title: Patient preference for autonomy: does it change as risk rises?
abstract: BACKGROUND
  It is unclear how patient preferences for autonomy vary given different severity of a single condition.
  
  
  OBJECTIVE
  To assess patient preferences for autonomy in making decisions about taking medication to prevent a heart attack, across a wide range of personal calculated cardiovascular disease (CVD) 5-year risk.
  
  
  METHODS
  Consecutive eligible patients in family practice waiting rooms in Auckland, New Zealand self-completed a questionnaire. Questions related to a hypothetical cardiovascular medication, where risks and benefits were framed from their personal predicted 5-year CVD risk. Participant preference for autonomy was measured by ranking their decision-making preference on 5-point scale from 'doctor only' to 'patient only'.
  
  
  RESULTS
  There were 934 participants, with personal predicted 5-year cardiovascular risks that ranged from 5% to 30%. Preference for autonomy decreased as CVD risk increased, after adjustment for age, gender, numeracy and ethnicity. Preference for autonomy increased independently among younger participants, women and those who were more numerate. Compared to participants of European ethnicity, those of Pacific, East Asian and Indian Asian ethnicity were more likely to want the doctor to decide.
  
  
  CONCLUSIONS
  No combination of predicted risk, demographics or attitudes strongly predicted the preference of an individual patient. Clinicians should therefore seek to understand and confirm each patient's preferences.
authors.affiliation: Department of General Practice and Primary Health Care, School of Nursing, University of Auckland, Auckland, New Zealand. t.kenealy@auckland.ac.nz
authors.forename: Timothy
authors.initials: T
authors.lastname: Kenealy
authors.forename: Felicity
authors.initials: F
authors.lastname: Goodyear-Smith
authors.forename: Susan
authors.initials: S
authors.lastname: Wells
authors.forename: Bruce
authors.initials: B
authors.lastname: Arroll
authors.forename: Rod
authors.initials: R
authors.lastname: Jackson
authors.forename: Margaret
authors.initials: M
authors.lastname: Horsburgh
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D044466:Asian People / Q000523:psychology; D002318:Cardiovascular Diseases / Q000188:drug therapy*; D003657:Decision Making; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000517:prevention & control; D009520:New Zealand; D057240:Patient Preference / Q000523:psychology*; D026684:Personal Autonomy; D010817:Physician-Patient Relations; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors; D011795:Surveys and Questionnaires; D044465:White People / Q000523:psychology