• Amy L McGuire, Laurence B McCullough, Susan C Weller, and Simon N Whitney.
• Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas 77098, USA.
• Med Care. 2005 May 1;43(5):466-70.

ObjectivePhysicians are encouraged to actively involve patients in clinical decision-making, but this expectation has not been adequately examined from the physicians' perspective. Our objective was to identify and characterize physicians' attitudes toward patient participation in decision-making and to gain insight into how they consequently think about and structure the decision-making process.DesignThis was a qualitative cross-sectional study of physicians' reported attitudes and practices.SettingThe study took place in private practice and academic physicians' practices.ParticipantsA total of 53 academic and private practice physicians from primary care and surgical specialties, ranging from first year residents to recently retired, participated in the study.MeasurementsWe performed a qualitative analysis of semistructured individual interviews.ResultsThe physicians in this study expressed consistently positive attitudes toward patient participation in medical decision-making. They identified patient autonomy as an essential justification for patient participation but often went beyond an autonomy-based rationale. Several were motivated by the fundamental principle of beneficence as well as their own self-interest in avoiding legal liability. Many physicians saw their role as an expert who educates the patient but retains control over the decision-making process; others took a more collaborative approach, encouraging patients to assume decisional priority. The decision-making process often was modified by patient, physician, and environmental factors.ConclusionsThe physicians in this study demonstrated a positive, flexible approach toward including patients in decision-making. A one-dimensional model of shared decision-making based solely on the principle of autonomy fails to account for variability in how physicians allocate decisional priority and is therefore ethically inadequate.

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