Share decision-making process with patients, says study

Many Singaporeans believe that decision-making should be shared between medical professionals and patients, as shown by the results of a cross-sectional survey. Both the education level and employment status of patients have influence on decision-making.

“As expectations and perceptions of informed consent are affected by one’s sociodemographic profile and education status, there is no one-size-fits-all approach to consent taking,” the researchers said.

“Therefore, the process of informed consent must be tailored to meet individual patient needs and expectations,” they added.

Overall, 445 adults completed the survey. Majority of the participants were aged <40 years (60.1 percent), female (70.1 percent), and degree holders (44.4 percent). More than half of the respondents (56.9 percent) wanted to know every possible risk, while nearly one in three (28.3 percent) wanted to know the common and serious risks. [Singapore Med J 2024;65:91-98]

Multivariate analysis revealed that older patients (age 61‒74 years; odds ratio [OR], 11.1, 95 percent confidence interval [CI], 2.2‒56.1; p=0.004; age >75 year: OR, 22.2, 95 percent CI, 1.8‒279.1; p=0.017) were less likely to know about any risks. Age also correlated with death disclosure risk (age 61‒74 years: OR, 13.4, 95 percent CI, 4.2‒42.6; p<0.001; age >75 years: OR, 32.0, 95 percent CI, 4.5‒228.0; p=0.001).

Notably, nearly half of the participants (48.1 percent) preferred making shared decisions with doctors, and employment status was a significant predictor (OR, 4.8, 95 percent CI, 1.9‒12.2; p=0.001).

“Sociodemographic factors and educational level influence decision-making, and therefore, the informed consent process should be tailored for each patient,” the researchers said.

Challenge

A previous cross-sectional survey of 80 postoperative patients at a teaching hospital in London, UK, found that less educated or unemployed patients were less likely to confront the healthcare staff about the care they were receiving. [Qual Saf Health Care 2008;17:90-96]

The current study showed that employed individuals were 4.8 times more likely to choose joint decision-making, and this finding might be associated with the educational background of the participants. [Med Care 2000;38:335-341; Med Decis Making 2014;34:216-230]

“We suggest targeting groups of individuals who are unemployed, with specific focus on encouragement from physicians to involve patients in the decision-making process to help them feel comfortable asking questions without ‘challenging’ healthcare staff,” the researchers said.

Another important finding of the present study was that older patients were less interested in knowing about any risk or risk of death after a procedure. This could be explained by either a generation gap or differing perspectives on life matters, according to the researchers.

In addition, older patients may choose not to participate in the decision-making process, potentially because of the paternalistic decision-making models used in the past. [Int J Surg 2007;5:57-65; BMC Fam Pract 2013;14:202]

“While we did not survey family members or caregivers, it is not uncommon to encounter a situation where family members (eg, children of elderly patients) request not to disclose high risks to the patient,” the researchers said. “Physicians then have to navigate the challenges of striking a balance between patient autonomy and family wishes.”

The current cross-sectional survey was conducted from January 2016 to March 2016 and involved adults attending the General Surgery outpatient clinics at Tan Tock Seng Hospital in Singapore. The researchers analysed the sociodemographic data, lifestyle- and health-related information, perception and purpose of consent forms, and decision-making preferences of the participants.