title: Participation in medical decision-making across Europe: An international longitudinal multicenter study.
abstract: The purpose of this paper was to examine national differences in the desire to participate in decision-making of people with severe mental illness in six European countries.
  
  
  
  The data was taken from a European longitudinal observational study (CEDAR; ISRCTN75841675). A sample of 514 patients with severe mental illness from the study centers in Ulm, Germany, London, England, Naples, Italy, Debrecen, Hungary, Aalborg, Denmark and Zurich, Switzerland were assessed as to desire to participate in medical decision-making. Associations between desire for participation in decision-making and center location were analyzed with generalized estimating equations.
  
  
  
  We found large cross-national differences in patients' desire to participate in decision-making, with the center explaining 47.2% of total variance in the desire for participation (P<0.001). Averaged over time and independent of patient characteristics, London (mean=2.27), Ulm (mean=2.13) and Zurich (mean=2.14) showed significantly higher scores in desire for participation, followed by Aalborg (mean=1.97), where scores were in turn significantly higher than in Debrecen (mean=1.56). The lowest scores were reported in Naples (mean=1.14). Over time, the desire for participation in decision-making increased significantly in Zurich (b=0.23) and decreased in Naples (b=-0.14). In all other centers, values remained stable.
  
  
  
  This study demonstrates that patients' desire for participation in decision-making varies by location. We suggest that more research attention be focused on identifying specific cultural and social factors in each country to further explain observed differences across Europe.
authors.affiliation: Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, PO Box 1930, 8021 Zurich, Switzerland. Electronic address: arlette.baer@puk.zh.ch.
authors.forename: A
authors.initials: A
authors.lastname: Bär Deucher
authors.affiliation: Department of Applied Psychology, Zurich University of Applied Sciences (ZHAW), Pfingstweidstrasse 96, PO Box 707, 8037 Zurich, Switzerland.
authors.forename: M P
authors.initials: MP
authors.lastname: Hengartner
authors.affiliation: Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, PO Box 1930, 8021 Zurich, Switzerland.
authors.forename: W
authors.initials: W
authors.lastname: Kawohl
authors.affiliation: Section Process-Outcome Research, Department of Psychiatry II, Ulm University, Ludwig-Heilmeyer-Str. 2, 89312 Günzburg, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Konrad
authors.affiliation: Section Process-Outcome Research, Department of Psychiatry II, Ulm University, Ludwig-Heilmeyer-Str. 2, 89312 Günzburg, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Puschner
authors.affiliation: Kings College London, Section for Recovery, Institute of Psychiatry, Psychology & Neuroscience, 16 De Crespigny Park, London SE5 8AF, UK.
authors.forename: E
authors.initials: E
authors.lastname: Clarke
authors.affiliation: Kings College London, Section for Recovery, Institute of Psychiatry, Psychology & Neuroscience, 16 De Crespigny Park, London SE5 8AF, UK.
authors.forename: M
authors.initials: M
authors.lastname: Slade
authors.affiliation: Department of Psychiatry, University of Naples SUN, Largo Madonna delle Grazie 1, 80138 Naples, Italy.
authors.forename: V
authors.initials: V
authors.lastname: Del Vecchio
authors.affiliation: Department of Psychiatry, University of Naples SUN, Largo Madonna delle Grazie 1, 80138 Naples, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Sampogna
authors.affiliation: Department of Psychiatry, Medical and Health Science Centre, University of Debrecen, 98, Nagyerdei krt, 4012, Debrecen, Hungary.
authors.forename: A
authors.initials: A
authors.lastname: Égerházi
authors.affiliation: Department of Psychiatry, Medical and Health Science Centre, University of Debrecen, 98, Nagyerdei krt, 4012, Debrecen, Hungary.
authors.forename: Á
authors.initials: Á
authors.lastname: Süveges
authors.affiliation: Aalborg University Hospital, Psychiatry, Mølleparkvej 10, Aalborg, 9000, Denmark.
authors.forename: M
authors.initials: M
authors.lastname: Krogsgaard Bording
authors.affiliation: Department M, Aarhus University Hospital, Skovagervej 2, 8240 Risskov, Denmark.
authors.forename: P
authors.initials: P
authors.lastname: Munk-Jørgensen
authors.affiliation: Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, PO Box 1930, 8021 Zurich, Switzerland.
authors.forename: W
authors.initials: W
authors.lastname: Rössler
mesh_terms: D000066491:Clinical Decision-Making; D003657:Decision Making; D005060:Europe; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D001523:Mental Disorders / Q000523:psychology*; D008875:Middle Aged; D010358:Patient Participation / Q000706:statistics & numerical data*; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D010817:Physician-Patient Relations; D019984:Quality Indicators, Health Care; D012720:Severity of Illness Index
keywords: Clinical decision-making; Multicenter study; Patient participation; Severe mental illness