Minimum Data Needed on Patient Preferences for Accurate, Efficient Medical Decision Making

Background: Patients vary in their desire to participate in medical decision-making (MDM), with some preferring passive roles and others preferring shared or autonomous roles. Yet little is known about the stability of patient preferences over time and whether patient preferences are aligned with how they actually experience the MDM process. We sought to determine the stability of MDM preferences for patients hospitalized with an AMI and assess whether there is concordance between the patient’s preference and their experience with care. Methods: In TRIUMPH, a 24-center, prospective US study of AMI patients, MDM preferences were assessed both at the time of hospitalization and one year later (n=2071). MDM preferences were assessed by the question, “Given the information about the risks and benefits of the treatment options, who should decide which treatment option should be selected? We categorized responses from a 5-item Likert scale into: passive (“doctor alone/mostly the doctor”), or shared/active (“doctor and you equally/mostly you or you alone”) and compared responses between baseline and 12-months following AMI. We assessed concordance between baseline MDM preferences with the patients’ perceived level of participation in MDM at 1 month with the question, “Who was responsible for making health decisions regarding the current treatment of your heart condition?” using the same 5-item Likert scale and categorization. Results: Over 2/3 of patients preferred shared/active MDM both at the time of their AMI (1446, 69.8%) and 1 year later (1411, 68.1%). However, individual preferences varied over time. Among patients with a baseline preference for shared/active MDM, 374 (25.9%) preferred passive participation 1 year later. Among patients preferring passive participation at the time of their AMI, 339 (54.2%) preferred a shared/active participatory role 1 year later. Comparing desired and perceived roles in MDM, only 54.5% of patients reported, at 1 month, an MDM process that was concordant with their baseline preferences. Among patients with a baseline preference for shared/active MDM, 48.3% reported experiencing a passive role in MDM 1 month following AMI. Among patients preferring a passive role at baseline, 39.3% reported experiencing a shared/active MDM process. Conclusion: Individual preferences for participation in MDM during and after AMI vary, with the majority preferring a shared/active role. These preferences change over time, highlighting the need for continual assessment. In the month following an AMI, half of patients experienced an MDM process that was not consistent with their stated preferences.

Download Full-text

Evidence-Based Medicine

Journal of the American Podiatric Medical Association ◽

10.7547/0960374 ◽

2006 ◽

Vol 96 (4) ◽

pp. 374-377 ◽

Cited By ~ 5

Author(s):

Marvin H. Waldman

Keyword(s):

Decision Making ◽

Patient Preferences ◽

Evidence Based Medicine ◽

Medical Decision Making ◽

Clinical Care ◽

Medical Decision ◽

Evidence Based ◽

Clinical Intuition ◽

Pros And Cons ◽

Based Medicine

The purpose of this article is to review the history and development of evidence-based medicine, to provide a basic outline of its application to clinical care, and to discuss its pros and cons. This article can be used as a tool in podiatric medicine and surgery to ensure that current best evidence, clinical intuition, and patient preferences inform and guide our medical decision making. (J Am Podiatr Med Assoc 96(4): 374–377, 2006)

Download Full-text

Patient Preferences Versus Physician Perceptions of Treatment Decisions in Cancer Care

Journal of Clinical Oncology ◽

10.1200/jco.2001.19.11.2883 ◽

2001 ◽

Vol 19 (11) ◽

pp. 2883-2885 ◽

Cited By ~ 218

Author(s):

Eduardo Bruera ◽

Catherine Sweeney ◽

Kathryn Calder ◽

Lynn Palmer ◽

Suzanne Benisch-Tolley

Keyword(s):

Decision Making ◽

Palliative Care ◽

Patient Preferences ◽

Medical Decision Making ◽

Treatment Decision ◽

Weighted Kappa ◽

Kappa Coefficient ◽

Medical Decision ◽

Initial Assessment ◽

Physician Perceptions

PURPOSE: To examine patient preferences as well as physician perceptions of these preferences for decision making and communication in palliative care. PATIENTS AND METHODS: Medical decision-making preferences (DMPs) were prospectively studied in 78 assessable cancer patients after initial assessment at a palliative care outpatient clinic. DMPs were assessed with a questionnaire using five possible choices ranging from 1 (patient prefers to make the treatment decision) to 5 (patient prefers the physician to make the decision). In addition, the physician’s perception of this preference was assessed. RESULTS: Full concordance between the physician and the patient was seen in 30 (38%) of 78 cases; when the five original categories were recombined to cover active, shared, and passive decision making, there was concordance in 35 (45%) of 78 cases. The kappa coefficient for agreement between physician and patient was poor at 0.14 (95% confidence limit, −0.01 to 0.30) for simple kappa and 0.17 (95% confidence interval [CI], 0.00 to 0.34) for weighted kappa (calculated on the three regrouped categories). Active, shared, and passive DMPs were chosen by 16 (20%) of 78, 49 (63%) of 78, and 13 (17%) of 78 patients, and by 23 (29%) of 78, 30 (39%) of 78, and 25 (32%) of 78 physicians, respectively. The majority of patients (49 [63%] of 78; 95% CI, 0.51 to 0.74) preferred a shared approach with physicians. Physicians predicted that patients preferred a less shared approach than they in fact did. Patient age or sex did not significantly alter DMP. CONCLUSION: An individual approach is needed and each patient should be assessed prospectively for DMP.

Download Full-text