Assessing patients' participation and quality of decision-making: insights from a study of routine practice in diverse settings.
In the context of a qualitative study exploring patients' participation in decision-making, we investigated how people interpret and respond to structured questions about decision-making about their health care. Seventy-four participants who attended consultations in five clinical areas completed structured measures of decision-making and discussed their responses during interviews. They identified a range of decisions as having being made in their consultations. People who picked particular responses on measures of participation in and satisfaction with decision-making gave varied explanations for these, not all of which were consistent with the way their responses are usually interpreted. The interview data suggest that people's evaluations of decisions to follow a particular course of action were influenced by various factors including what they focused on as the alternative, their perceptions of constraints on choices, and their assessment of how good the best possible solution was. Responses to simple structured measures of participation in and satisfaction with decision-making should be interpreted with caution. They are not reliably attributable to health care providers' actions and are thus unsuitable for performance assessment purposes.
Entwistle
Vikki A
VA
Health Services Research Unit, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, Scotland, UK. vae@hsru.abdn.ac.uk
Watt
Ian S
IS
Gilhooly
Ken
K
Bugge
Carol
C
Haites
Neva
N
Walker
Anne E
AE
D001291:Attitude of Health Personnel; D003142:Communication; D003299:Cooperative Behavior; D003657:Decision Making; D004739:England; D005193:Family Planning Services; D005194:Family Practice; D005260:Female; D005826:Genetics, Medical; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006705:Homeopathy; D006801:Humans; D008297:Male; D008495:Medical Oncology; D008875:Middle Aged; D010358:Patient Participation / Q000523:psychology*; D010817:Physician-Patient Relations; D036301:Qualitative Research; D012017:Referral and Consultation; D012380:Role; D012606:Scotland; D012649:Self Concept; D011795:Surveys and Questionnaires