Review
Patient preferences for shared decisions: A systematic review

https://doi.org/10.1016/j.pec.2011.02.004Get rights and content

Abstract

Objectives

Empirical literature on patient decision role preferences regarding treatment and screening was reviewed to summarize patients’ role preferences across measures, time and patient population.

Methods

Five databases were searched from January 1980 to December 2007 (1980–2007 Ovid MEDLINE, Cochrane Database of Systematic Reviews, PsychInfo, Web of Science and PubMed (2005–2007)). Eligible studies measured patient decision role preferences, described measures, presented findings as percentages or mean scores and were published in English from any country. Studies were compared by patient population, time of publication, and measure.

Results

115 studies were eligible. The majority of patients preferred sharing decisions with physicians in 63% of the studies. A time trend appeared. The majority of respondents preferred sharing decision roles in 71% of the studies from 2000 and later, compared to 50% of studies before 2000. Measures themselves, in addition to patient population, influenced the preferred decision roles reported.

Conclusion

Findings appear to vary with the measure of preferred decision making used, time of the publication and characteristics of the population.

Practice implications

The role preference measure itself must be considered when interpreting patient responses to a measure or question about a patient's preference for decision roles.

Introduction

Health care providers have been urged to integrate patients more actively as partners in decisions [1], [2], [3], [4], [5], [6], [7], [8], [9]. Such patient involvement is often considered to fall under a model of shared decision making where both patient and provider contribute to the decision [3]. This contrasts with a patient delegating a decision to the health care provider. When patient involvement does not occur, it may be due to a perceived lack of time or because the provider does not have the skills to involve patients in decision making [5]. The approach of involving patients in decision making has been debated due to conflicting findings about decision roles preferred by patients [10], [11], [12], [13], [14]. Patients who have just received a serious diagnosis and feel vulnerable may not want the responsibility of being involved in decision making [11]. For example, research has found that in order to cope with their cancer diagnosis, some patients may not want the information about their cancer that would be necessary for participation in decision making [13].

To date, no comprehensive review has identified time trends, targeted health problem/population trends, and the influence of different measures on patients’ reported decision role preferences across a range of patient contexts. While earlier reviews examined a single disease group such as cancer [15], this paper compares decision role preferences in a variety of contexts by looking at a fuller range of patient populations. This review seeks to examine and summarize patients’ decision role preferences across studies that have used different measures, time of publication and patient populations.

Section snippets

Data sources and search strategy

This review included empirical, peer-reviewed journal articles that measured patient decision role preferences, described measures, presented findings as percentages or mean scores and were published in English from any country. Three strategies were used to identify relevant studies. First, we searched for relevant studies published between January 1980 and December 2007 using Ovid MEDLINE, Cochrane Database of Systematic Reviews, PsychInfo, Web of Science and PubMed (2005–2007). A combination

Descriptive overview

One hundred and fifteen articles met all eligibility criteria for this review. The most frequently used measures were the CPS (44 analyses), API or API-modified (16 analyses), PSDM (6 analyses), and HOS (5 analyses). Other measures were used in a total of 49 analyses; none were evident in more than two of these study analyses. The sum of these analyses (119) exceeds 115 articles because some articles included more than one measure to analyze. Four studies compared two different existing

Discussion

This comprehensive review compared findings between health populations studied, recency of publication and measures utilized. Several patterns emerged along with implications for both researchers and practitioners.

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