title: Preferences for shared decision making in chronic pain patients compared with patients during a premedication visit.
abstract: BACKGROUND
  There is some evidence that patients' outcomes improve if they are involved in shared decision making (SDM). A chronic pain clinic or premedication visit could be adequate settings for the implementation of SDM. So far, the patients' preference for involvement in decision making and their desire for information have not been tested in anesthesiological settings.
  
  
  METHODS
  A group of chronic pain patients was compared with a group of patients in the premedication visit with respect to SDM, the desire for information and perceived involvement in care. The autonomy preference index (API, measuring preference for involvement and desire for information) and the perceived involvement in care scale (PICS, measuring patients' perception of easier involvement by doctors and information exchange) were administered.
  
  
  RESULTS
  In total, 190 chronic pain patients and 151 patients of premedication were included in this study. Patient of the premedication visit had significantly higher SDM scores. Desire for information was high, but there were no differences between groups. Younger patients [B (estimate) =- 0.3; 95% CI (-0.4) - (-0.1)], women (B = 10.9; 95% CI 6.3-15.4) and patients with higher educational level (B = 10.1; 95% CI 5.6-14.6) had more desire for SDM. PICS scores were basically influenced by groups: chronic pain patients felt more facilitated by doctors [B =- 0.185; 95% CI (-0.4) - (-0.1)] and had more information exchange [B =- 19.5; 95% CI (-15.8) - (-2.4)] than patients in the premedication visit.
  
  
  CONCLUSIONS
  In both anesthesiological settings, the desire for information was high, but patients in the premedication visit had higher SDM scores, especially young female patients with higher educational level. Real patient-physician interaction showed that premedication patients felt less involved by doctors and had less information exchange compared with the chronic pain patients. Therefore, premedication visits should be focussed more on adequate information exchange and involvement of the patient in the shared decision making process.
authors.affiliation: Department of Anesthesiology and Intensive Care, Charite - University Medicine Berlin, Berlin, Germany. claudia.spies@charite.de
authors.forename: C D
authors.initials: CD
authors.lastname: Spies
authors.forename: C M
authors.initials: CM
authors.lastname: Schulz
authors.forename: E
authors.initials: E
authors.lastname: Weiss-Gerlach
authors.forename: B
authors.initials: B
authors.lastname: Neuner
authors.forename: T
authors.initials: T
authors.lastname: Neumann
authors.forename: V
authors.initials: V
authors.lastname: von Dossow
authors.forename: M
authors.initials: M
authors.lastname: Schenk
authors.forename: K-D
authors.initials: KD
authors.lastname: Wernecke
authors.forename: G
authors.initials: G
authors.lastname: Elwyn
mesh_terms: D000328:Adult; D000368:Aged; D001290:Attitude; D002908:Chronic Disease; D003657:Decision Making; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000523:psychology*; D059408:Pain Management; D010353:Patient Education as Topic / Q000706:statistics & numerical data* / Q000639:trends; D010358:Patient Participation; D010817:Physician-Patient Relations; D011292:Premedication / Q000523:psychology*; D011795:Surveys and Questionnaires