Contact: Brian McKinstry
+44 (0)1506 655 886
brian.mckinstry@ed.ac.uk.

Do Patients Wish to be Involved in Treatment Decisions?

Patients favour a direct approach from their doctor when discussing physical problems, but prefer to help decide their treatment for psychiatric and lifestyle problems, according to a study in this week's BMJ.

Dr. Brian McKinstry showed videos of common consultation scenarios -- in which patients were or were not involved in deciding their management -- to 410 patients attending surgeries in Lothian. The videos represented five common general practice consultations -- a bleeding mole, a sprained calf, chronic rheumatoid arthritis, depression and smoking advice.

The author found that patients preferred consultations in which the doctor largely decided treatment for all the scenarios except those for depression and smoking advice. For these two problems, more chose scenarios that involved the patient helping to decide on treatment. Patients aged 61 years or older preferred a more direct approach, says the author. However, patients from higher social classes preferred a shared approach, as did patients who smoked, he adds.

These associations are far from absolute, stresses the author. Doctors need the skills, knowledge of their patients, and sufficient time in consultations to determine how much involvement each patient wants in decision making, he concludes.

Contact: Brian McKinstry, Principal in General Practice, Ashgrove Health Centre, West Lothian, Scotland. Tel: +44 (0)1506 655 886 Fax: +44 (0)1506 634 790 Thursday only available via mobile: 0780 326 8660 e-mail: brian.mckinstry@ed.ac.uk.

(Do patients wish to be involved in decision making in the consultation? A cross sectional survey with video vignettes) BMJ Volume 321, pp 867-871

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