THE EFFECT OF UNCERTAINTY ON PATIENTS PREFERRED ROLE IN DECISION MAKING

Background: Experts recommend that clinicians determine patients' preferred decision role and tailor their interactions accordingly. Patients’ preferred decision role varies with underlying disease severity and age, but neither of these factors can be modified prior to engaging in decision making. Based on previous qualitative studies, we hypothesized that preferred decision role is also associated with modifiable factors, particularly patients’ level of uncertainty.
Methods: 142 subjects were interviewed as part of a larger study of patient preferences. As part of the baseline assessment, patients completed Degner’s 5-item Control Preferences scale (see Table 1) and a choice predisposition 11-point scale that expressed their degree of certainty about desiring treatment. On this scale, scores were grouped into three groups: 0-3 indicating a predisposition not to be treated; 7-10 indicating a predisposition in favor of treatment; and 4-6 indicating uncertainty. The significance of uncertainty on preferred role in decision making was examined using a multinomial logistic regression model. To facilitate analysis, Degner categories 4 and 5 were combined.
Results: The mean (±SD) age of the sample was 51 ± 8, 85% male, 59% Caucasian, 30% African American, and 45% had a college education. The number of patients per preferred role are in Table 1. We found that level of uncertainty was a significant predictor of preferred role in decision making (chi-square = 21.2, p = 0.002). This relationship persisted after controlling for age and underlying disease severity (chi-square = 19.3, p = 0.004), and the full model explained over 19% of the variance. The most significant single parameter was between patient uncertainty and preference for Role 2, indicating that patients who were most uncertain were more likely to want to “seriously consider their physicians’ opinions”.
Conclusion: Uncertainty is associated with patients’ preferred decision role. Physicians should effectively inform their patients in order to minimize uncertainty before ascertaining their patients’ preferred role in decision making.
Table 1. Distribution of Preferred Decision Roles.

Degner’s Item (abbreviated)	Frequency (%)
1. I prefer to make the final selection	26 (18)
2. I prefer to make the final selection after seriously considering my doctor’s opinion	50 (35)
3. I prefer that my doctor and I share responsibility	47 (33)
4. I prefer that my doctor make the final decision	9 (6)
5. I prefer to leave all decisions up to my doctor	10 (7)