Clinical decision-making: Patients' preferences and experiences

Patient Educ Couns. 2007 Feb;65(2):189-96. doi: 10.1016/j.pec.2006.07.007. Epub 2006 Sep 7.


Objective: To determine the congruence between patients' preferred style of clinical decision-making and the style they usually experienced and whether this congruence was associated with socio-economic status and/or the perceived quality of care provided by the respondent's regular doctor.

Methods: Cross-sectional survey of the American public using computer-assisted telephone interviewing.

Results: Three thousand two hundred and nine interviews were completed (completion rate 72%). Sixty-two percent of respondents preferred shared decision-making, 28% preferred consumerism and 9% preferred paternalism. Seventy percent experienced their preferred style of clinical decision-making. Experiencing the preferred style was associated with high income (OR, 1.59; 95% CI, 1.16-2.16) and having a regular doctor who was perceived as providing excellent or very good care (OR, 2.39; 95% CI, 1.83-3.11).

Conclusion: Both socio-economic status and having a regular doctor whom the respondent rated highly are independently associated with patients experiencing their preferred style of clinical decision-making.

Practice implications: Systems which promote continuity of care and the development of an on-going doctor-patient relationship may promote equity in health care, by helping patients experience their preferred style of clinical decision-making.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Analysis of Variance
  • Clinical Competence*
  • Communication
  • Continuity of Patient Care
  • Cooperative Behavior
  • Cross-Sectional Studies
  • Decision Making*
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Income
  • Middle Aged
  • Paternalism
  • Patient Education as Topic / organization & administration
  • Patient Participation / methods
  • Patient Participation / psychology*
  • Patient Satisfaction*
  • Physician's Role / psychology
  • Physician-Patient Relations*
  • Quality of Health Care
  • Socioeconomic Factors
  • Surveys and Questionnaires
  • United States