This Article Full Text (PDF) All Versions of this Article: 0272989X07312712v1 28/3/385    most recent References Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Hudak, P. L. Articles by Levinson, W. Search for Related Content PubMed PubMed Citation Articles by Hudak, P. L. Articles by Levinson, W. Social Bookmarking                         What's this?

Do Patients' Communication Behaviors Provide Insight into Their Preferences for Participation in Decision Making?

Department of Medicine, St. Michael's Hospital, 30 Bond Street, Toronto ON, Canada, M5B 1W8, hudakp{at}smh.toronto.on.ca

Richard M. Frankel, PhD

Richard L. Roudebush Veteran's Administration Medical Centre, Indiana University, School of Medicine, Indianapolis, Indiana

Clarence Braddock, III, MD, MPH

Department of Medicine, Stanford University School of Medicine, Stanford, California

Rosane Nisenbaum, PhD

Centre for Research on Inner City Health, The Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada

Paola Luca, HBSc

School of Medicine, University of Toronto, Toronto, Ontario, Canada

Caitlin McKeever, BA

Centre for Research on Inner City Health, The Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada

Wendy Levinson, MD, FRCPC

Department of Medicine, The Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada

Background. The Institute of Medicine report "Crossing the Quality Chasm'' encourages physicians to tailor their approaches to care according to each patient's individual preferences for participation in decision making. How physicians should determine these preferences is unclear. Objective. The objective of this study is to assess whether judgments of patient communication behaviors, either globally or individually, can yield insight into patient preferences for participation in decision making. Methods. Using questionnaire responses to 3 items about the desired level of participation in decision making from a communication study involving 886 audiotaped visits between older patients and surgeons, the authors purposively selected 25 patients who preferred a large role and 25 who preferred a small role in decision making. Two independent raters listened to the audiotapes and coded them for the presence of 7 communication behaviors (question asking, information behavior, initiating, statements of preference, processing, resistance, deference). On the basis of their listening and coding, raters judged patient preferences for participation in decision making. Results. Neither rater accurately judged preferences for participation in decision making beyond chance agreement (kappa statistics: rater 1 = 0.16, rater 2 = 0.20). Inter-rater reliability for the communication behaviors was also generally poor. Area-under-the-curve values for all communication behaviors hovered around 0.50, indicating that none of the behaviors had adequate power to discriminate between patients preferring large versus small roles. Conclusion. Patient preferences for participation in decision making cannot be reliably judged during routine visits based on judgments of patient communication behaviors. Engaging patients in a discussion of preferences for decision making may be the best way to determine the role each wants to play in any given decision.

Key Words: patient preferences for participation in decision making • communication behaviors.

This version was published on June 1, 2008

Medical Decision Making, Vol. 28, No. 3, 385-393 (2008)
DOI: 10.1177/0272989X07312712


CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter    What's this?