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A Prospective Cohort Study of Medical Decision-Making Roles and Their Associations with Patient Characteristics and Patient-Reported Outcomes among Patients with Heart Failure

Author

Listed:
  • Semra Ozdemir

    (Signature Program in Health Services and Systems Research, Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore
    Department of Population Health Sciences, Duke Clinical Research Institute, Duke University, USA)

  • Jia Jia Lee

    (Research Associate, Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore)

  • Khung Keong Yeo

    (National Heart Centre Singapore, Singapore)

  • Kheng Leng David Sim

    (National Heart Centre Singapore, Singapore)

  • Eric Andrew Finkelstein

    (Signature Program in Health Services and Systems Research, Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore
    Saw Swee Hock School of Public Health, National University of Singapore, Singapore
    Duke Global Health Institute, Duke University, USA)

  • Chetna Malhotra

    (Signature Program in Health Services and Systems Research, Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore)

Abstract

Objective Among patients with heart failure (HF), we examined 1) the evolution of patient involvement in decision making over 2 y, 2) the association of patient characteristics with decision-making roles, and 3) the association of decision-making roles with distress, spiritual well-being, and quality of physician communication. Methods We administered the survey every 4 mo over 24 mo to patients with New York Heart Association class 3/4 symptoms recruited from inpatient clinics. The decision-making roles were categorized as no patient involvement, physician/family-led, joint (with family and/or physicians), patient-led, or patient-alone decision making. The associations between patient characteristics and decision-making roles were assessed using a mixed-effects ordered logistic regression, whereas those between patient outcomes and decision-making roles were investigated using mixed-effects linear regressions. Results Of the 557 patients invited, 251 participated in the study. The most common roles in decision making at baseline assessment were “no involvement†(27.53%) and “patient-alone decision making†(25.10%). The proportions of different decision-making roles did not change over 2 y ( P  = 0.37). Older age (odds ratio [OR] = 0.97; P  = 0.003) and being married (OR = 0.63; P  = 0.035) were associated with lower involvement in decision making. Chinese ethnicity (OR = 1.91; P  = 0.003), higher education (OR = 1.87; P  = 0.003), awareness of terminal condition (OR = 2.00; P  

Suggested Citation

  • Semra Ozdemir & Jia Jia Lee & Khung Keong Yeo & Kheng Leng David Sim & Eric Andrew Finkelstein & Chetna Malhotra, 2023. "A Prospective Cohort Study of Medical Decision-Making Roles and Their Associations with Patient Characteristics and Patient-Reported Outcomes among Patients with Heart Failure," Medical Decision Making, , vol. 43(7-8), pages 863-874, October.
    • Handle: RePEc:sae:medema:v:43:y:2023:i:7-8:p:863-874
    DOI: 10.1177/0272989X231201609
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    References listed on IDEAS

    as
    1. Semra Ozdemir & Isha Chaudhry & Si Ning Germaine Tan & Irene Teo & Chetna Malhotra & Rahul Malhotra & Eric Andrew Finkelstein, 2023. "Variation in Patient-Reported Decision-Making Roles in the Last Year of Life among Patients with Metastatic Cancer: A Longitudinal Study," Medical Decision Making, , vol. 43(2), pages 203-213, February.
    2. Heather Orom & Caitlin Biddle & Willie Underwood III & Christian J. Nelson & D. Lynn Homish, 2016. "What Is a “Good†Treatment Decision? Decisional Control, Knowledge, Treatment Decision Making, and Quality of Life in Men with Clinically Localized Prostate Cancer," Medical Decision Making, , vol. 36(6), pages 714-725, August.
    3. L. Aubree Shay & Jennifer Elston Lafata, 2015. "Where Is the Evidence? A Systematic Review of Shared Decision Making and Patient Outcomes," Medical Decision Making, , vol. 35(1), pages 114-131, January.
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