IDENTIFYING CULTURAL INFLUENCES ON PATIENTS' DESIRED LEVELS OF PARTICIPATION IN MEDICAL DECISION MAKING: A MULTI-CULTURAL INVESTIGATION

Purpose: Despite a vibrant stream in the West, cross-cultural understanding of factors associated with different levels of patient desire for participation in medical decision making (MDM) remains limited.  This study presents results from a collaborative investigation involving researchers from five countries in the Asia Pacific region.      

Method: The multicultural team first identified 4 culturally and age-relevant disease conditions that varied in severity. Based on past research, cultural values were hypothesized to affect desired levels of self-participation and family-participation in MDM. Panel samples of approximately 300 middle class urban respondents (30-44; 50% female) completed a 20 minute online survey. Tests for convergent/discriminant validity, common method bias and measurement invariance were successful. Structural equation model (SEM) analyses of 3 out of 7 national samples (India, Malaysia, US) are complete. 

Results: Multi-group analyses compared the effects of cultural antecedents (self-independence, group-interdependence, and respect for hierarchy) on a mediator (desire for MDM information) and two outcomes (desired level of self- and family-participation in MDM). Higher value placed on self-independence predicted higher desire for MDM information in all countries. Higher value placed on self-independence also predicted lower desire for family-participation in the US/Malaysia, but higher desire for self-participation in the US only. Higher value placed on group-interdependence positively predicted desire for family-participation in Malaysia, but was marginal in the US and insignificant in India.  Lower value placed on hierarchy positively predicted desire for MDM information in the US/Malaysia. Unexpectedly, higher desire for self-participation led to higher desire for family-participation in all countries. 

Conclusion: The findings point to the importance of cross-cultural study of desired participation in MDM. For example, researchers and practitioners should be aware that patients in 3 diverse cultures who want to participate in MDM also tend to want their family involved.  In addition, self-independence emerges as the most important predictor of desire for MDM information and a negative indicator of desired family involvement, even in collectivist Malaysia. Surprisingly, group-interdependence appears relatively less important, primarily impacting desired family-participation in Malaysia. And, clearly, patients in Malaysia and the US who value hierarchy less also desire higher levels of MDM information. Analysis of these relationships in the 4 remaining national samples will further enhance our understanding ways to work effectively with culture, improving medical decision making processes and outcomes.