PATIENTS PREFERENCES FOR PARTICIPATION IN CLINICAL DECISION-MAKING - A REVIEW OF PUBLISHED SURVEYS

Models of doctor-patient relations vary between ''paternalistic'' and ''informative.'' The paternalistic model emphasizes doctors' authority ; alternative models allow patients to exercise their rights to autono my. Published surveys indicate that most patients want to be informed about their diseases, that a proportion of patients want to participat e in planning management of their illnesses, and that some patients wo uld rather be completely passive and would avoid any information. The severity of the patients' conditions, and their being older less well educated, and male are predictors of a preference for the passive role in the doctor-patient relationship, but demographic and situational c haracteristics explain only 20% or less of the variability in preferen ces. The only way a physician can gain insight into an individual pati ent's desire to participate in decision making is through direct enqui ry. The ability to communicate health-related information and to deter mine the patients' desire to participate in medical decisions should b e viewed as a basic clinical skill.