Is Patients' Preferred Involvement in Health Decisions Related to Outcomes for Patients with HIV?

A survey of 1,027 HIV-infected patients was used in this research to examine how patient preference in decision-making affected outcome. The study population was mostly young African-American males. Respondents were asked to select one of these categories to describe their attitude toward treatment: "the doctor takes the initiative and decides what is best for me;" "the doctor considers some of my ideas but still makes [most] of the final decisions;" "the doctor and I make the final decisions together;" and "I make all of the final decisions." The authors then measured association between individual responses and three outcome measures: receipt of HAART (highly active antiretroviral therapy) among eligible patients; adherence to HAART, and absence of detectable HIV-1 RNA.

Key Findings:

  • Patients who preferred their provider to make most or all of the decisions were equally as likely as patients who shared decisions to receive HAART, but significantly less likely to adhere to it; they also were less likely to have undetectable HIV-1 RNA.
  • Patients who preferred to make all decisions themselves were less likely to receive HAART, equally likely to adhere to it, and less likely to have undetectable HIV-1 RNA than patients who shared decisions.
  • 63 percent of patients fell into the 'shared decisions' category, a number that is at the high end of the range of reported preferences for shared decision-making roles. This number may indicate that HIV patients prefer relatively high levels of involvement. Younger patients were more likely to prefer more involvement.
  • Patients who preferred to share decisions also reported better communication with providers.

This research suggests that clinicians should encourage patients to share decisions, including patients that are highly independent decision-makers, because patients who shared decision-making had better outcomes than either patients who deferred completely to doctors or patients who made all decisions themselves. Future work is needed to understand effective ways of modifying patients' preferences for decision-making and to understand whether such modifications can improve patient outcomes.