Are patients' decision-making preferences being met?

Abstract

Objective: To investigate the information and decision-making expectations of general practice patients during real life consultations.

Design: Post-consultation, quantitative patient preference and enablement questionnaire.

Setting and participants: Patients attending for routine appointments in general practice surgeries in Oxfordshire, UK.

Results: Thirteen Oxfordshire general practitioners (GPs) volunteered to take part and a total of 171 patients completed and returned the questionnaire. Between a quarter and one-third of patients reported receiving less information than they desired, particularly in relation to the risks and benefits of medical treatments. Patients who preferred the doctor to make decisions for them (35%), were more likely to have their preferences met (64%) compared with patients wishing to share decisions (47%) or make their own (18%) who were less likely to achieve this role (52 and 41%, respectively). However, it could not be demonstrated unequivocally that these differences were statistically significant. In total, 61% of patients perceived that they achieved their preferred decision-making role. No significant differences were found in post-consultation enablement scores between any of the decision preference groups. Patients' assessments indicated that some doctors were more successful at achieving congruence than others.

Conclusion: The decision-making preferences of general practice patients tend to vary. However, there was a substantial mismatch between the stated preferences of patients for the role they wanted to have in decision-making and what they felt actually took place in their consultation. Therefore, it remains a challenge for doctors to match their consultation style to the decision-making preferences of individual patients.