title: Patients' involvement in decisions about medicines: GPs' perceptions of their preferences.
abstract: BACKGROUND
  Patients vary in their desire to be involved in decisions about their care.
  
  
  OBJECTIVE
  To assess the accuracy and impact of GPs' perceptions of their patients' desire for involvement.
  
  
  METHODS
  Consultation-based study.
  
  
  METHODS
  Five primary care centres in south London.
  
  
  METHODS
  Consecutive patients completed decision-making preference questionnaires before and after consultation. Eighteen GPs completed a questionnaire at the beginning of the study and reported their perceptions of patients' preferences after each consultation. Patients' satisfaction was assessed using the Medical Interview Satisfaction Scale. Analyses were conducted in 190 patient-GP pairs that identified the same medicine decision about the same main health problem.
  
  
  RESULTS
  A total of 479 patients participated (75.7% of those approached). Thirty-nine per cent of these patients wanted their GPs to share the decision, 45% wanted the GP to be the main (28%) or only (17%) decision maker regarding their care, and 16% wanted to be the main (14%) or only (2%) decision maker themselves. GPs accurately assessed patients' preferences in 32% of the consultations studied, overestimated patients' preferences for involvement in 45%, and underestimated them in 23% of consultations studied. Factors protective against GPs underestimating patients' preferences were: patients preferring the GP to make the decision (odds ratio [OR] 0.2 per point on the five-point scale; 95% confidence interval [CI] = 0.1 to 0.4), and the patient having discussed their main health problem before (OR 0.3; 95% CI = 0.1 to 0.9). Patients' educational attainment was independently associated with GPs underestimation of preferences.
  
  
  CONCLUSIONS
  GPs' perceptions of their patients' desire to be involved in decisions about medicines are inaccurate in most cases. Doctors are more likely to underestimate patients' preferred level of involvement when patients have not consulted about their condition before.
authors.affiliation: King's College London, Department of General Practice and Primary Care, London.
authors.forename: Kate
authors.initials: K
authors.lastname: Cox
authors.forename: Nicky
authors.initials: N
authors.lastname: Britten
authors.forename: Richard
authors.initials: R
authors.lastname: Hooper
authors.forename: Patrick
authors.initials: P
authors.lastname: White
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D003657:Decision Making; D005194:Family Practice; D005260:Female; D006801:Humans; D008131:London; D008297:Male; D008875:Middle Aged; D010358:Patient Participation; D017060:Patient Satisfaction; D010465:Perception; D010819:Physician's Role; D010817:Physician-Patient Relations; D011795:Surveys and Questionnaires