Preferences of acutely ill patients for participation in medical decision-making

Objectives: To determine patient preferences for information and for participation in decision-making, and the determinants of these preferences in patients recently admitted to an acute hospital. Design: Prospective questionnaire-based study. Setting: Medical wards of an acute teaching hospital. Participants: One hundred and fifty-two consecutive acute medical inpatients, median age 74 years. Measurements: Standardised assessment included abbreviated mental test and subjective measure of severity of illness. Patients' desire for information was assessed using a 5-point Likert scale, and their desire for a role in medical decision-making using the Degner Control of Preferences Scale. Results: Of the 152 patients, 93 (61%) favoured a passive approach to decision-making ( either "leave all decisions to the doctor'' or "doctor makes final decision but seriously considers my opinion.'' In contrast, 101 (66%) patients sought "very extensive'' or "a lot'' of information about their condition. No significant effects of age, sex, socio-economic group or severity of acute illness on desire for information or the Degner scale result were found. There was no agreement between patients' preferences on the Degner scale and their doctors' predictions of those preferences. Conclusions: Acute medical inpatients want to receive a lot of information about their illness, but most prefer a relatively passive role in decision-making. The only way to determine individual patient preferences is to ask them; preferences cannot be predicted from clinical or socio-demographic data.