NCPA - National Center for Policy Analysis

Empowering Patients: Preference-Based Care

September 28, 2001

Preference-based care is transforming the patient-clinician relationship. In a traditional "management model," physicians make treatment decisions, while in the preference-based paradigm, patients choose the treatments that best conform to their values.

The preference model fulfills a fundamental tenet of high-quality care -- that the patient should be involved in the decision process. It also respects patient preferences. Patients place a value on potential outcomes (favorable and adverse) for each treatment alternative. These valuations constitute patient preferences. Patients then choose the options they prefer. For instance:

  • Men may decline prostate surgery due to fear of erectile dysfunction.
  • Patients who drink may decline medications that preclude alcohol.
  • Some patients may prefer that physicians make critical judgments -- which also constitutes a preference of sorts.

However, experts warn there might be some disadvantages. The preference model is rooted in sound principles of decision-making, but it does not translate seamlessly across sex, ethnic and racial lines. It is possible that preference-based care may reinforce inequities and disparities in health care. Misinformation, bias and resignation may underlie patient preferences.

A remedy is for clinicians to determine whether patients' fundamental assumptions about the risks and benefits of medical interventions are accurate. If not, misinformation should be corrected.

While the physician may play an active role, patients' preferences ultimately drive decisions in the preference-based model. Patients appear to be more satisfied with preference-based care.

Source: Jeffrey N. Katz, "Patient Preferences and Health Disparities," Commentary, Journal of the American Medical Association, September 26, 2001.


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