Background:
Patients vary in their desire to participate in medical decision-making (MDM), with some preferring passive roles and others preferring shared or autonomous roles. Yet little is known about the stability of patient preferences over time and whether patient preferences are aligned with how they actually experience the MDM process. We sought to determine the stability of MDM preferences for patients hospitalized with an AMI and assess whether there is concordance between the patient’s preference and their experience with care.
Methods:
In TRIUMPH, a 24-center, prospective US study of AMI patients, MDM preferences were assessed both at the time of hospitalization and one year later (n=2071). MDM preferences were assessed by the question, “Given the information about the risks and benefits of the treatment options, who should decide which treatment option should be selected? We categorized responses from a 5-item Likert scale into: passive (“doctor alone/mostly the doctor”), or shared/active (“doctor and you equally/mostly you or you alone”) and compared responses between baseline and 12-months following AMI. We assessed concordance between baseline MDM preferences with the patients’ perceived level of participation in MDM at 1 month with the question, “Who was responsible for making health decisions regarding the current treatment of your heart condition?” using the same 5-item Likert scale and categorization.
Results:
Over 2/3 of patients preferred shared/active MDM both at the time of their AMI (1446, 69.8%) and 1 year later (1411, 68.1%). However, individual preferences varied over time. Among patients with a baseline preference for shared/active MDM, 374 (25.9%) preferred passive participation 1 year later. Among patients preferring passive participation at the time of their AMI, 339 (54.2%) preferred a shared/active participatory role 1 year later. Comparing desired and perceived roles in MDM, only 54.5% of patients reported, at 1 month, an MDM process that was concordant with their baseline preferences. Among patients with a baseline preference for shared/active MDM, 48.3% reported experiencing a passive role in MDM 1 month following AMI. Among patients preferring a passive role at baseline, 39.3% reported experiencing a shared/active MDM process.
Conclusion:
Individual preferences for participation in MDM during and after AMI vary, with the majority preferring a shared/active role. These preferences change over time, highlighting the need for continual assessment. In the month following an AMI, half of patients experienced an MDM process that was not consistent with their stated preferences.
Implicit persuasion in medical decision-making
