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Characteristics of Physicians with Participatory Decision-Making Styles

Sherrie H. Kaplan, PhD, MPH; Sheldon Greenfield, MD; Barbara Gandek, MS; William H. Rogers, PhD; and John E. Ware Jr., PhD
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From New England Medical Center, Boston, Massachusetts. Acknowledgments: The authors thank Drs. Alvin Tarlov, Nicole Lurie, Anthony Suchman, Rebecca Silliman, Anita Stewart, and Lisa M. Sullivan and Kimberly A. Dukes for assistance and support; the ANCHOR Organization for Health Maintenance in Chicago, Illinois, CIGNA Health Plans of Southern California, and the Harvard Community Health Plan in Boston, Massachusetts, for assistance with recruitment of clinicians; and Linda Jackson for editing and preparing the manuscript. Grant Support: By grant 8409 from the National Institute on Aging. Medical Outcomes Study data collection and analysis were sponsored by the Henry J. Kaiser Family Foundation, The Robert Wood Johnson Foundation, and the Pew Charitable Trusts. Requests for Reprints: Sherrie H. Kaplan, PhD, New England Medical Center Hospitals, Primary Care Outcomes Research Institute, 750 Washington Street, Box 345, Boston, MA 02111. Current Author Addresses: Drs. Kaplan and Greenfield: New England Medical Center Hospitals, Primary Care Outcomes Research Institute, 750 Washington Street, Box 345, Boston, MA 02111.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1996;124(5):497-504. doi:10.7326/0003-4819-124-5-199603010-00007
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Objectives: To identify physician and practice characteristics associated with a physician's propensity to involve patients in diagnostic and treatment decisions, or participatory decision-making style.

Design: A representative cross-sectional sample of patients participating in the Medical Outcomes Study characterized each physician's style by using a self-reported questionnaire. A single averaged style score was generated for each physician. Style scores were compared among physicians who differed in age, sex, minority status, specialty, primary care training or training in interviewing skills, satisfaction with professional autonomy, and practice volume.

Settings: Solo practices, multispecialty groups, and health maintenance organizations in Boston, Chicago, and Los Angeles.

Participants: 7730 patients sampled over 9 days from the practices of 300 physicians. Physicians were practicing general internal medicine, family medicine, cardiology, and endocrinology.

Measurements: Participatory decision-making style was measured using a three-item scale on a questionnaire that was completed by patients after their office visit. Physician and practice characteristics were reported by physicians on self-administered questionnaires.

Results: Among patients of physicians who were rated in the lowest (least participatory) quartile, one third changed physicians in the following year; among patients of physicians who were rated in the highest quartile, only 15% changed physicians. Higher scores were associated with greater patient satisfaction. Physicians who had had primary care training or training in interviewing skills scored higher than those without such training. Physicians in higher-volume practices were rated as less participatory than those in lower-volume practices. Physicians who were satisfied with their level of professional autonomy were rated as more participatory than those who were dissatisfied.

Conclusion: Participatory decision-making style is influenced by physicians' background, training, practice volume, and professional autonomy. Because participatory decision-making style is related to patient satisfaction and loyalty to the physician, cost-containment strategies that reduce time with patients and decrease physician autonomy may result in suboptimal patient outcomes.





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