A typology of preferences for participation in healthcare decision making
A typology of preferences for participation in healthcare decision making
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DOI：
10.1016/j.socscimed.2006.03.030
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发表时间：
2006-09-01
影响因子：
5.4
通讯作者：
Vanness, David
中科院分区：
文献类型：
--
作者：
Flynn, Kathryn E.;Smith, Maureen A.;Vanness, David
将患者在医疗决策方面分为“主动”或“被动”是误导性的，因为患者对决策过程的不同组成部分有不同的期望。区分病人所期望的角色是促进尊重和回应个别病人偏好的护理的重要一步。我们纳入了2004年威斯康星州纵向研究邮件调查的项目，测量决策过程中四个组成部分的偏好：医生对患者病史的了解，医生对治疗选择的披露，治疗选择的讨论和治疗选择的选择。我们使用聚类分析的5199名老年人的偏好类型。96%的受访者表示有四种偏好类型，所有这些类型都更喜欢与医生进行最大程度的信息交流。57%的受访者希望保留对重要医疗决定的个人控制权（“医疗专家”）。在这些患者中，81%的人更愿意与医生讨论治疗选择。39%的受访者希望他们的医生做出重要的医疗决定（“委托人”）。在授权者中，41%的人更愿意讨论治疗选择。女性，更高的教育程度，更好的自我评价的健康，更少的处方药，并有一个较短的时间在一个通常的地方护理预测一个显着更高的概率最积极参与讨论和选择治疗的选择。绝大多数老年人希望获得治疗选择，并让他们的医生了解他们的病史;然而，在他们希望如何参与讨论和选择治疗方面存在重大差异。(c)2006爱思唯尔有限公司版权所有。
Classifying patients as "active" or "passive" with regard to healthcare decision making is misleading, since patients have different desires for different components of the decision-making process. Distinguishing patients' desired roles is an essential step towards promoting care that respects and responds to individual patients' preferences. We included items on the 2004 Wisconsin Longitudinal Study mail survey measuring preferences for four components of the decision-making process: physician knowledge of patient medical history, physician disclosure of treatment choices, discussion of treatment choices, and selection of treatment choice. We characterized preference types for 5199 older adults using cluster analysis. Ninety-six percent of respondents are represented by four preference types, all of which prefer maximal information exchange with physicians. Fifty-seven percent of respondents wanted to retain personal control over important medical decisions ("autonomists"). Among the autonomists, 81% preferred to discuss treatment choices with their physician. Thirty-nine percent of respondents wanted their physician to make important medical decisions ("delegators"). Among the delegators, 41% preferred to discuss treatment choices. Female gender, higher educational attainment, better self-rated health, fewer prescription medications, and having a shorter duration at a usual place of care predicted a significantly higher probability of the most active involvement in discussing and selecting treatment choices. The overwhelming majority of older adults want to be given treatment options and have their physician know everything about their medical history; however, there are substantial differences in how they want to be involved in discussing and selecting treatments. (c) 2006 Elsevier Ltd. All rights reserved.