Family involvement in medical decision making in Europe and the United States is independent from cultural stereotypes

Published on April 7, 2022 – The desired degree of family involvement in medical decisions is an individual preference that is largely independent from cultural stereotypes. This is concluded in a recent replication study in four European countries (Netherlands, Austria, Belgium, Germany) and the United States published in Social Science & Medicine.

The study is a direct replication and extension from a previous study of Alden et al. (2018) in Australia, China, Malaysia, India, South Korea, Thailand and the United States. In Europe and North America, medical decisions are often made through a process of shared decision making between patients and their health care provider. Medical decision making includes the choice of tests, therapies, or support based on clinical evidence and considers the patient’s informed preferences, options, possible outcomes as well as uncertainties, and may involve information sharing with other family members. Family involvement matters because it can contribute to how satisfied patients are with the decision. However, most research on medical decision making mainly focused on the patient-provider relationship. The previous study of Alden et al. (2018) showed that patient desires for shared decision making operate largely independent of national culture, but are influenced by individual preferences for family involvement and individual-level interdependence, that is, the subjective relevance attributed to relationships with others.

The present study replicated the original primary finding that those with higher self-involvement in medical decision making preferred less family involvement. Furthermore, patients with lower self-independence, higher relational interdependence, and stronger beliefs in social hierarchy are more likely to want their families involved in medical decisions next to their health care provider. These findings suggest that overcoming cultural-stereotypes and assessing preferences for family involvement individually during the treatment process represent important steps forward. The study underlines the importance of screening for individual-level, psychological variables such as relational interdependence, self-independence, and desire for self-involvement. Inclusion of information on the level of desired family involvement in medical decision making as part of the clinical consultation may enhance provider recognition of important individual differences resulting in higher patient satisfaction and better treatment outcomes compared to continued reliance on cultural stereotypes of patients’ desired level of family involvement in medical decision making.

The study was conducted by Sebastian Scherr (Texas A&M University, USA), Doreen Reifegerste (University of Bielefeld, Germany), Florian Arendt (University of Vienna, Austria), Dana Alden (University of Hawaii, USA) and ACHC member Julia van Weert.

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