Ideals of patient autonomy in clinical decision making: a study on the development of a scale to assess patients' and physicians' views.
OBJECTIVE
Evidence based patient choice seems based on a strong liberal individualist interpretation of patient autonomy; however, not all patients are in favour of such an interpretation. The authors wished to assess whether ideals of autonomy in clinical practice are more in accordance with alternative concepts of autonomy from the ethics literature. This paper describes the development of a questionnaire to assess such concepts of autonomy.


METHODS
A questionnaire, based on six moral concepts from the ethics literature, was sent to aneurysm patients and their surgeons. The structure of the questionnaire was assessed by factor analysis, and item reduction was based on reliability.


RESULTS
Ninety six patients and 58 surgeons participated. The questionnaire consisted of four scales. Two of the scales reflected the paternalistic and consumerist poles of the liberal individualist model, one scale reflected concepts of Socratic autonomy and of procedural independence, and the fourth scale reflected ideals of risk disclosure.


CONCLUSIONS
The Ideal Patient Autonomy Scale is a 14 item normative instrument. It is clearly distinct from the generally used psychological preference questionnaires that assess preferences for physician-patient roles.
Stiggelbout
A M
AM
Department of Medical Decision Making, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands. a.m.stiggelbout@lumc.nl
Molewijk
A C
AC
Otten
W
W
Timmermans
D R M
DR
van Bockel
J H
JH
Kievit
J
J
D001291:Attitude of Health Personnel; D003657:Decision Making; D026690:Ethics, Clinical; D005163:Factor Analysis, Statistical; D013502:General Surgery; D006801:Humans; D026684:Personal Autonomy; D010817:Physician-Patient Relations; D011795:Surveys and Questionnaires