Do Patients Want to Participate in Medical Decision Making?

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 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.A survey of hypertensive outpatients and their physicians in three different clinic settings revealed differences between patients and physicians in their perceptions of disclosure and decision making. Patients wanted more discussion of therapy and of decisions about treatment but preferred to leave decision making to their clinicians. Physicians underestimated both the amount of information patients received and the amount they desired, but overestimated both the amount of actual patient participation in decision making and their patients' desire to make decisions. The authors suggest that, in view of these discrepancies, physicians and patients should engage in direct discussion of their preferences.