What role do patients prefer in medical decision-making?: a population-based nationwide cross-sectional study.

OBJECTIVE: To assess patients' preferred roles in healthcare-related decision-making in a representative sample of the Portuguese population. DESIGN: Population-based nationwide cross-sectional study. SETTING AND PARTICIPANTS: A sample of Portuguese people 20 years or older were interviewed face-to-face using a questionnaire with the Problem-Solving Decision-Making scale. OUTCOMES: The primary outcome was patients' preferred role for each vignette of the problem-solving decision-making scale. Sociodemographic factors associated with the preferred roles were the secondary outcomes. RESULTS: 599 participants (20-99 years, 53.8% women) were interviewed. Three vignettes of the Problem-Solving Decision-Making scale were compared: morbidity, mortality and quality of life. Most patients preferred a passive role for both the problem-solving and decision-making components of the scale, particularly for the mortality vignette (66.1% in the analysis of the three vignettes), although comparatively more opted to share decision in the decision-making component. For the quality of life vignette, a higher percentage of patients wanted a shared role (44.3%) than with the other two vignettes. In the problem-solving component, preferences were significantly associated with area of residence (p<0.001) and educational level (p=0.013), while in the decision-making, component preferences were associated with age (p=0.020), educational level (p=0.015) and profession (p<0.001). CONCLUSIONS: In this representative sample of the Portuguese mainland population, most patients preferred a practitioner-controlling role for both the problem-solving and decision-making components. In a life-threatening situation, patients were more willing to let the doctor decide. In contrast, in a less serious situation, there is a greater willingness to participate in decision-making. We have found that shared decision-making is more acceptable to better-educated patients in the problem-solving component and to people who are younger, higher educated and employed, in the decision-making component.

Patients' Perspectives about Lifestyle Behaviors and Health in the Context of Family Medicine: A Cross-Sectional Study in Portugal.

Lifestyle interventions are recognized as essential in the prevention and treatment of non-communicable diseases. Previous studies have shown that Portuguese patients tend to give more importance to diagnostic and laboratory tests than to lifestyle measures, and seem unaware that behavioral risks are the main modifiable risk factors. The study aimed to analyze patients' perspectives about lifestyle behaviors and health in the context of family medicine in Portugal. A population-based cross-sectional study was carried out in Portugal (the mainland). A total of 900 Portuguese patients aged ≥20 years, representative of the population, were surveyed using face-to-face questionnaires. Participants were selected by the random route method. Descriptive statistics and non-parametric tests were performed to evaluate differences between the personal beliefs and the personal behavior self-assessment, as well as between the level of importance given to the family doctor to address health behaviors and the reported approach implemented by the family doctor, and its association with bio-demographic variables. The results indicate that the vast majority of this Portuguese cohort has informed beliefs regarding lifestyle behaviors, tends to overestimate their own behavior self-assessment, and strongly agrees that it is important that their family doctor asks/advises on these lifestyle behaviors, although the proportion of those who totally agree that their family doctor usually does this is significantly lower. Differences concerning bio-demographic variables were found. Future research directions should focus on the politics, economics, and policy aspects that may have an impact in this area. It will also be important to understand more broadly the relationships between lifestyle behaviors and clinical, physical, and sociodemographic variables.

The Problem-Solving Decision-Making scale-translation and validation for the Portuguese language: a cross-sectional study.

OBJECTIVES: To translate and validate the Problem-Solving Decision-Making scale instrument into the Portuguese language. DESIGN: Cross-sectional study. SETTING PARTICIPANTS: The Problem-Solving Decision-Making scale was translated from English to Portuguese and then back-translated to obtain a final version. The questionnaire was then applied face-to-face from January to March 2019 in a representative sample of the Portuguese population (n=301 people aged 20 years or more) to validate the Problem-Solving Decision-Making scale in a Portuguese population. OUTCOMES: Principal component analysis and Cronbach's alpha. RESULTS: Principal component analysis was used to evaluate the validity of the internal structure of the scale. The results identified two components: problem-solving and decision-making with an explained variance of 65.9%. For internal consistency, three different techniques were used and applied to the two components. All of the items have very good internal consistency (problem-solving Cronbach's alpha=0.931 and decision-making Cronbach's alpha=0.951). CONCLUSIONS: The validation of the Portuguese scale agreed well with the existing literature. The scale can be divided into two components: the problem-solving component and the decision-making component. The translated scale demonstrated good internal consistency and can therefore be used in future studies.