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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References
- Heart disease and stroke statistics—2007 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee.Circulation. 2007; 115: e69-e171
- Consensus recommendations for the management of chronic heart failure.Am J Cardiol. 1999; 83: 1A-38A
- Health Spotlight.(Updated January 2007) (Accessed January 17, 2008)
- Chronic Heart Failure, QUERI Fact Sheet.(February 2007) (Accessed January 17, 2008)
- Improving chronic illness care: translating evidence into action.Health Aff (Millwood). 2001; 20: 64-78
- Organizing care for patients with chronic illness.Milbank Q. 1996; 74: 511-544
- A framework for the study of self- and family management of chronic conditions.Nurs Outlook. 2006; 54: 278-286
- Crossing the quality chasm: a new health system for the 21st century.National Academy Press, Washington, DC2001
- Assessing the effects of physician-patient interactions on the outcomes of chronic disease.Med Care. 1989; 27: S110-S127
- Measuring patient-centered communication in patient-physician consultations: theoretical and practical issues.Soc Sci Med. 2005; 61: 1516-1528
- Patient centered medicine.JAMA. 1996; 275: 152-156
- Patient participation in the patient-provider interaction: the effects of patient question asking on the quality of interaction, satisfaction, and compliance.Health Educ Monogr. 1977; 5: 281-315
- Effective physician-patient communication and health outcomes: a review.CMAJ. 1995; 152: 1423-1433
- Chasms in communication.BMJ. 1990; 301: 1407-1408
- Physician behaviors that correlate with patient satisfaction.J Med Educ. 1982; 57: 105-112
- When the diagnosis is cancer: patient communication experiences and preferences.Cancer. 1996; 77: 2630-2637
- Qualitative analysis of living with heart failure.Heart Lung. 2003; 32: 32-40
- Patients' preferences for participation in clinical decision making: a review of published surveys.Behav Med. 1998; 24: 81-88
- Patient and visit characteristics related to physicians' participatory decision-making style.Med Care. 1995; 33: 1176-1187
- Preferences for involvement in medical decision-making: situational and demographic influences.Patient Educ Couns. 1993; 22: 133-140
- Sources of variation in physician adherence with clinical guidelines: results from a factorial experiment.J Gen Intern Med. 2007; 22: 289-296
- Variability in patient preferences for participating in medical decision making: implication for the use of decision support tools.Qual Health Care. 2001; 10: i34-i38
- Patient preferences for medical decision making: who really wants to participate?.Med Care. 2000; 38: 335-341
- Medical decision making: do patients really want to participate?.Abstr Book Assoc Health Serv Res Meet. 1998; 15: 252-253
- Measuring patients' desire for autonomy: decision making and information-seeking preferences among medical patients.J Gen Intern Med. 1989; 4: 23-30
- Determinants of participation in treatment decision-making by older breast cancer patients.Breast Cancer Res Treat. 2004; 85: 201-209
- Medical decision-making and information needs in end-stage renal disease patients.Gen Hosp Psychiatry. 2003; 25: 324-331
- Using BNP to diagnose, manage, and treat heart failure.Cleve Clin J Med. 2003; 70: 333-336
- Early outcomes of a care coordination-enhanced telehome care program for elderly veterans with chronic heart failure.Telemed J E Health. 2005; 11: 20-27
Rodriguez KL, Appelt CJ, Switzer GE, Sonel AF, Arnold RM. ‘They diagnosed bad heart': a qualitative exploration of heart failure patients' knowledge about and experiences with their condition. Heart Lung (in press).
- The MOS 36-item short form health survey (SF-36).Med Care. 1992; 30: 473-483
- The Control Preferences Scale.Can J Nurs Res. 1997; 29: 21-43
- Patients' Perceived Involvement in Care Scale: relationship to attitudes about illness and medical care.J Gen Intern Med. 1990; 5: 29-33
- Patient preferences for medical decision making: who really wants to participate?.Med Care. 2000; 38: 335-341
- Patient information-seeking behaviors when communicating with doctors.Med Care. 1990; 28: 19-28
- Perceptions and behaviour among elderly hospital patients: description and explanation of age differences in satisfaction, knowledge, emotions, and behaviour.Soc Sci Med. 1990; 31: 1377-1385
- Older patient satisfaction with communication during an initial medical encounter.Soc Sci Med. 1994; 38: 1279-1288
- Physician-patient interaction: what do elders want?.J Am Osteopath Assoc. 2002; 102: 73-78
- Issues in elderly patient-provider interactions.Res Aging. 1987; 9: 3-44
- Educational needs of patients with advanced heart failure and their caregivers.J Heart Lung Transplant. 2001; 20: 766-769
- Patient characteristics associated with care by a cardiologist among adults hospitalized with severe congestive heart failure.J Am Coll Cardiol. 2000; 36: 2119-2125
- Socioeconomic status, treatment, and outcomes among elderly patients hospitalized with heart failure: findings from the National Heart Failure Project.Am Heart J. 2006; 152: 371-378
- The outpatient medical encounter and elderly patients.Clin Geriatr Med. 2000; 16: 95-107
- Meetings between experts: an approach to sharing ideas in medical consultations.Tavistock Publications, London1985
- Personality and health care decision-making style.J Gerontol B Psychol Sci Soc Sci. 2007; 62: P261-P267
- Clinical factors that influence patients' desire for participation in decisions about illness.Arch Intern Med. 2000; 160: 2991-2996
- Decision making during serious illness: what role do patients really want to play?.J Clin Epidemiol. 1992; 45: 941-950
- Physician-patient relations: no more models.Am J Bioeth. 2004; 4: W16-W19
- Sharing decisions in cancer care.Soc Sci Med. 2001; 52: 1865-1878
- Influence of physician communication on newly diagnosed breast cancer patients' psychologic adjustment and decision-making.Cancer. 1994; 74: 336-341
- The dynamics of change: Cancer patients' preferences for information, involvement and support.Ann Oncol. 1997; 8: 857-863
- Patient preferences versus physician perceptions of treatment decisions in cancer care.J Clin Oncol. 2001; 19: 2883-2885
- Insights from cancer patient communication research.Hematol Oncol Clin North Am. 2002; 16: 731-743
- Exploring information-exchange in consultation: the patients' view of performance and outcomes.Patient Educ Couns. 1995; 25: 237-246
- Issues underlying prevalence of “doctor-shopping” behavior.J Health Soc Behav. 1976; 17: 329-339
- Communication, compliance, and concordance between physicians and patients with prescribed medications.Am J Public Health. 1976; 66: 847-853
Article info
Publication history
Published online: October 02, 2008
Identification
Copyright
© 2008 Published by Elsevier Inc.
