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

Pamela L. Hudak, Richard M. Frankel, Clarence Braddock, Rosane Nisenbaum, Paola Luca, Caitlin McKeever and Wendy Levinson
Additional contact information
Pamela L. Hudak: Department of Medicine, St. Michael's Hospital, 30 Bond Street, Toronto ON, Canada, M5B 1W8, hudakp@smh.toronto.on.ca
Richard M. Frankel: Richard L. Roudebush Veteran's Administration Medical Centre, Indiana University, School of Medicine, Indianapolis, Indiana
Clarence Braddock: Department of Medicine, Stanford University School of Medicine, Stanford, California
Rosane Nisenbaum: 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: School of Medicine, University of Toronto, Toronto, Ontario, Canada
Caitlin McKeever: 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: 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

Medical Decision Making, 2008, vol. 28, issue 3, 385-393

Abstract: 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.

Keywords: patient preferences for participation in decision making; communication behaviors. (search for similar items in EconPapers)
Date: 2008
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Citations: View citations in EconPapers (2)

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Persistent link: https://EconPapers.repec.org/RePEc:sae:medema:v:28:y:2008:i:3:p:385-393

DOI: 10.1177/0272989X07312712

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