Patient Autonomy in Practice - A Privilege or a Burden?

BACKGROUND: Patient-centered approach contributes to overall quality of healthcare, can reduce healthcare utilization by targeted treatments, and may increase patient-provider trust. Beyond attention to patient's needs and characteristics, granting them with autonomy in the decisions-making process is required. However, it is important to recognize not all patients are capable nor desire to translate autonomy into action. METHODS: A survey among a representative sample of 462 adults in Israel (50% response rate), examined the ability and willingness of individuals to be involved in decisions related to their own care. The questionnaire included items concerning trust in providers, perceived ability, and degree of desired autonomy (decisional and executive). RESULTS: While 341 (74%) estimated their abilities as medium or high, only 171 participants (37%) express they will to make the decisions (following doctor's opinion, or even against recommendations). A mediation process model demonstrated that high capabilities indirectly effects trust in providers through two mediators - decisional and executive autonomy [F(8,402) = 2.82, R2 = .06, p=.0047]. High perceived capabilities associate participants with higher desired autonomy to take the decision by themselves, and the latter associates with higher tendency to execute willingness to actions (e.g., non-adhere to treatment recommendations). Finally, higher tendency to perform executive autonomy results in lower trust in providers. The indirect effect is significant (-.006, .003, [-.0118-0010]). CONCLUSIONS: we present an innovative model correlating autonomy, trust and willing to act by patients facing health decisions. Providers should be aware that the desire to be autonomous does not always merge with the ability or willing to take actions. Personalized approach based on the autonomous profile of each patient could lead to more efficient utilization of medical resources. KEY MESSAGES: • Autonomy may not align with desires and abilities of some patients. • Autonomy preferences affect adherence, trust and potentially also healthcare utilization, emphasizing the need for personalized care.