Do people want to be autonomous patients? Preferred roles in treatment decision-making in several patient populations

Health Expect. 2007 Sep;10(3):248-58. doi: 10.1111/j.1369-7625.2007.00441.x.


Background: What role do people want to play in treatment decision-making (DM)?

Objective: Examine the role patients indicate they would prefer in making treatment decisions across multiple clinical settings in Ontario, Canada.

Design: Secondary analysis of a series of survey/interview-based studies measuring preferred role, conducted in 12 different populations.

Setting and participants: Respondents were outpatients, largely but not entirely attending outpatient clinics in large teaching hospitals in urban settings in the Province of Ontario, Canada. The subgroups and sample sizes were: breast cancer (202), prostate disease (202), fractures (202), continence (46), orthopaedic (111), rheumatology (56), multiple sclerosis (22), HIV/AIDS (431), infertility (454), benign prostatic hyperplasia (678) and cardiac disease (300), plus 50 healthy nursing students (for scale validation).

Measurements: All studies categorized preferred role using the Problem-Solving Decision-Making (PSDM) scale with one or both of the Current Health condition and Chest Pain vignettes.

Results: Few respondents preferred an autonomous role (1.2% for the current health condition vignette and 0.7% for the chest pain vignette); most preferred shared DM (77.8% current health condition; 65.1% chest pain) or a passive role (20.3% current health condition; 34.1% chest pain). Familiarity with a clinical condition increases desire for a shared (as opposed to passive) role. Preferences for passive vs. shared roles varied across settings; older and less educated individuals were most likely to prefer passive roles.

Conclusions: Despite consumerist rhetoric among some bioethicists, very few respondents wish an autonomous role. Most wish to share DM with their providers.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Attitude to Health
  • Decision Making*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Patient Participation / psychology*
  • Patient Satisfaction*
  • Physician's Role / psychology
  • Socioeconomic Factors