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Do people intend to have an active role in medical decision-making? The role of social resources.

Brabers, A., Jong, J. de, Groenewegen, P., Dijk, L. van. Do people intend to have an active role in medical decision-making? The role of social resources. European Journal of Public Health: 2015, 25(spl. 3) 254. Abstract: 8th European Public Health Conference: "Health in Europe - from global to local policies, methods and practices". 14-17 oktober 2015 in Milan.
Introduction
There is growing emphasis to include patients in medical decision-making (MDM). Still, not all patients are actively involved in MDM. It depends upon circumstances whether they are actively involved. Until now, research mainly focused on the influence of characteristics of the patient and the diagnosis on patients’ preferences for active involvement. However, in examining this, a patient’s social context also has to be taken into account as social norms, as well as social resources, affect individual behavior. We examined the influence of social resources - in the form of informational and emotional support - on the intention to have an active role in MDM.

Methods
In 2013, a survey was sent to members of the Dutch Health Care Consumer Panel (response 70%; n = 1,300). Questions were aimed at measuring the intention to have an active role in MDM, informational and emotional support. Patient characteristics (age, gender, educational level) were taken into account too. A regression model was constructed to explain the influence of informational and emotional support on the intention to have an active role in MDM.

Results
People who have more informational support from their social network are more likely to intend to have an active role in MDM. For low educated people emotional support positively influences their intention to have an active role in MDM. People with a middle and high level of education are more likely to intend to have an active role in MDM, no matter what level of emotional support. Finally, the older people are the less likely they intend to have an active role in MDM.

Conclusions
This study shows that social context influences the intention to have an active role in MDM. To enhance patient participation in MDM, it is recommended to examine how people without support from their social network can be supported. The provision of information (e.g. by a decision aid) or the use of volunteers who can give emotional support might have a role in this.

Key messages
Informational support (for all people) and emotional support (only for low educated people) positively influence the intention to have an active role in medical decisionmaking.
To enhance patient participation in medical decisionmaking, it is recommended to examine how people without support from their social network can be supported.
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