title: Missed expectations? Physicians' views of patients' participation in medical decision-making.
abstract: OBJECTIVE
  Physicians are encouraged to actively involve patients in clinical decision-making, but this expectation has not been adequately examined from the physicians' perspective. Our objective was to identify and characterize physicians' attitudes toward patient participation in decision-making and to gain insight into how they consequently think about and structure the decision-making process.
  
  
  METHODS
  This was a qualitative cross-sectional study of physicians' reported attitudes and practices.
  
  
  METHODS
  The study took place in private practice and academic physicians' practices.
  
  
  METHODS
  A total of 53 academic and private practice physicians from primary care and surgical specialties, ranging from first year residents to recently retired, participated in the study.
  
  
  METHODS
  We performed a qualitative analysis of semistructured individual interviews.
  
  
  RESULTS
  The physicians in this study expressed consistently positive attitudes toward patient participation in medical decision-making. They identified patient autonomy as an essential justification for patient participation but often went beyond an autonomy-based rationale. Several were motivated by the fundamental principle of beneficence as well as their own self-interest in avoiding legal liability. Many physicians saw their role as an expert who educates the patient but retains control over the decision-making process; others took a more collaborative approach, encouraging patients to assume decisional priority. The decision-making process often was modified by patient, physician, and environmental factors.
  
  
  CONCLUSIONS
  The physicians in this study demonstrated a positive, flexible approach toward including patients in decision-making. A one-dimensional model of shared decision-making based solely on the principle of autonomy fails to account for variability in how physicians allocate decisional priority and is therefore ethically inadequate.
authors.affiliation: Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas 77098, USA.
authors.forename: Amy L
authors.initials: AL
authors.lastname: McGuire
authors.forename: Laurence B
authors.initials: LB
authors.lastname: McCullough
authors.forename: Susan C
authors.initials: SC
authors.lastname: Weller
authors.forename: Simon N
authors.initials: SN
authors.lastname: Whitney
mesh_terms: D000046:Academic Medical Centers; D001291:Attitude of Health Personnel; D026686:Beneficence; D003299:Cooperative Behavior; D003430:Cross-Sectional Studies; D003657:Decision Making / Q000941:ethics; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D010358:Patient Participation; D026684:Personal Autonomy; D010819:Physician's Role; D010817:Physician-Patient Relations / Q000941:ethics; D010820:Physicians / Q000523:psychology*; D011331:Private Practice; D017009:Professional Autonomy; D014481:United States