Impact of Patient Acuity on Preference for Information and Autonomy in Decision Making

Abstract

Abstract. Objectives:To test the hypotheses that ED patients' desires for medical information and for autonomy in decision making are inversely related to increasing acuity of illness, increasing age, and lower level of formal education. Methods: The authors conducted a prospective study of ED patients who presented for care during seven nonconsecutive 24-hour periods. Of 804 patients approached, 665 completed a questionnaire that was administered by a trained research assistant. Patients rated their desire for medical information, and for participation in medical decision making, on two 10-cm visual analog scales. Patient acuity level was determined in routine fashion by trained triage nurses, who were unaware of the nature of this study. Results: Desire for information was uniformly high, and did not vary statistically between triage groups (p = 0.41). The most acutely ill patients (level I) were more likely to be excluded by the research interviewer (p < 0.001). Of included level I patients, desire to participate was not decreased (p < 0.01). Higher level of formal education (p = 0.036) and younger age (p < 0.001) were associated with greater desire for autonomy in decision making. Conclusion: Among ED patients able to participate, higher acuity of illness was not associated with a decreased desire for medical information. Many very acutely ill patients preferred autonomy in medical decision making. Older patients and those with less formal education expressed a lesser desire for decision-making autonomy. Key words: patient acuity; patient preferences; autonomy; decision making; age; education. ACADEMIC EMERGENCY MEDICINE 1999; 6:781-785 P ATIENTS vary in their desire both to obtain information regarding their conditions and to participate in medical decision making.1-5 As physicians attempt to facilitate greater patient involvement in medical decision making, it is important to understand what factors influence patients' interest in being informed about, and being involved in, making such decisions.There is little information regarding integrating ED patient preferences into decisions about care. Although some believe that more acutely ill patients are less likely to desire medical information and decision-making autonomy than are less acutely ill patients, the impact of acuity of illness on patients' preference for involvement in medical decision making is in fact unknown. This study was designed to test the primary hypothesis that sicker patients would be less interested both in obtaining medical information and in participating in decision making. We also tested the secondary hy- METHODSStudy Design. This was a prospective study of ED patients' desire for medical information and autonomy in decision making. Eligible patients were administered a questionnaire that noted their desire for information and participation in decisions on a visual analog scale (VAS). The study was approved by the study hospital's Committee on Clinical Investigations. Study Population and Setting. Patients presenting for evaluati...

Emergency Physician Perceptions of Shared Decision‐making

“…2,[28][29][30] Prior ED studies have shown that almost all patients express a strong desire to receive medical information, irrespective of acuity, and be actively involved in decision-making. 22,31,32 Given the contrast between the existing literature and the perceptions of our respondents, future research is needed to assess the reasons for this disconnect and to evaluate ways to bridge this knowledge gap. Qualitative studies of ED patients could further assess to what extent, and in what manner, patients want to be involved in emergency care decisions.…”

Emergency Physician Perceptions of Medically Unnecessary Advanced Diagnostic Imaging

“…Increased involvement of ED patients in a shared decision-making process has in fact been shown to improve patient satisfaction and decrease utilization without causing patient harm. 63,64 Prior studies have found that almost all ED patients express a strong desire to receive medical information irrespective of acuity, 65 but it remains unclear if EPs feel this tool could be routinely incorporated into their practice and if this would actually result in decreased health care costs. 66 Future studies should further evaluate ways to appropriately incorporate shared decision-making in emergency care with the goal of reducing overuse.…”

The Role of Patient Activation in Preferences for Shared Decision Making: Results From a National Survey of U.S. Adults

“…Preferences for involvement in medical decision making can vary according to the situation (Say, Murtagh, & Thomson, 2006). For example, members of the public express more interest in being involved in disease prevention decisions such as smoking cessation and lifestyle change (Mansell, Poses, Kazis, & Duefield, 2000) but prefer to be more passive in situations with more immediate consequences (e.g., cancer treatment; Chewning et al, 2012;Davis, Hoffman, & Hsu, 1999). Yet these generalizations are not universal, and research investigating variation across decision types is needed (Mansell et al, 2000;Waller et al, 2012).…”