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7.2.2 Factors that May Influence Patient Decision-Making
Based on an extensive review of literature, Siani and Assaraf ( 2016 ) noted several
types of factors that may influence a patient’s decision-making about genetic testing
and genetic counseling. These include genetic knowledge (e.g., of the condition),
attitudes and perceptions (e.g., of the relevance of the services to one’s self/family),
religion and ethnicity (e.g., level of one’s religiosity), personal factors (e.g., patient
needs and expectations), practical issues (e.g., cost, access), socioeconomic status,
privacy concerns, and emotional factors (e.g., fear of stigma). We discuss several
factors in greater detail in this section. Each of these factors may either facilitate or
hinder decision-making.
Patient Decision-Making Styles
A number of individual and cultural differences play a role in patients’ decision-
making. Scott and Bruce ( 1995 ) developed and validated an instrument that assesses
five different types of decision-making styles:
- Rational: characterized by a thorough search for and logical evaluation of
alternatives - Intuitive: characterized by reliance on hunches and feelings
- Dependent: characterized by a search for advice and direction from others
- Avoidant: characterized by attempts to evade decision-making
- Spontaneous: characterized by a sense of immediacy and desire to get through
the decision-making process as soon as possible.
The author’s note that “decision-making styles are not mutually exclusive” and
“individuals use a combination of decision-making styles in making important deci-
sions” (p. 829).
Internal and External Factors
- Medical constraints: limits regarding information about the disorder, availability
of medical options, patient health, and actual or perceived failure rates of tests
and procedures (Pivetti and Melotti 2013), availability of diagnosis (Frets et al.
1992 ), and availability of relevant predictive genetic test(s) (Manuel and Brunger
2014 ). - Financial constraints: limited financial means, uncertainty about future financial
status, and insurance coverage (Pivetti and Melotti 2013). - Psychosocial impact: patient concerns about the emotional and psychological
implications of a positive test result (Pivetti and Melotti 2013).
7 Providing Information and Facilitating Patient Decision-Making