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Decision-Making Role Preferences Among Patients with HIV: Associations with Patient and Provider Characteristics and Communication Behaviors

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Abstract

BACKGROUND

A preference for shared decision-making among patients with HIV has been associated with better health outcomes. One possible explanation for this association is that patients who prefer a more active role in decision-making are more engaged in the communication process during encounters with their providers. Little is known, however, about patient and provider characteristics or communication behaviors associated with patient decision-making preferences in HIV settings.

OBJECTIVE

We examined patient and provider characteristics and patient-provider communication behaviors associated with the decision-making role preferences of patients with HIV.

DESIGN

Cross-sectional analysis of patient and provider questionnaires and audio recorded clinical encounters from four sites.

PARTICIPANTS

A total of 45 providers and 434 of their patients with HIV.

MEASURES

Patients were asked how they prefer to be involved in the decision-making process (doctor makes all/most decisions, patients and doctors share decisions, or patients make decisions alone). Measures of provider and patient communication behaviors were coded from audio recordings using the Roter Interaction Analysis System.

MAIN RESULTS

Overall, 72% of patients preferred to share decisions with their provider, 23% wanted their provider to make decisions, and 5% wanted to make decisions themselves. Compared to patients who preferred to share decisions with their provider, patients who preferred their provider make decisions were less likely to be above the age of 60 (ARR 0.09, 95% CI 0.01–0.89) and perceive high quality provider communication about decision-making (ARR 0.41, 95% CI 0.23–0.73), and more likely to have depressive symptoms (ARR 1.92, 95% CI 1.07–3.44). There was no significant association between patient preferences and measures of provider or patient communication behavior.

CONCLUSION

Observed measures of patient and provider communication behavior were similar across all patient decision-making role preferences, indicating that it may be difficult for providers to determine these preferences based solely on communication behavior. Engaging patients in open discussion about decision-making preferences may be a more effective approach.

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Acknowledgements

The authors would like to thank Drs. Lisa Cooper, Jeanne M. Clark, L. Ebony Boulware, and Sandra Moody for their suggestions and feedback on earlier drafts. This research was supported by a contract from the Health Resources Service Administration and the Agency for Healthcare Research and Quality (AHRQ 290-01-0012). In addition, Dr. Korthuis was supported by the National Institute of Drug Abuse (K23 DA019808). Dr. Chander was supported by the National Institute on Alcoholism and Alcohol Abuse (K23 AA015313). Dr. Beach was supported by the Agency for Healthcare Research and Quality (K08 HS013903-05), and both Drs. Beach and Saha were supported by Robert Wood Johnson Generalist Physician Faculty Scholars Awards.

Conflict of Interest

None disclosed.

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Authors and Affiliations

  1. Johns Hopkins University, 2024 East Monument Street, Suite 2-600, Baltimore, MD, 21205, USA

    Rashmi Kumar MD, MHS, Geetanjali Chander MD, MPH, Richard Moore MD, MHS & Mary Catherine Beach MD, MPH

  2. Oregon Health Science University, Portland, OR, USA

    P. Todd Korthuis MD & Somnath Saha MD, MPH

  3. Saint-Lukes Roosevelt, New York, NY, USA

    Victoria Sharp MD

  4. Wayne State University, Detroit, MI, USA

    Jonathon Cohn MD

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  1. Rashmi Kumar MD, MHS
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  2. P. Todd Korthuis MD
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  3. Somnath Saha MD, MPH
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  4. Geetanjali Chander MD, MPH
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  5. Victoria Sharp MD
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  6. Jonathon Cohn MD
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  7. Richard Moore MD, MHS
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  8. Mary Catherine Beach MD, MPH
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Correspondence to Rashmi Kumar MD, MHS.

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Kumar, R., Korthuis, P.T., Saha, S. et al. Decision-Making Role Preferences Among Patients with HIV: Associations with Patient and Provider Characteristics and Communication Behaviors. J GEN INTERN MED 25, 517–523 (2010). https://doi.org/10.1007/s11606-010-1275-3

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  • DOI: https://doi.org/10.1007/s11606-010-1275-3

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