title: What perceptions do patients have of decision making (DM)? Toward an integrative patient-centered care model. A qualitative study using focus-group interviews.
abstract: OBJECTIVE
  To understand patients' perceptions of decision making and identify relationships among decision-making models.
  
  
  METHODS
  This qualitative study was made up of four focus group interviews (elderly persons, users of health support groups, students, and rural inhabitants). Participants were asked to report their perceptions of decision making in three written clinical scenarios (hypertension, breast cancer, prostate cancer). The analysis was based on the principles of grounded theory.
  
  
  RESULTS
  Most patients perceived decision making as shared decision making, a deliberative question-response interaction with the physician that allowed patients to be experts in obtaining clearer information, participating in the care process, and negotiating compromises with physician preferences. Requesting second opinions allowed patients to maintain control, even within the paternalistic model preferred by elderly persons. Facilitating factors (trust, qualitative non-verbal communication, time to think) and obstacles (serious/emergency situations, perceived inadequate scientific competence, problems making requests, fear of knowing) were also part of shared decision making.
  
  
  CONCLUSIONS
  In the global concept of patient-centered care, shared decision making can be flexible and can integrate paternalistic and informative models. Physicians' expertise should be associated with biomedical and relational skills through listening to, informing, and advising patients, and by supporting patients' choices.
authors: Department of General Practice, University Claude Bernard Lyon 1, France. alainmoreau0917@orange.fr
authors: Alain
authors: A
authors: Moreau
authors: Laurent
authors: L
authors: Carol
authors: Marie Cécile
authors: MC
authors: Dedianne
authors: Christian
authors: C
authors: Dupraz
authors: Corinne
authors: C
authors: Perdrix
authors: Xavier
authors: X
authors: Lainé
authors: Gilbert
authors: G
authors: Souweine
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D003657:Decision Making; D005260:Female; D017144:Focus Groups; D006801:Humans; D007258:Informed Consent; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D010358:Patient Participation; D018802:Patient-Centered Care; D010465:Perception; D010817:Physician-Patient Relations; D036301:Qualitative Research; D012424:Rural Population; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D013637:Tape Recording; D055815:Young Adult