Skip to main content
NCBI home page
Thorax logoLink to Thorax
. 2001 Feb;56(2):126–132. doi: 10.1136/thorax.56.2.126

Patient preferences for autonomy in decision making in asthma management

R Adams 1, B Smith 1, R Ruffin 1
PMCID: PMC1746006  PMID: 11209101

Abstract

BACKGROUND—Lower patient preferences for autonomy in management decision making during asthma exacerbations have been associated with an increased risk for future hospital admissions. We sought to examine patient preferences for asthma self-management autonomy, and the clinical and psychosocial factors associated with autonomy preferences.
METHODS—A cross sectional observational study was performed with data collected between June 1995 and December 1997 of 212 adult patients with moderate to severe asthma managed, at least in part, at two teaching hospitals. Subjects completed a survey of autonomy preferences, quality of life, clinical morbidity and health service use, asthma knowledge, self-efficacy, coping styles, and psychosocial measures.
RESULTS—Patients preferred clinicians to assume the major role in most decision making about their management. However, patients wished to remain in control in choosing when to seek care and wanted to share decisions regarding initiating changes in medications during a moderate exacerbation. Multiple regression analysis showed that concerns about adverse effects of medications, education level, an active coping style, perceptions of the propensity of physicians to involve them in treatment decision making, and concerns about costs causing delays in seeking medical care were associated with preferences for autonomy in decision making. Autonomy preferences were not related to measures of concurrent clinical asthma control or health related quality of life.
CONCLUSIONS—In a group of patients with moderate to severe asthma, a high proportion of whom were from socioeconomically disadvantaged backgrounds, education level, perceived physician behaviour, cost barriers to care, and psychosocial factors (but not clinical asthma control or management) were related to patient preferences for autonomy in management decision making during asthma exacerbations. This has implications for asthma action plans and design of self-management programmes.



Full Text

The Full Text of this article is available as a PDF (146.2 KB).

Selected References

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

  1. Abdulwadud O., Abramson M., Forbes A., James A., Light L., Thien F., Walters E. H. Attendance at an asthma educational intervention: characteristics of participants and non-participants. Respir Med. 1997 Oct;91(9):524–529. doi: 10.1016/s0954-6111(97)90085-8. [DOI] [PubMed] [Google Scholar]
  2. Adams R. J., Smith B. J., Ruffin R. E. Factors associated with hospital admissions and repeat emergency department visits for adults with asthma. Thorax. 2000 Jul;55(7):566–573. doi: 10.1136/thorax.55.7.566. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Adams R., Ruffin R., Wakefield M., Campbell D., Smith B. Asthma prevalence, morbidity and management practices in South Australia, 1992-1995. Aust N Z J Med. 1997 Dec;27(6):672–679. doi: 10.1111/j.1445-5994.1997.tb00997.x. [DOI] [PubMed] [Google Scholar]
  4. Bailey W. C., Richards J. M., Jr, Brooks C. M., Soong S. J., Windsor R. A., Manzella B. A. A randomized trial to improve self-management practices of adults with asthma. Arch Intern Med. 1990 Aug;150(8):1664–1668. [PubMed] [Google Scholar]
  5. 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]
  6. Bolton M. B., Tilley B. C., Kuder J., Reeves T., Schultz L. R. The cost and effectiveness of an education program for adults who have asthma. J Gen Intern Med. 1991 Sep-Oct;6(5):401–407. doi: 10.1007/BF02598160. [DOI] [PubMed] [Google Scholar]
  7. Bosley C. M., Fosbury J. A., Cochrane G. M. The psychological factors associated with poor compliance with treatment in asthma. Eur Respir J. 1995 Jun;8(6):899–904. [PubMed] [Google Scholar]
  8. Braddock C. H., 3rd, Fihn S. D., Levinson W., Jonsen A. R., Pearlman R. A. How doctors and patients discuss routine clinical decisions. Informed decision making in the outpatient setting. J Gen Intern Med. 1997 Jun;12(6):339–345. doi: 10.1046/j.1525-1497.1997.00057.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Campbell D. A., Yellowlees P. M., McLennan G., Coates J. R., Frith P. A., Gluyas P. A., Latimer K. M., Luke C. G., Martin A. J., Ruffin R. E. Psychiatric and medical features of near fatal asthma. Thorax. 1995 Mar;50(3):254–259. doi: 10.1136/thx.50.3.254. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Clark N. M., Gong M. Management of chronic disease by practitioners and patients: are we teaching the wrong things? BMJ. 2000 Feb 26;320(7234):572–575. doi: 10.1136/bmj.320.7234.572. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Clark N. M., Gong M., Schork M. A., Evans D., Roloff D., Hurwitz M., Maiman L., Mellins R. B. Impact of education for physicians on patient outcomes. Pediatrics. 1998 May;101(5):831–836. doi: 10.1542/peds.101.5.831. [DOI] [PubMed] [Google Scholar]
  12. Clark N. M., Gong M., Schork M. A., Maiman L. A., Evans D., Hurwitz M. E., Roloff D., Mellins R. B. A scale for Assessing Health Care Providers' Teaching and Communication Behavior regarding asthma. Health Educ Behav. 1997 Apr;24(2):245–256. doi: 10.1177/109019819702400211. [DOI] [PubMed] [Google Scholar]
  13. Deber R. B., Kraetschmer N., Irvine J. What role do patients wish to play in treatment decision making? Arch Intern Med. 1996 Jul 8;156(13):1414–1420. [PubMed] [Google Scholar]
  14. 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]
  15. Ende J., Kazis L., Moskowitz M. A. Preferences for autonomy when patients are physicians. J Gen Intern Med. 1990 Nov-Dec;5(6):506–509. doi: 10.1007/BF02600881. [DOI] [PubMed] [Google Scholar]
  16. Gibson P. G., Talbot P. I., Toneguzzi R. C. Self-management, autonomy, and quality of life in asthma. Population Medicine Group 91C. Chest. 1995 Apr;107(4):1003–1008. doi: 10.1378/chest.107.4.1003. [DOI] [PubMed] [Google Scholar]
  17. Greenfield S., Kaplan S. H., Ware J. E., Jr, Yano E. M., Frank H. J. Patients' participation in medical care: effects on blood sugar control and quality of life in diabetes. J Gen Intern Med. 1988 Sep-Oct;3(5):448–457. doi: 10.1007/BF02595921. [DOI] [PubMed] [Google Scholar]
  18. Greineder D. K., Loane K. C., Parks P. Reduction in resource utilization by an asthma outreach program. Arch Pediatr Adolesc Med. 1995 Apr;149(4):415–420. doi: 10.1001/archpedi.1995.02170160069010. [DOI] [PubMed] [Google Scholar]
  19. Hilton S., Sibbald B., Anderson H. R., Freeling P. Controlled evaluation of the effects of patient education on asthma morbidity in general practice. Lancet. 1986 Jan 4;1(8471):26–29. doi: 10.1016/s0140-6736(86)91904-5. [DOI] [PubMed] [Google Scholar]
  20. Kaplan G. A., Camacho T. Perceived health and mortality: a nine-year follow-up of the human population laboratory cohort. Am J Epidemiol. 1983 Mar;117(3):292–304. doi: 10.1093/oxfordjournals.aje.a113541. [DOI] [PubMed] [Google Scholar]
  21. Kaplan S. H., Gandek B., Greenfield S., Rogers W., Ware J. E. Patient and visit characteristics related to physicians' participatory decision-making style. Results from the Medical Outcomes Study. Med Care. 1995 Dec;33(12):1176–1187. doi: 10.1097/00005650-199512000-00002. [DOI] [PubMed] [Google Scholar]
  22. Kaplan S. H., Greenfield S., Gandek B., Rogers W. H., Ware J. E., Jr Characteristics of physicians with participatory decision-making styles. Ann Intern Med. 1996 Mar 1;124(5):497–504. doi: 10.7326/0003-4819-124-5-199603010-00007. [DOI] [PubMed] [Google Scholar]
  23. Klingelhofer E. L., Gershwin M. E. Asthma self-management programs: premises, not promises. J Asthma. 1988;25(2):89–101. doi: 10.3109/02770908809071359. [DOI] [PubMed] [Google Scholar]
  24. Kolbe J., Vamos M., Fergusson W., Elkind G. Determinants of management errors in acute severe asthma. Thorax. 1998 Jan;53(1):14–20. doi: 10.1136/thx.53.1.14. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Kolbe J., Vamos M., Fergusson W., Elkind G., Garrett J. Differential influences on asthma self-management knowledge and self-management behavior in acute severe asthma. Chest. 1996 Dec;110(6):1463–1468. doi: 10.1378/chest.110.6.1463. [DOI] [PubMed] [Google Scholar]
  26. Lupton D. Consumerism, reflexivity and the medical encounter. Soc Sci Med. 1997 Aug;45(3):373–381. doi: 10.1016/s0277-9536(96)00353-x. [DOI] [PubMed] [Google Scholar]
  27. Marks G. B., Burney P. G., Premaratne U. N., Simpson J., Webb J. Asthma in Greenwich, UK: impact of the disease and current management practices. Eur Respir J. 1997 Jun;10(6):1224–1229. doi: 10.1183/09031936.97.10061224. [DOI] [PubMed] [Google Scholar]
  28. Osman L. M., Russell I. T., Friend J. A., Legge J. S., Douglas J. G. Predicting patient attitudes to asthma medication. Thorax. 1993 Aug;48(8):827–830. doi: 10.1136/thx.48.8.827. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Ruffin R. E., Wilson D., Southcott A. M., Smith B., Adams R. J. A South Australian population survey of the ownership of asthma action plans. Med J Aust. 1999 Oct 4;171(7):348–351. doi: 10.5694/j.1326-5377.1999.tb123690.x. [DOI] [PubMed] [Google Scholar]
  30. Schlösser M., Havermans G. A self-efficacy scale for children and adolescents with asthma: construction and validation. J Asthma. 1992;29(2):99–108. doi: 10.3109/02770909209059878. [DOI] [PubMed] [Google Scholar]
  31. Sherbourne C. D., Hays R. D., Ordway L., DiMatteo M. R., Kravitz R. L. Antecedents of adherence to medical recommendations: results from the Medical Outcomes Study. J Behav Med. 1992 Oct;15(5):447–468. doi: 10.1007/BF00844941. [DOI] [PubMed] [Google Scholar]
  32. Sterk P. J., Fabbri L. M., Quanjer P. H., Cockcroft D. W., O'Byrne P. M., Anderson S. D., Juniper E. F., Malo J. L. Airway responsiveness. Standardized challenge testing with pharmacological, physical and sensitizing stimuli in adults. Report Working Party Standardization of Lung Function Tests, European Community for Steel and Coal. Official Statement of the European Respiratory Society. Eur Respir J Suppl. 1993 Mar;16:53–83. [PubMed] [Google Scholar]
  33. Yoon R., McKenzie D. K., Bauman A., Miles D. A. Controlled trial evaluation of an asthma education programme for adults. Thorax. 1993 Nov;48(11):1110–1116. doi: 10.1136/thx.48.11.1110. [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. Yoon R., McKenzie D. K., Miles D. A., Bauman A. Characteristics of attenders and non-attenders at an asthma education programme. Thorax. 1991 Dec;46(12):886–890. doi: 10.1136/thx.46.12.886. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Thorax are provided here courtesy of BMJ Publishing Group

RESOURCES