Intended for healthcare professionals

Rapid response to:

General Practice

Do patients wish to be involved in decision making in the consultation? A cross sectional survey with video vignettes

BMJ 2000; 321 doi: https://doi.org/10.1136/bmj.321.7265.867 (Published 07 October 2000) Cite this as: BMJ 2000;321:867

Rapid Response:

Preferences on participation in decision making in NICU.

Dear Editor,

We read with interest the findings by McKinstry on patients’
preferences for participation in decision making in general practice
consultations for different medical problems (1).

Our group has been evaluating different ways of promoting family
centred care (2) and fostering partnership (3) with parents of sick babies
in the intensive care situation. An important but difficult role for the
neonatal team is to tailor information provision and decision making to
the individual preferences of parents in Neonatal Intensive Care. It is
always a challenge to both ensure accessibility to people with limited
literacy and to inform adequately those who desired detailed information
and involvement. At the beginning of the neonatal journey it is important
and useful to know the parents' preferences. As part of a project on
improving parental experiences in NICU we have been seeking the views of
parents of NICU babies regarding information and involvement in decision
making (2). Thus far 104 parents of babies newly admitted to our NICU
have completed a questionnaire and the percentages endorsing each response
option are:

A The doctor should make the decisions using all that's known
about the treatments (26%).

B The doctor should make the decisions but strongly consider my
needs and priorities (43%).

C The doctor and I should make the decisions together on an equal
basis (26%).

D I should make the decisions, but strongly consider the doctor's
opinion (4.8%).

E I should make the decisions using all I know or learn about the
treatments (0%).

Interestingly, these percentages tend towards greater doctor
responsibility than those reported in adult medicine settings. For
example, more cancer patients prefer to make the decisions themselves (5).

It takes the parents 2 minutes to fill in this one- side A4
questionnaire. This is clearly a worthwhile addition to clinical practice.
These "decision" profiles may change at different stages of the baby's
stay. It is possible that there may be differences between father and
mother. The impact of such interventions deserves further study.

Yours sincerely,

THHG Koh FRCPCH FRACP
Senior Staff Specialist in Neonatal
Paediatrics

Budge D RN
Neonatal Research Nurse

Collie L RN
Neonatal Research Nurse

Kirwan Hospital
Townsville,
Great Barrier Reef, QLD 4817 AUSTRALIA

guan_koh@health.qld.gov.au

Assoc Prof P Butow PhD MPH,

Executive Director,
Medical Psychology Unit, University of Sydney NSW 2006
AUSTRALIA

phyllisb@med.usyd.edu.au

This is part of the T.A.P.E. project, funded by The Royal Children's
Hospital Foundation, Brisbane.

1) Brian McKinstry.Do patients wish to be involved in decision making
in the consultation? A cross sectional survey with video vignettes. BMJ
2000;321:867-871 ( 7 October )

2)Harrison H. The principles of family-centered neonatal care.
Pediatrics 1993;92: 643-650.

3) Richards T. Partnership with patients. BMJ 1998; 316: 85-8

4) Koh THHG, Casey A Budge D, Collie L, Bolisetty S, Whitehall J,
Dunn S, Patole S, Tattersall M, Butow P. Parental preferences for
information and role in decision making in NICU. Proceedings of the
Perinatal Society of Australia and New Zealand 7th Annual Congress,
Brisbane March 2000.

5) Butow PN, Maclean M, Dunn SM, Tattersall MHN, Boyer MJ. (1997)
The dynamics of change: cancer patients’ preferences for information,
involvement and support. Annals of Oncology, 8, 857-863.

Competing interests: No competing interests

16 October 2000
T H H G Koh
Senior staff specialist in neonatal paediatrics
D Budge, L Collie, P Butow
NICU, Kirwan Hospital, Townsville, Great Barrier Reef, QLD 4817, AUSTRALIA