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Veterans' decision-making preferences and perceived involvement in care for chronic heart failure

  • Keri L. Rodriguez
    Correspondence
    Corresponding author: Keri L. Rodriguez, PhD, VA Pittsburgh Healthcare System, Center for Health Equity Research and Promotion, 7180 Highland Drive, Building 2, Room 4083E (151C-H), Pittsburgh, PA 15206
    Affiliations
    Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania

    Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania

    Geriatric Research Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
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  • Cathleen J. Appelt
    Affiliations
    Mental Illness Research, Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
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  • Galen E. Switzer
    Affiliations
    Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania

    Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania

    Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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  • Ali F. Sonel
    Affiliations
    Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania

    Cardiology Division, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania

    Cardiovascular Institute, University of Pittsburgh, Pennslvania
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  • Robert M. Arnold
    Affiliations
    Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania

    Section of Palliative Care and Medical Ethics, University of Pittsburgh, Pennsylvania

    Institute to Enhance Palliative Care, University of Pittsburgh, Pittsburgh, Pennsylvania
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Published:October 02, 2008DOI:https://doi.org/10.1016/j.hrtlng.2008.02.003

      Background

      Patients with heart failure require a great deal of information about their disease, but it is also important to know about their preferences for involvement in medical decision making and about factors that may influence their preferences so that patients' needs, values, and preferences can be met by clinicians.

      Objectives

      We assessed patients' preferred role and perceived level of involvement in medical decision making and tested the effects of patients' age and role preference on perceived involvement in medical decision making.

      Methods

      We conducted a telephone survey of 90 adults being treated for heart failure by a Veterans Affairs primary care provider or cardiologist. Patients' preferred role in treatment decisions was assessed using the Control Preferences Scale. Perceptions about their involvement in decision making during the most recent clinic visit was measured using a subscale of the Perceived Involvement in Care Scale. Descriptive, correlational, and generalized linear regression analyses were conducted.

      Results

      Most patients were elderly (mean = 70.1 years), male (94.4%), and white (85.6%), and had New York Heart Association class II disease (55.6%). Forty-three patients (47.8%) preferred a passive role in decision making, 19 patients (21.1%) preferred an active role, and 28 patients (31.1%) preferred a collaborative role. Most patients believed that their decision-making involvement was relatively passive, as indicated by a mean score of .96 (range, 0-4) on the Perceived Involvement in Care Scale decision-making subscale. Older age was associated with passive role preference (r = .263; P < .05) and less perceived involvement in decision making (r = −.279; P < .01). In addition, less perceived involvement in decision making during the last clinic visit was associated with a preference for a more passive decision-making role (r = ρ.355; P < .01). Generalized linear regression analysis indicated that when patients' perceived decision-making involvement was regressed on age and patients' role preferences, age was no longer significantly associated with involvement (β = −.196; P = .061), but that control preferences continued to exhibit an independent effect on perceived involvement in medical decision making (β = −.341; P = .003).

      Conclusion

      The results suggest that the preferences of patients with heart failure for a more passive role in decision making may be a stronger independent predictor of patients' perceived involvement in decision making than patients' age.
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