Skip to main content
PMC home page
Journal of Medical Ethics logoLink to Journal of Medical Ethics
. 2004 Jun;30(3):268–274. doi: 10.1136/jme.2003.003095

Ideals of patient autonomy in clinical decision making: a study on the development of a scale to assess patients' and physicians' views

A Stiggelbout 1, A Molewijk 1, W Otten 1, D Timmermans 1, J H van Bockel 1, J Kievit 1
PMCID: PMC1733851  PMID: 15173361

Abstract

Objectives: Evidence based patient choice seems based on a strong liberal individualist interpretation of patient autonomy; however, not all patients are in favour of such an interpretation. The authors wished to assess whether ideals of autonomy in clinical practice are more in accordance with alternative concepts of autonomy from the ethics literature. This paper describes the development of a questionnaire to assess such concepts of autonomy.

Methods: A questionnaire, based on six moral concepts from the ethics literature, was sent to aneurysm patients and their surgeons. The structure of the questionnaire was assessed by factor analysis, and item reduction was based on reliability.

Results: Ninety six patients and 58 surgeons participated. The questionnaire consisted of four scales. Two of the scales reflected the paternalistic and consumerist poles of the liberal individualist model, one scale reflected concepts of Socratic autonomy and of procedural independence, and the fourth scale reflected ideals of risk disclosure.

Discussion: The Ideal Patient Autonomy Scale is a 14 item normative instrument. It is clearly distinct from the generally used psychological preference questionnaires that assess preferences for physician-patient roles.

Full Text

The Full Text of this article is available as a PDF (93.2 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Agich G. J. Reassessing autonomy in long-term care. Hastings Cent Rep. 1990 Nov-Dec;20(6):12–17. [PubMed] [Google Scholar]
  2. Benbassat J., Pilpel D., Tidhar M. Patients' preferences for participation in clinical decision making: a review of published surveys. Behav Med. 1998 Summer;24(2):81–88. doi: 10.1080/08964289809596384. [DOI] [PubMed] [Google Scholar]
  3. Bland J. M., Altman D. G. Cronbach's alpha. BMJ. 1997 Feb 22;314(7080):572–572. doi: 10.1136/bmj.314.7080.572. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Charles C., Gafni A., Whelan T. Decision-making in the physician-patient encounter: revisiting the shared treatment decision-making model. Soc Sci Med. 1999 Sep;49(5):651–661. doi: 10.1016/s0277-9536(99)00145-8. [DOI] [PubMed] [Google Scholar]
  5. Coulter A. Partnerships with patients: the pros and cons of shared clinical decision-making. J Health Serv Res Policy. 1997 Apr;2(2):112–121. doi: 10.1177/135581969700200209. [DOI] [PubMed] [Google Scholar]
  6. Degner L. F., Sloan J. A., Venkatesh P. The Control Preferences Scale. Can J Nurs Res. 1997 Fall;29(3):21–43. [PubMed] [Google Scholar]
  7. Emanuel E. J., Emanuel L. L. Four models of the physician-patient relationship. JAMA. 1992 Apr 22;267(16):2221–2226. [PubMed] [Google Scholar]
  8. Ende J., Kazis L., Ash A., Moskowitz M. A. Measuring patients' desire for autonomy: decision making and information-seeking preferences among medical patients. J Gen Intern Med. 1989 Jan-Feb;4(1):23–30. doi: 10.1007/BF02596485. [DOI] [PubMed] [Google Scholar]
  9. Entwistle V. A., Sheldon T. A., Sowden A., Watt I. S. Evidence-informed patient choice. Practical issues of involving patients in decisions about health care technologies. Int J Technol Assess Health Care. 1998 Spring;14(2):212–225. doi: 10.1017/s0266462300012204. [DOI] [PubMed] [Google Scholar]
  10. Falkum E., Førde R. Paternalism, patient autonomy, and moral deliberation in the physician-patient relationship. Attitudes among Norwegian physicians. Soc Sci Med. 2001 Jan;52(2):239–248. doi: 10.1016/s0277-9536(00)00224-0. [DOI] [PubMed] [Google Scholar]
  11. Krosnick J. A. Survey research. Annu Rev Psychol. 1999;50:537–567. doi: 10.1146/annurev.psych.50.1.537. [DOI] [PubMed] [Google Scholar]
  12. Molewijk A. C., Stiggelbout A. M., Otten W., Dupuis H. M., Kievit J. Implicit normativity in evidence-based medicine: a plea for integrated empirical ethics research. Health Care Anal. 2003 Mar;11(1):69–92. doi: 10.1023/A:1025390030467. [DOI] [PubMed] [Google Scholar]
  13. Nease R. F., Jr, Brooks W. B. Patient desire for information and decision making in health care decisions: the Autonomy Preference Index and the Health Opinion Survey. J Gen Intern Med. 1995 Nov;10(11):593–600. doi: 10.1007/BF02602742. [DOI] [PubMed] [Google Scholar]
  14. Smith R. Medicine's core values. BMJ. 1994 Nov 12;309(6964):1247–1248. doi: 10.1136/bmj.309.6964.1247. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Sutherland H. J., Llewellyn-Thomas H. A., Lockwood G. A., Tritchler D. L., Till J. E. Cancer patients: their desire for information and participation in treatment decisions. J R Soc Med. 1989 May;82(5):260–263. doi: 10.1177/014107688908200506. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Journal of Medical Ethics are provided here courtesy of BMJ Publishing Group

RESOURCES