preferred decision-making roles over time in patients with heart failure.

METHODS AND RESULTS

During the CASA (Collaborative Care to Alleviate Symptoms and Adjust to Illness) trial, patients' preferred roles in decision making were measured using the Control Preferences Scale (range 1-5; higher = less active; n = 312) at 4 timepoints over 1 year. The effect of the CASA intervention on preferred decision-making roles was tested using generalized linear mixed models. Whether preferences changed over time in the whole population was determined using linear regression. Demographic and health-related factors were examined as predictors of change using multiple linear regression. At baseline, most participants preferred active (score 1-2, 37.2%) or collaborative (score 3, 44.9%) roles. The CASA intervention did not influence preferred decision-making roles (P > 0.1). Preferences significantly changed over 1 year (P < 0.01), becoming more active (82.1%, 84.2%, 89.0%, 90.1% active/collaborative at each timepoint). Among all models and covariates, there were no significant predictors of change (P > 0.1).

CONCLUSIONS

Patients' preferred roles in decision making change over time, but changes are not well predicted. Clinicians should frequently and directly communicate with patients about their preferred decision-making roles.

Did You Get What You Wanted? Patient Satisfaction and Congruence Between Preferred and Perceived Roles in Medical Decision Making in a Hungarian National Survey

OBJECTIVES

In a growing number of countries, patient involvement in medical decisions is considered a cornerstone of broader health policy agendas. This study seeks to explore public preferences for and experiences with participation in treatment decisions in Hungary.

METHODS

A nationally representative online panel survey was conducted in 2019. Outcome measures included the Control Preferences Scale for the preferred and actual role in the decision, the 9-item Shared Decision Making Questionnaire, and a Satisfaction With Decision numeric rating scale.

RESULTS

A total of 1000 respondents participated in the study, 424 of whom reported having had a treatment decision in the preceding 6 months. Overall, 8%, 18%, 51%, 19%, and 4% of the population preferred an active, semiactive, shared, semipassive, and passive role in decision making, respectively. Corresponding rates for perceived role were as follows: 9%, 15%, 35%, 26%, and 15%. Preferred and perceived roles matched for 52% of the population, whereas 32% preferred more and 16% less participation. Better health status, attaining role congruence, and higher 9-item Shared Decision Making Questionnaire scores were positively associated with satisfaction, accounting for 32% of the variation in Satisfaction With Decision scores (P < .05).

CONCLUSIONS

This study represents the first national survey on decisional roles in healthcare in Hungary and, more broadly, in Central and Eastern Europe. Shared decision making is the most preferred decisional role in Hungary; nevertheless, there is still room to improve patient involvement in decision making. It seems that patient satisfaction may be improved through tailoring the decisional role to reflect patients' preferences and through practices that encourage shared decision making.

Internet use, online information seeking and knowledge among third molar patients attending public dental services

BACKGROUND

While Australians are searching the internet for third molar (TM) information, the usefulness of online sources may be questioned due to quality variation. This study explored: (i) internet use, online information-seeking behaviour among TM patients attending public dental services; and (ii) whether patients' TM knowledge scores are associated with the level of internet use and eHealth Literacy Scale (eHEALS) scores.

METHODS

Baseline survey data from the 'Engaging Patients in Decision-Making' study were used. Variables included: sociodemographics, internet access status, online information-seeking behaviour, eHEALS, the Control Preferences Scale (CPS) and TM knowledge.

RESULTS

Participants (N = 165) were mainly female (73.8%), aged 19-25 years (42.4%) and had 'secondary school or less' education (58.4%). A majority (N = 79, 52.7%) had sought online dental information which was associated with active decisional control preference (odds ratio = 3.1, P = 0.034) and higher educational attainment (odds ratio = 2.7, P = 0.040). TM knowledge scores were not associated with either the level of internet use (F_(2,152) = 2.1, P = 0.094, χ² = 0.0310) or the eHEALS scores (r = 0.147, P = 0.335).

CONCLUSIONS

'The internet-prepared patient' phenomena exists among public TM patients and was explained by preference for involvement in decision-making. However, internet use was not associated with better TM knowledge. Providing TM patients with internet guidance may be an opportunity to improve TM knowledge.

Validity of the Control Preferences Scale in patients with emotional disorders

BACKGROUND

The Control Preferences Scale (CPS) is the most frequently used measure of patients' preferred roles in treatment decisions. The aim of this study was to provide data about the validity of CPS in psychiatric care of patients with emotional disorders.

METHODS

The original CPS was translated to Spanish using the process of cross-cultural adaptation of self-reported measures as the methodological model for Spanish translation. The final version was tested in a convenience sample of 621 consecutive psychiatric outpatients (461 depressive and 160 anxiety disorders) that also completed the Shared Decision-Making Questionnaire, the Multidimensional Health Locus of Control Scale, the Drug Attitude Inventory, and a questionnaire including sociodemographic and clinical variables.

RESULTS

CPS showed a moderate internal consistency and a good convergent validity. Patients with collaborative and passive preferences expressed a greater reliance on psychotropics. Patients preferring a collaborative role self-reported greater perception of involvement in decision-making about their treatment. Patients preferring a passive role showed a greater external health locus of control. The most common preferred role was the collaborative-passive. Older patients and those under longer treatments preferred a passive role, while patients with higher levels of education preferred a collaborative role.

CONCLUSION

The CPS is a valid measure of the amount of control that psychiatric outpatients with emotional disorders want to assume in the process of making decisions about their treatment.

Preferences for Shared Decision Making in Older Adult Patients With Orthopedic Hand Conditions

PURPOSE

The practice of medicine is shifting from a paternalistic doctor-patient relationship to a model in which the doctor and patient collaborate to decide optimal treatment. This study aims to determine whether the older orthopedic population desires a shared decision-making approach to care and to identify patient predictors for the preferred type of approach.

METHODS

This cross-sectional investigation enrolled 99 patients, minimum age 65 years, at a tertiary hand specialty practice between March and June 2015. All patients completed the Control Preferences Scale, a validated system that distinguishes among patient preferences for patient-directed, collaborative, or physician-directed decision making. Bivariate and logistic regression analyses assessed associations among demographic data; clinic encounter variables such as familiarity with provider, trauma, diagnosis, and treatment decision; and the primary outcome of Control Preferences Scale preferences.

RESULTS

A total of 81% of patients analyzed preferred a more patient-directed role in decision making; 46% of the total cohort cited a collaborative approach as their most preferred treatment approach. Sixty-seven percent cited the most physician-directed approach as their least preferred model of decision making. In addition, 49% reported that spending more time with their physician to address questions and explain the diagnosis would be most useful when making a health care decision and 73% preferred additional written informational material. Familiarity with the provider was associated with being more likely to prefer a collaborative approach.

CONCLUSIONS

Older adult patients with symptomatic upper-extremity conditions desire more patient-directed roles in treatment decision making. Given the limited amount of reliable information obtained independently outside the office visit, our data suggest that written decision aids offer an approach to shared decision making that is most consistent with the preferences of the older orthopedic patient.

CLINICAL RELEVANCE

This study quantifies older adults' desire to participate in decision making when choosing among treatments for hand conditions.