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Preferences of Older and Younger Adults With Serious Mental Illness for Involvement in Decision-Making in Medical and Psychiatric Settings

From the Dartmouth Psychiatric Research Center Lebanon, Lebanon, NH (ELO, GJM, ADV, RED, SJB); and Dartmouth College Hanover, Hanover, NH (JRA).

Objectives: There is a growing call for greater consumer participation in health care encounters. Prior research suggests that older age is associated with a greater preference for a more passive role in clinical decision-making, yet little is known about preferences for persons with mental illness. This pilot study compared preferences for involvement in decision-making between older and younger adults with serious mental illness.

Design: Cross-sectional observational survey.

Participants: The authors surveyed 33 older adults (50 years) and 32 younger adults (<50 years) with serious mental illness from two mental health center clinics and one residential facility for their preferences on decision-making with their psychiatrists and primary care providers.

Measurements: Measures included the Control Preferences Scale, the Autonomy Preference Index, and the Decision Self-Efficacy Scale.

Results: Contrary to our primary hypothesis, older adults reported a stronger desire for involvement in decision-making compared with younger adults. However, both age groups were similar in their desire for information to aid in decision-making. The majority in both age groups also preferred a collaborative role with a psychiatrist for medication decisions, an autonomous role for decisions related to psychosocial interventions, and a passive role with their primary care provider. Older and younger adults expressed similar decision self-efficacy.

Conclusion: Our study suggests that older persons with serious mental illness have a stronger desire for involvement in decision-making than younger consumers. Additionally, role preference for involvement in decision-making varies across different clinical decisions and for psychopharmacological versus psychosocial interventions.

Key Words: Treatment planning • preferences • decision-making • informed patient choice • shared decision making