MEASURING TAIWANESE PATIENTS' READINESS FOR INVOLVEMENT IN MEDICAL DECISION-MAKING

Purpose: To evaluate the Taiwanese patients’ readiness for participate in medical decision making and to explore the provider roles in cross-national cultural differences for effective consignable service.

Method: The shared decision-making questionnaire of Simon et al. (2006) was independently translated into Chinese by two native speakers, and checked by a schoolteacher of Chinese. Further, an expert panel discussed some language differences and agreed upon the final version of the questionnaire.

Result: 120 consecutive patients were recruited from ChungShan Medical University Hospital. The respondents’ aged between 21 and 78, the majority was married and the gender distribution was fairly even. With regard to measurement, there were rang of involvement orders, from most active item 4 (Mean=3.33) to the passive item 1 (Mean=2.79). Respondents to the older, male and married were statistical significant difference, and revealed less likely to prefer an active role and were more likely to prefer physician’s decision. Further, readiness analysis of the verbatim content regarding patients’ rationales revealed the following: 90(75%) patients mentioned lack of knowledge as influencing their in readiness for participate in decisions, and comment that “I don’t know the medicine, so I’ll leave the decision to doctor”. Further, trust was specifically referred to by 102(85%) patients’ comment was “if you can’t trust the doctor, there’s something wrong”. Therefore, lack of knowledge about health care appeared to be closely linked with trust for these patients. Besides, 110(92%) patients cited to honor family wishes over individual wish in medical decision making.

Conclusion: This study found that there was no clear evidence that Taiwanese patients prefer more passive roles than do their counterparts in western countries, if they and their family members are fully informed. In other words, if providers know more about patients’ family needs and concerns, they can help patients choose more appropriate methods. Thus, this finding suggest that (1) establishing a trusting relationship, (2) facilitating the involvement of family members, (3) warning patients about the nature of the discussion and communicating to them that no harm is intended. In conclusion, culture is the interrelationship of values, beliefs, behaviors, and transmitted from generation to generation. Patient participation encompasses several aspects that are not necessarily alike among different countries. Future research could focus on evaluation and modification of the specific recommendations made in this article.