Do patients want to participate in medical decision making?

Abstract

Although shared decision making by patients and clinicians has been advocated, little is known about the degree of participation in decision making that patients actually prefer or about clinicians' appreciation of these preferences. We administered questionnaires about three aspects of decision making to 210 hypertensive outpatients and to their 50 clinicians, who represented three types of medical practices. We found that 41% of patients preferredmoreinformation about hypertension; cliniciansunderestimatedpatient preferences for discussion about therapy in 29% of cases andoverestimatedin 11% (K=.22); and 53% of patients preferred to participate in making decisions, while clinicians believed that their patients desired to participate in 78% of cases. Many patients who preferred not to make initial therapeutic decisions did want to participate in ongoing evaluation of therapy. Thus, cliniciansunderestimatepatients' desire for information and discussion butoverestimatepatients' desire to make decisions. Awareness of this discrepancy may facilitate communication and decision making. (JAMA1984;252:2990-2994)