title: How do patients from eastern and western Germany compare with regard to their preferences for shared decision making?
abstract: BACKGROUND
  Increasing emphasis is being placed on involving patients in decisions concerning their health. This shift towards more patient engagement by health professionals and towards more desire by patients for participation may be partly based on socio-political factors.
  
  
  METHODS
  To compare the preferences for shared decision making of patients from eastern and western Germany we analysed five patient samples (n = 2318) (general practice patients and schizophrenia patients from eastern and western Germany). Patients' role preferences for shared decisions were measured using the decision-making subscale of the Autonomy Preference Index.
  
  
  RESULTS
  Patients resident in eastern Germany expressed lower preferences for shared decision making than patients in western Germany. This was true after controlling for socio-demographic variables and for patient group.
  
  
  CONCLUSIONS
  The cultural imprint (e.g. western vs. former communist society) seems to have a significant influence on patients' expectations and behaviour in the medical encounter. Health services providers need to be aware that health attitudes within the same health system might vary for historical and cultural reasons. The engagement of patients in medical decisions might not be susceptible to a 'one size fits all' approach; doctors should instead aim to accommodate the individual patient's desire for autonomy.
authors.affiliation: Klinik und Poliklinik für Psychiatrie und Psychotherapie, Technische Universität München, Germany. j.hamann@lrz.tum.de
authors.forename: Johannes
authors.initials: J
authors.lastname: Hamann
authors.forename: Christiane
authors.initials: C
authors.lastname: Bieber
authors.forename: Glyn
authors.initials: G
authors.lastname: Elwyn
authors.forename: Eva
authors.initials: E
authors.lastname: Wartner
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Hörlein
authors.forename: Werner
authors.initials: W
authors.lastname: Kissling
authors.forename: Christfried
authors.initials: C
authors.lastname: Toegel
authors.forename: Hendrik
authors.initials: H
authors.lastname: Berth
authors.forename: Klaus
authors.initials: K
authors.lastname: Linde
authors.forename: Antonius
authors.initials: A
authors.lastname: Schneider
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001294:Attitude to Health; D003299:Cooperative Behavior; D003657:Decision Making; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D010358:Patient Participation; D057240:Patient Preference; D017060:Patient Satisfaction; D010361:Patients / Q000523:psychology / Q000706:statistics & numerical data; D010817:Physician-Patient Relations; D012044:Regression Analysis; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D055815:Young Adult