Abstract
OBJECTIVES: To compare results on the Autonomy Preference Index (API) and the Health Opinion Survey (HOS), two instruments that measure patient desire for information and involvement in decision making.
DESIGN: Cross-sectional survey.
SETTING: University-based primary care outpatient longitudinal and acute care clinic.
PATIENTS: 167 patients with benign prostatic hyperplasia, back pain, or mild hypertension seen from October 1991 to December 1992.
MEASUREMENTS AND MAIN RESULTS: On the API and the HOS (both scaled from 0 to 1), the patients had intermediate desire for involvement in decision making (median API: 0.42; HOS: 0.36) and higher desire for information (median API: 0.97; HOS: 0.57). With either instrument, the desire for information exceeded that for involvement in decision making (p<0.0001). The API information scores were higher than the HOS information scores (p < 0.0001), probably because the HOS focuses on patient behavior rather than desire. Variation in desire for information and involvement in decision making was substantial and largely unexplained.
CONCLUSIONS: Most patients have a high desire for information, the desire for information and involvement in decision making varies substantially among patients, and the API is preferable to the HOS for researchers interested in focusing solely on patient desire for information.
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Barry MJ. Mulley AG, Fowler FJ, Wennberg JE. Watchful waiting versus immediate transurethral resection for symptomatic prostatism. JAMA. 1988;259:3010–7.
Mulley AG. Assessing patients’ utilities: can the ends justify the means? Med Care. 1989;27(3 suppl):S269-S281.
Nease R. Kneeland T, O’Connor G, Sox H, Sumner W. Variation in patient utilities for outcomes of the management of chronic stable angina. Implications for clinical practice guidelines. JAMA. 1995;273:1185–90.
Fowler FJ. Wennberg JE, Timothy RP, Barry MJ, Mulley AG, Hanley D. Symptom status and quality of life following prostatectomy. JAMA. 1988;259:3018–22.
Greenfield S, Kaplan S, Ware JE Jr. Expanding patient involvement in care. Ann Intern Med. 1985;102:520–8.
Orth JE, Stiles WB. Patient exposition and provider explanation in routine interviews and hypertensive patients’ blood pressure control. Health Psychol. 1987;6:29–42.
Greenfield S, Kaplan SH, Ware JE Jr, Yano EM, Frank HJ. Patients’ participation in medical care. Blood sugar control and quality of life in diabetes. J Gen Intern Med. 1988;3:448–57.
Kaplan SH, Greenfield S, Ware JE Jr. Assessing the effects of physician—patient interactions in the outcomes of chronic disease. Med Care. 1989;27(suppl):S110-S127.
Christenson AJ, Smith TW, Turner CW, Holman JM, Gregory MC. Type of hemodialysis and preferences for behavioral involvement: interactive effects on adherence in end-stage renal disease. Health Psychol. 1990;9:225–36.
Mahler HIM, Kulik JA. Health care involvement preferences and social-emotional recovery of male coronary artery bypass patients. Health Psychol. 1991;10:399–408.
Ross CK, Steward CA, Sinacore JM. The importance of patient preferences in the measurement of health care satisfaction. Med Care. 1993;31:1138–49.
Speeding EJ, Rose DN. Building an effective doctor - patient relationship: from patient satisfaction to patient-participation. Soc Sci Med. 1985;21:115–20.
Brody DS, Miller SM, Lerman CE, Smith DG, Caputo GC. Patient perception of involvement in medical care. Relationship to illness attitudes and outcomes. J Gen Intern Med. 1989;4:506–11.
Lewis CC, Pantell RH, Sharp L. Increasing knowledge, satisfaction and involvement: randomized trial of a communication intervention. Pediatrics. 1991;88:351–8.
Sutherland HJ, Llewellyn-Thomas HA, Lockwood GA, Tritchler DL, Till JE. Cancer patients. Their desire for information and participation in treatment decisions. J R Soc Med. 1989;82:260–3.
Gadow S. An ethical case for patient self determination. Semin Oncol Nurs. 1989;5:99–101.
Pelligrino ED. The relationship of autonomy and integrity in medical ethics. Bull Pan Am Health Organ. 1990;24:361–71.
Pollard BJ. Autonomy and paternalism in medicine. Med J Aust. 1993;159:797–802.
Strull WM, Lo B, Charles G. Do patients want to participate in medical decision making? JAMA. 1984;252:2990–4.
Casilleth BR. Supkis RV, Sutton-Smith K, Marck V. Information and participation preferences among cancer patients. Ann intern Med. 1989;92:832–6.
Ende J, Kazis L, Moskowitz MA. Preferences for autonomy when patients are physicians. J Gen Intern Med. 1990;5:506–9.
Degner LF, Sloan JA. Decision making during serious illness: what role do patients really want to play? J Clin Epidemiol. 1992;45:941–50.
Thompson SC, Pitts JS, Schwankovsky L. Preferences for involvement in medical decision making: situational and demographic influences. Patient Educ Couns. 1993;22:133–40.
Ende J, Kazis L, Ash A, Moskowitz MA. Measuring patients’ desire for autonomy. Decision making and information-seeking preferences among medical patients. J Gen Intern Med. 1989;4:23–30.
Krantz DS, Baum A, Wideman M. Assessment of preferences for self-treatment and information in health care. J Pers Soc Psychol. 1980;39:977–90.
Hathaway SR. The MMPI Handbook. New York: New York Psychological Corporation, 1943.
Wallston BS, Wallston KA, Kaplan GD, Maides SA. Development and validation of the Health Locus of Control (HLC) scale. J Consult Clin Psychol. 1976;44:580–5.
Crowne DP, Marlowe D. The Approval Motive. New York: Wiley. 1964.
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Received from the Department of Medicine, Dartmouth — Hitchcock Medical Center, Lebanon, New Hampshire.
Preliminary analyses were presented at the annual meeting of the Society for Medical Decision Making, Portland, Oregon, October 17–20, 1992.
Supported by a grant from the Pew Charitable Trusts. Dr. Nease is a Picker/Commonwealth Scholar.
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Nease, R.F., Brooks, W.B. Patient desire for information and decision making in health care decisions. J Gen Intern Med 10, 593–600 (1995). https://doi.org/10.1007/BF02602742
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DOI: https://doi.org/10.1007/BF02602742