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A typology of preferences for participation in healthcare decision making

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  • Flynn, Kathryn E.
  • Smith, Maureen A.
  • Vanness, David

Abstract

Classifying patients as "active" or "passive" with regard to healthcare decision making is misleading, since patients have different desires for different components of the decision-making process. Distinguishing patients' desired roles is an essential step towards promoting care that respects and responds to individual patients' preferences. We included items on the 2004 Wisconsin Longitudinal Study mail survey measuring preferences for four components of the decision-making process: physician knowledge of patient medical history, physician disclosure of treatment choices, discussion of treatment choices, and selection of treatment choice. We characterized preference types for 5199 older adults using cluster analysis. Ninety-six percent of respondents are represented by four preference types, all of which prefer maximal information exchange with physicians. Fifty-seven percent of respondents wanted to retain personal control over important medical decisions ("autonomists"). Among the autonomists, 81% preferred to discuss treatment choices with their physician. Thirty-nine percent of respondents wanted their physician to make important medical decisions ("delegators"). Among the delegators, 41% preferred to discuss treatment choices. Female gender, higher educational attainment, better self-rated health, fewer prescription medications, and having a shorter duration at a usual place of care predicted a significantly higher probability of the most active involvement in discussing and selecting treatment choices. The overwhelming majority of older adults want to be given treatment options and have their physician know everything about their medical history; however, there are substantial differences in how they want to be involved in discussing and selecting treatments.

Suggested Citation

  • Flynn, Kathryn E. & Smith, Maureen A. & Vanness, David, 2006. "A typology of preferences for participation in healthcare decision making," Social Science & Medicine, Elsevier, vol. 63(5), pages 1158-1169, September.
  • Handle: RePEc:eee:socmed:v:63:y:2006:i:5:p:1158-1169
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    References listed on IDEAS

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    1. Charles, Cathy & Gafni, Amiram & Whelan, Tim, 1997. "Shared decision-making in the medical encounter: What does it mean? (or it takes at least two to tango)," Social Science & Medicine, Elsevier, vol. 44(5), pages 681-692, March.
    2. Stevenson, Fiona A. & Barry, Christine A. & Britten, Nicky & Barber, Nick & Bradley, Colin P., 2000. "Doctor-patient communication about drugs: the evidence for shared decision making," Social Science & Medicine, Elsevier, vol. 50(6), pages 829-840, March.
    3. Matthias Schonlau, 2002. "The clustergram: A graph for visualizing hierarchical and nonhierarchical cluster analyses," Stata Journal, StataCorp LP, vol. 2(4), pages 391-402, November.
    4. Ong, L. M. L. & de Haes, J. C. J. M. & Hoos, A. M. & Lammes, F. B., 1995. "Doctor-patient communication: A review of the literature," Social Science & Medicine, Elsevier, vol. 40(7), pages 903-918, April.
    5. Falkum, Erik & Førde, Reidun, 2001. "Paternalism, patient autonomy, and moral deliberation in the physician-patient relationship: Attitudes among Norwegian physicians," Social Science & Medicine, Elsevier, vol. 52(2), pages 239-248, January.
    6. Charles, Cathy & Gafni, Amiram & Whelan, Tim, 1999. "Decision-making in the physician-patient encounter: revisiting the shared treatment decision-making model," Social Science & Medicine, Elsevier, vol. 49(5), pages 651-661, September.
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    Cited by:

    1. Semra Özdemir & Ateesha F. Mohamed & F. Reed Johnson & A. Brett Hauber, 2010. "Who pays attention in stated-choice surveys?," Health Economics, John Wiley & Sons, Ltd., vol. 19(1), pages 111-118.
    2. Meinow, Bettina & Parker, Marti G. & Thorslund, Mats, 2011. "Consumers of eldercare in Sweden: The semblance of choice," Social Science & Medicine, Elsevier, vol. 73(9), pages 1285-1289.

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