Clinical Decision-making: Patients' Preferences and Experiences

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.