Variability in patient preferences for participating in medical decision making: implication for the use of decision support tools

While there is an increasing emphasis on patient empowerment and shared dec ision making, evidence suggests that many patients do not wish to be involv ed in decisions about their own care. Previous research has found patient p references for involvement in decision making to vary with age, socioeconom ic status, illness experience, and the gravity of the decision. Furthermore , there is evidence that certain patients may experience disutility from be ing involved in decision making about the treatment of their health problem s. We discuss the implications of these findings for the use of decision su pport tools and the difficulties of targeting their use towards those patie nts most likely to benefit. We argue that patients may be ill informed abou t what participation in decision making actually entails and unaware of the benefits they stand to gain by articulating their preferences to their cli nician. Furthermore, clinicians are not good at accurately assessing patien ts' preferences, while patients may have unrealistic expectations about the ir clinician's ability to "know what is best" for them. Further research is required to understand variations in patients' preferences for information and involvement in decision making, and the factors that influence them.