BACKGROUND: Patients vary in their desire to be involved in decisions about their care. AIM: To assess the accuracy and impact of GPs' perceptions of their patients' desire for involvement. DESIGN OF STUDY: Consultation-based study. SETTING: Five primary care centres in south London. METHOD: Consecutive patients completed decision-making preference questionnaires before and after consultation. Eighteen GPs completed a questionnaire at the beginning of the study and reported their perceptions of patients' preferences after each consultation. Patients' satisfaction was assessed using the Medical Interview Satisfaction Scale. Analyses were conducted in 190 patient-GP pairs that identified the same medicine decision about the same main health problem. RESULTS: A total of 479 patients participated (75.7% of those approached). Thirty-nine per cent of these patients wanted their GPs to share the decision, 45% wanted the GP to be the main (28%) or only (17%) decision maker regarding their care, and 16% wanted to be the main (14%) or only (2%) decision maker themselves. GPs accurately assessed patients' preferences in 32% of the consultations studied, overestimated patients' preferences for involvement in 45%, and underestimated them in 23% of consultations studied. Factors protective against GPs underestimating patients' preferences were: patients preferring the GP to make the decision (odds ratio [OR] 0.2 per point on the five-point scale; 95% confidence interval [CI] = 0.1 to 0.4), and the patient having discussed their main health problem before (OR 0.3; 95% CI = 0.1 to 0.9). Patients' educational attainment was independently associated with GPs underestimation of preferences. CONCLUSION: GPs' perceptions of their patients' desire to be involved in decisions about medicines are inaccurate in most cases. Doctors are more likely to underestimate patients' preferred level of involvement when patients have not consulted about their condition before.
BACKGROUND:Patients vary in their desire to be involved in decisions about their care. AIM: To assess the accuracy and impact of GPs' perceptions of their patients' desire for involvement. DESIGN OF STUDY: Consultation-based study. SETTING: Five primary care centres in south London. METHOD: Consecutive patients completed decision-making preference questionnaires before and after consultation. Eighteen GPs completed a questionnaire at the beginning of the study and reported their perceptions of patients' preferences after each consultation. Patients' satisfaction was assessed using the Medical Interview Satisfaction Scale. Analyses were conducted in 190 patient-GP pairs that identified the same medicine decision about the same main health problem. RESULTS: A total of 479 patients participated (75.7% of those approached). Thirty-nine per cent of these patients wanted their GPs to share the decision, 45% wanted the GP to be the main (28%) or only (17%) decision maker regarding their care, and 16% wanted to be the main (14%) or only (2%) decision maker themselves. GPs accurately assessed patients' preferences in 32% of the consultations studied, overestimated patients' preferences for involvement in 45%, and underestimated them in 23% of consultations studied. Factors protective against GPs underestimating patients' preferences were: patients preferring the GP to make the decision (odds ratio [OR] 0.2 per point on the five-point scale; 95% confidence interval [CI] = 0.1 to 0.4), and the patient having discussed their main health problem before (OR 0.3; 95% CI = 0.1 to 0.9). Patients' educational attainment was independently associated with GPs underestimation of preferences. CONCLUSION: GPs' perceptions of their patients' desire to be involved in decisions about medicines are inaccurate in most cases. Doctors are more likely to underestimate patients' preferred level of involvement when patients have not consulted about their condition before.
Authors: Heather M Davey; Alexandra L Barratt; Elizabeth Davey; Phyllis N Butow; Sally Redman; Nehmat Houssami; Glenn P Salkeld Journal: Health Expect Date: 2002-12 Impact factor: 3.377
Authors: Nancy L Keating; Edward Guadagnoli; Mary Beth Landrum; Catherine Borbas; Jane C Weeks Journal: J Clin Oncol Date: 2002-03-15 Impact factor: 44.544
Authors: Annette M O'Connor; Elizabeth R Drake; George A Wells; Peter Tugwell; Andreas Laupacis; Tom Elmslie Journal: Health Expect Date: 2003-06 Impact factor: 3.377
Authors: Lesley A Stainkey; Isaac A Seidl; Andrew J Johnson; Gladys E Tulloch; Tilley Pain Journal: BMC Health Serv Res Date: 2010-11-04 Impact factor: 2.655
Authors: Rachael Gooberman-Hill; Anna Sansom; Caroline M Sanders; Paul A Dieppe; Jeremy Horwood; Ian D Learmonth; Susan Williams; Jenny L Donovan Journal: BMC Musculoskelet Disord Date: 2010-09-17 Impact factor: 2.362
Authors: Thomas Agoritsas; Anja Fog Heen; Linn Brandt; Pablo Alonso-Coello; Annette Kristiansen; Elie A Akl; Ignacio Neumann; Kari Ao Tikkinen; Trudy van der Weijden; Glyn Elwyn; Victor M Montori; Gordon H Guyatt; Per Olav Vandvik Journal: BMJ Date: 2015-02-10