Patient preferences for autonomy in decision making in asthma management

Background-Lower patient preferences for autonomy in management decision ma king during asthma exacerbations have been associated with an increased ris k far future hospital admissions. We sought to examine patient preferences for asthma self-management autonomy, and the clinical and psychosocial fact ors associated with autonomy preferences. Methods-A cross sectional observational study was performed with data colle cted between June 1995 and December 1997 of 212 adult patients with moderat e to severe asthma managed, at least in part, at two teaching hospitals. Su bjects completed a survey of autonomy preferences, quality of life, clinica l morbidity and health service use, asthma knowledge, self-efficacy, coping styles, and psychosocial measures. Results-Patients preferred clinicians to assume the major role in most deci sion making about their management. However, patients wished to remain in c ontrol in choosing when to seek care and wanted to share decisions regardin g initiating changes in medications during a moderate exacerbation. Multipl e regression analysis showed that concerns about adverse effects of medicat ions, education level, an active coping style, perceptions of the propensit y of physicians to involve them in treatment decision making, and concerns about costs causing delays in seeking medical care were associated with pre ferences for autonomy in decision making. Autonomy preferences were not rel ated to measures of concurrent clinical asthma control or health related qu ality of life. Conclusions-In a group of patients with moderate to severe asthma, a high p roportion of whom were from socioeconomically disadvantaged backgrounds, ed ucation level, perceived physician behaviour, cost barriers to care, and ps ychosocial factors (but not clinical asthma control or management) were rel ated to patient preferences for autonomy in management decision making duri ng asthma exacerbations. This has implications for asthma action plans and design of selfmanagement programmes.