Patients Want Medical Guidance When Making Care Decisions

May 15, 2020

Patients were more likely to recommend and return to providers who were paternalistic rather than autonomous.

Emma Levine, PhD

Recent study findings revealed that people want expert guidance when making decisions about their medical care.

Emma Levine, PhD, and colleagues found that advisers who gave advisees decisional autonomy over offering paternalistic advice were considered less competent and less helpful. The findings highlighted that advisees were less likely to return to and recommend such advisers.

“Our results suggest that advisees facing difficult decisions do not perceive autonomy as the gold standard,” Levine, assistant professor of behavioral science at the University of Chicago Booth School of Business, said in a statement.

Levine, a Charles E. Merrill Faculty Scholar at Chicago Booth, and a team of investigators ran a pilot study along with 6 experimental studies to test whether doctors believed patients valued decisional autonomy.

The team ran a pilot study with 127 employed physicians with the mean age of 39.8 years old—44.9% were female. The physicians were presented with a scenario in which they needed to indicate which action they would do to make them seem competent and helpful to a patient. The options included: providing the patient with their personal opinion of what the patient should choose or withholding their opinion. The team found that 56%, 49%, 52%, and 48% of physicians in the pilot study believed patients would find them to be more competent, more helpful, more likely to return to them, and more likely to recommend them for providing decisional autonomy instead of paternalistic advice.

In 1 study, 196 participants were asked to imagine they were a patient who had a difficult medical decision to make. The participants picked between 2 procedures and imagined they asked their physician what to do.

Each participant was randomly assigned to either autonomy or paternalism. In both conditions, the doctor reminded the participants of different risks and that either procedure could lead to positive outcomes. The physician then gave the patient a clear recommendation and said they should choose procedure A (or B if paternalism) or did not give them a recommendation and told them that the choice was the patient’s choice to make (autonomy).

Those who received paternalistic advice evaluated the doctor as more competent (P=.016) and more helpful (P=.014) than those who received full autonomy. Such patients also said they would be more likely to return to and recommend the doctor than those who received full decisional autonomy (P=.018).

In another study, the investigators examined whether advisees’ preference for paternalism was actually driven by a preference for an adviser who did what was asked of them. During the study, participants read a medical scenario and were randomly assigned to imagine they either asked the doctor what to do (solicited advice condition) or that they had not asked the doctor what they should do (unsolicited advice condition).

If the advisee asked the doctor what they should do, the doctor proceeded to provide either full decisional autonomy or paternalistic advice. In the unsolicited condition, it was the same as the solicited advice, but they did not ask what the doctor should do.

Once again, the team found that paternalistic advisers were perceived to be more competent and helpful than those who provided autonomy. Participants once more were more likely to return to and recommend such advisers (P <.001).

The results of this study suggested that regardless of whether an explicit recommendation was solicited or not, paternalism improved judgments of the adviser’s helpfulness and competence and increased intention to return to and recommend the adviser in the future.

The study, “Decisional autonomy undermines advisees’ judgments of experts in medicine and in life,” was published online in Proceedings of the National Academy of Sciences.