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Patients prefer physicians to make care decisions

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Most Portuguese patients prefer a passive role in problem-solving and decision-making related to their health care, especially in life-threatening situations.

These conclusions come from a study carried out by researchers from the Faculty of Medicine of the University of Porto (FMUP) and CINTESIS – Center for Research in Health Technologies and Services.

The team, coordinated by Carlos Martins (FMUP/CINTESIS), evaluated 599 Portuguese between 20 and 99 years old (average of 51.9 years old), in a representative sample of the national population.

The aim was to understand to what extent the Portuguese want to be involved in the medical decision-making process.

The results surprised the researchers because of the low proportion of Portuguese who, faced with different types of clinical situations, consider that the decision should be shared between the doctor and the patient.

“The vast majority of patients prefer the doctor to take control of problem solving and decision making, whether in terms of quality of life, diseases or life-threatening clinical situations. Portuguese patients prefer a passive role and want the doctor to decide,” the authors explain.

Faced with a life-threatening clinical situation, 66.1% of Portuguese respondents believe that the decision should be made by the doctor, with patients assuming a passive role.

In a situation of non-fatal illness, 64.4% consider that the decision should be taken by the doctor, and in a situation of quality of life, 55.4% of the Portuguese believe that the decision should also be taken by the doctor.

The researchers also found that taking an active role and sharing decisions with the doctor was more accepted by younger, more educated and employed people.

According to Carlos Martins, this is a sign of evolution “in the way decisions are made during medical consultations. Increasingly, pedagogically and scientifically, we are investing in patient-centered consultation, based on a model of shared medical decision-making, instead of the paternalistic consultation model in which the decision-making power rests entirely with the physician”.

For the authors, this study further reinforces the importance of “training physicians to adequately involve patients in decision-making, in a shared manner”.

“The shared medical decision is not the simple fact of a doctor, with empathy, sharing his decision with the patient. The shared medical decision involves much more than that, it involves training the patient, so that he perceives the benefits and the risks of treatment A and also of treatment B, to decide, together, on the therapeutic option”.