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December 7, 1984

Do Patients Want to Participate in Medical Decision Making?

Author Affiliations

From the Robert Wood Johnson Clinical Scholars Program, University of California, San Francisco, Veterans Administration Medical Center, and the Kaiser Hospital—Permanente Medical Group (Dr Strull); the Divisions of General Internal Medicine and Medical Ethics and the Institute for Health Policy Studies, University of California, San Francisco (Dr Lo); and the Health Systems and Planning Research Group, Veterans Administration Medical Center (Dr Charles), San Francisco.

JAMA. 1984;252(21):2990-2994. doi:10.1001/jama.1984.03350210038026

Although shared decision making by patients and clinicians has been advocated, little is known about the degree of participation in decision making that patients actually prefer or about clinicians' appreciation of these preferences. We administered questionnaires about three aspects of decision making to 210 hypertensive outpatients and to their 50 clinicians, who represented three types of medical practices. We found that 41% of patients preferred more information about hypertension; clinicians underestimated patient preferences for discussion about therapy in 29% of cases and overestimated in 11% (K=.22); and 53% of patients preferred to participate in making decisions, while clinicians believed that their patients desired to participate in 78% of cases. Many patients who preferred not to make initial therapeutic decisions did want to participate in ongoing evaluation of therapy. Thus, clinicians underestimate patients' desire for information and discussion but overestimate patients' desire to make decisions. Awareness of this discrepancy may facilitate communication and decision making.

(JAMA 1984;252:2990-2994)