Shared decision making: views of first-year residents and clinic patients.

PURPOSE

Patients' and physicians' views of their roles in decision making have implications for patient care and medical education. This study was designed to determine perspectives of residents and patients on the amount of control each should have in health care decisions.

METHOD

Data were collected from a self-administered questionnaire of 45 first-year residents and a parallel structured interview with 92 patients from three resident clinics. Information Seeking (IS) and Decision Making (DM) scales from the Autonomy Preference Index were supplemented by five clinical scenarios focused on decisions concerning hypertension, depression, cholecystectomy, hysterectomy, and prostate cancer. Analysis of variance (ANOVA) and repeated-measures ANOVA were used to test for significant differences in scores.

RESULTS

Patients' and residents' mean scores on IS were practically equivalent, indicating strong desire for information sharing. For DM, patients indicated a desire for slightly less than equal control in decisions, while residents thought patients should have a more than equal role. Given the specific clinical scenarios, the picture varied. Patients wanted equal roles in the hypertension, depression, and prostate cancer scenarios, while residents wanted to have more control in these decisions. Conversely, patients wanted greater control in the hysterectomy and cholecystectomy scenarios, and residents wanted a less than equal role in these decisions. Patients thought consultants such as surgeons desired the same role as their physicians, but residents assumed consultants wanted more control.

CONCLUSIONS

Patients from a disadvantaged population indicated a strong desire for information and participation in making decisions about their care. Understanding the similarities and discrepancies in patients' and first-year residents' perspectives on shared decision making can have consequences for the patient-physician relationship and medical education.