Impact of age, health locus of control and psychological co-morbidity on patients' preferences for shared decision making in general practice

Patient Educ Couns. 2006 May;61(2):292-8. doi: 10.1016/j.pec.2005.04.008.


Objective: The aim of this study was to explore if patients' preferences to be involved in decision making correlates with reasons for encounter, psychological or demographic characteristics and with the physicians' estimation of the patients' preferred communication styles.

Methods: Two hundred and thirty-four patients in general practice completed a questionnaire, which included the 'Autonomy Preference Index' (API), 'health locus of control' and 'hospital anxiety and depression'. The physicians documented the diagnoses and estimated the patients' preference for an autonomous, paternalistic or shared decision communication style.

Results: The preference for involvement varied across the reason for encounter (range 36.6-50.6), but this effect is explained by the patients' age (p<0.01). The participation preferences and the external and internal health locus of control declined with age whereas depression scores rose (p<0.01). The physicians estimation corresponded with patient API scores (p<0.05).

Conclusion: It must be questioned if the preference for involvement is really a stable characteristic. The physicians were able to estimate the preferred communication style of their patients presumably on the basis of the patients' age and education.

Practice implications: It appears that not every situation in general practice requires SDM, though different communication styles could be useful if adapted to the individual situation.

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Aged
  • Analysis of Variance
  • Anxiety / diagnosis
  • Anxiety / psychology
  • Communication
  • Comorbidity
  • Cooperative Behavior
  • Cross-Sectional Studies
  • Decision Making*
  • Depression / diagnosis
  • Depression / psychology
  • Family Practice / methods*
  • Germany
  • Humans
  • Internal-External Control*
  • Mental Health*
  • Middle Aged
  • Paternalism
  • Patient Participation* / methods
  • Patient Participation* / psychology
  • Patient Satisfaction*
  • Personal Autonomy
  • Physician-Patient Relations
  • Surveys and Questionnaires