Do patients wish to be involved in decision making in the consultation? A cross-sectional survey with video vignettes
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OBJECTIVE: To determine patients' preferences for a shared or directed style of consultation in the decision making part of the general practice consultation. DESIGN: Structured interview, with video vignettes of acted consultations. SETTING: 5 practices in Lothian, Scotland. PARTICIPANTS: 410 patients (adults and adults accompanying children) attending surgery appointments. MAIN OUTCOME MEASURES: Preference for shared or directed form of video vignette for five different presenting conditions. RESULTS: Patients varied in their preference for involvement in decision making in the consultation. Under multiple regression analysis, patients' preference was found to be independently predicted by the problem viewed (patients presented with physical problems preferred a directed approach), patients' age (patients aged 61 or older were more likely to prefer the directed approach), social class (social classes I and II were more likely to prefer the shared approach), and smoking status (smokers more likely to prefer the shared approach). Those patients who were able to answer (or who thought their doctor's style similar to those in the vignettes) were more likely to describe their own doctor's style as similar to their preferred style. No major association in preference was found with sex, frequency of attendance, or perceived chronic ill health. CONCLUSION: Patients may vary in their desire for involvement in decision making in consultations. Although this variation seems to depend on the presenting problem, age, social class, and smoking status, these associations are not absolute, with large minorities in each group. Doctors need the skills, knowledge of their patients, and the time to determine on which occasions, with which illnesses, and at which level their patients wish to be involved in decision making.
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McKinstry found lower social class predicted lower preference for shared decision making style (odds ratio 0.35 (0.13-0.94) for highest social class and 1.05 (0.54-2.02) for lowest social class).
“Also a lower social class predicted a lower preference for shared decision making style (odds ratio 0,35 (0,13-0,94) for the highest social class and 1,05 (0,54-2.02)for the lowest social class).”
From Socio-economic status of the patient and doctor–patient communication: does it make a difference? (2005) · cites this paper as [34]
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- Authors
- McKinstry, B.
- Corresponding author
- McKinstry, B.
- ORCID
- McKinstry, B.
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2000-10-07
- Volume
- 321
- Issue
- 7265
- Pages
- 867-871
- ISSN
- 0959-8138 (ISSN-L)
- PMC
- PMC27496
- OpenAlex
- W2135217794
- Cited by
- 344
- References
- 1
- Citations by year
- 2025: 3 · 2024: 6 · 2023: 5 · 2022: 9 · 2021: 10 · 2020: 5 · 2019: 5 · 2018: 12 · 2017: 13 · 2016: 20 · 2015: 13 · 2014: 6 · 2013: 17 · 2012: 14
- FWCI
- 40.69
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- BMJ (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- DigitalGeorgetown (Georgetown University Library) (submittedVersion)
- Topics
- Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
- Keywords
- patient involvement in treatment decisions, shared decision-making, physician-patient communication, patient preferences, general practitioner visits, video vignettes, social class, smoking status, age differences
- MeSH terms
- Adult, Age Factors, Child, Decision Making, Female, Humans, Male, Middle Aged, Patient Participation, Regression Analysis, Patient Satisfaction
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