Patient preferences for medical decision making - Who really wants to participate?

OBJECTIVES. TO identify the determinants of patient preferences for partici pation in medical decision making. METHODS. Data were analyzed for 2,197 patients from the Medical Outcomes St udy, a 4-year observational study of patients with chronic disease (hyperte nsion, diabetes, myocardial infarction, congestive heart failure, and depre ssion). Multivariate logistic regression models estimated the effects of pa tients' sociodemographic, clinical, psychosocial, and lifestyle characteris tics 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 signi ficantly decreased with age and increased with education. Women were more l ikely to be active than men (odds ratio [OR] = 1.44, P < 0.001). Compared w ith patients who only suffered with unsevere hypertension, those with sever e 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 de pression were more likely to be active (OR = 1.64, P = 0.01). Patients purs uing active coping strategies had higher odds for an active role than "pass ive" 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 ma king to physicians, preferences vary significantly by patient characteristi cs. Approaches to enhancing patient involvement will need to be flexible an d accommodating to individual preferences in order to maximize the benefits of patient participation on health outcomes.