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

Author

Listed:
  • 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 III

    (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)

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.

Suggested Citation

  • Pamela L. Hudak & Richard M. Frankel & Clarence Braddock III & Rosane Nisenbaum & Paola Luca & Caitlin McKeever & Wendy Levinson, 2008. "Do Patients' Communication Behaviors Provide Insight into Their Preferences for Participation in Decision Making?," Medical Decision Making, , vol. 28(3), pages 385-393, May.
    • Handle: RePEc:sae:medema:v:28:y:2008:i:3:p:385-393
    DOI: 10.1177/0272989X07312712
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    References listed on IDEAS

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    1. Charles, Cathy & Gafni, Amiram & Whelan, Tim, 1997. "Shared decision-making in the medical encounter: What does it mean? (or it takes at least two to tango)," Social Science & Medicine, Elsevier, vol. 44(5), pages 681-692, March.
    2. Street, Richard L., 1991. "Information-giving in medical consultations: The influence of patients' communicative styles and personal characteristics," Social Science & Medicine, Elsevier, vol. 32(5), pages 541-548, January.
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    2. Edi Karni & Moshe Leshno & Sivan Rapaport, 2014. "Helping patients and physicians reach individualized medical decisions: theory and application to prenatal diagnostic testing," Theory and Decision, Springer, vol. 76(4), pages 451-467, April.

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