What role do patients prefer in medical decision-making?: a population-based nationwide cross-sectional study

Micaela Gregório; Andreia Teixeira; Teresa Henriques; Rosália Páscoa; Sofia Baptista; Rosa Carvalho; Carlos Martins

doi:10.1136/bmjopen-2020-048488

What role do patients prefer in medical decision-making?: a population-based nationwide cross-sectional study

BMJ Open. 2021 Oct 12;11(10):e048488. doi: 10.1136/bmjopen-2020-048488.

Authors

Micaela Gregório^{1

2}, Andreia Teixeira^{1

3

4}, Teresa Henriques^{1

3}, Rosália Páscoa^{1

2

3}, Sofia Baptista^{1

2

3}, Rosa Carvalho², Carlos Martins^{5

2

3}

Affiliations

¹ MEDCIDS - Department of Community Medicine, Information and Decision in Health, Faculty of Medicine, University of Porto, 4099-002 Porto, Portugal.
² #H4A Primary Healthcare Research Network, Porto, Portugal.
³ Centre for Health Technology and Services Research (CINTESIS), Universidade do Porto, Porto, Portugal.
⁴ AdiT-LAB, Instituto Politécnico de Viana do Castelo, Rua Escola Industrial e Comercial Nun' Álvares, 4900-347 Viana do Castelo, Portugal.
⁵ MEDCIDS - Department of Community Medicine, Information and Decision in Health, Faculty of Medicine, University of Porto, 4099-002 Porto, Portugal carlosmartins20@gmail.com.

Abstract

Objective: To assess patients' preferred roles in healthcare-related decision-making in a representative sample of the Portuguese population.

Design: Population-based nationwide cross-sectional study.

Setting and participants: A sample of Portuguese people 20 years or older were interviewed face-to-face using a questionnaire with the Problem-Solving Decision-Making scale.

Outcomes: The primary outcome was patients' preferred role for each vignette of the problem-solving decision-making scale. Sociodemographic factors associated with the preferred roles were the secondary outcomes.

Results: 599 participants (20-99 years, 53.8% women) were interviewed. Three vignettes of the Problem-Solving Decision-Making scale were compared: morbidity, mortality and quality of life. Most patients preferred a passive role for both the problem-solving and decision-making components of the scale, particularly for the mortality vignette (66.1% in the analysis of the three vignettes), although comparatively more opted to share decision in the decision-making component. For the quality of life vignette, a higher percentage of patients wanted a shared role (44.3%) than with the other two vignettes. In the problem-solving component, preferences were significantly associated with area of residence (p<0.001) and educational level (p=0.013), while in the decision-making, component preferences were associated with age (p=0.020), educational level (p=0.015) and profession (p<0.001).

Conclusions: In this representative sample of the Portuguese mainland population, most patients preferred a practitioner-controlling role for both the problem-solving and decision-making components. In a life-threatening situation, patients were more willing to let the doctor decide. In contrast, in a less serious situation, there is a greater willingness to participate in decision-making. We have found that shared decision-making is more acceptable to better-educated patients in the problem-solving component and to people who are younger, higher educated and employed, in the decision-making component.

Keywords: general medicine (see internal medicine); medical education & training; medical ethics.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Clinical Decision-Making
Cross-Sectional Studies
Decision Making
Female
Humans
Male
Patient Participation*
Physician-Patient Relations
Quality of Life*