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Patient Preferences for Medical Decision Making: Who Really Wants to Participate?

Arora, Neeraj K. MS*; McHorney, Colleen A. PhD

Brief Report

Objectives. To identify the determinants of patient preferences for participation in medical decision making.

Methods. Data were analyzed for 2,197 patients from the Medical Outcomes Study, a 4-year observational study of patients with chronic disease (hypertension, diabetes, myocardial infarction, congestive heart failure, and depression). Multivariate logistic regression models estimated the effects of patients' sociodemographic, clinical, psychosocial, and lifestyle characteristics on their decision-making preferences.

Results. A majority of the patients (69%) preferred to leave their medical decisions to their physicians. The odds for preferring an active role significantly decreased with age and increased with education. Women were more likely to be active than men (odds ratio [OR] = 1.44, P < 0.001). Compared with patients who only suffered with unsevere hypertension, those with severe diabetes (OR = 0.62, P = 0.04) and unsevere heart disease (OR = 0.45, P = 0.02) were less likely to prefer an active role. Patients with clinical depression were more likely to be active (OR = 1.64, P = 0.01). Patients pursuing active coping strategies had higher odds for an active role than "passive" copers, while those who placed higher value on their health were less likely to be active than those with low health value (OR = 0.59, P < 0.001).

Conclusions. Although a majority of patients prefer to delegate decision making to physicians, preferences vary significantly by patient characteristics. Approaches to enhancing patient involvement will need to be flexible and accommodating to individual preferences in order to maximize the benefits of patient participation on health outcomes.

*From the Center for Health Systems Research and Analysis, University of Wisconsin, Madison, Wisconsin.

From the Departments of Medicine and Preventive Medicine, University of Wisconsin-Madison School of Medicine, Madison, Wisconsin.

Results presented in part at the 15th annual meeting of the Association for Health Services Research; Washington, DC; June 1998. An earlier version of this paper was adjudged the "1998 Student Paper of the Year" by the Wisconsin Network for Health Policy Research.

Address correspondence to: Neeraj K. Arora, MS, Center for Health Systems Research and Analysis, 1236 WARF Building, 610 Walnut Street, University of Wisconsin, Madison, WI 53705. E-mail:

Received April 8, 1999; initial review completed June 10, 1999; accepted September 27, 1999.

© 2000 Lippincott Williams & Wilkins, Inc.