Identifying Factors Associated With Involvement in Healthcare Decisions in Wales
Author(s)
Nichola Thuvesholmen, PhD1, Sarah Puntoni, BA2, Sally Cox, PgDip1, Kathleen Withers, MSc3, Jasmine Rollings, PhD3, Katherine Woolley, PhD3, Christian Newman, MSc2, Alexander Shaw, MBChB1.
1DHCW, Cardiff, United Kingdom, 2NHS Wales Performance and Improvement, Cardiff, United Kingdom, 3CEDAR, Cardiff, United Kingdom.
1DHCW, Cardiff, United Kingdom, 2NHS Wales Performance and Improvement, Cardiff, United Kingdom, 3CEDAR, Cardiff, United Kingdom.
OBJECTIVES: Historically, healthcare systems have operated within a clinician-centred framework, where physicians directed treatment with limited patient input. In recent decades, a shift toward patient-centred care has placed individuals' needs, values, and experiences at the forefront. This transformation is associated with improved outcomes and satisfaction. However, little is known about how involved patients feel in decisions about their healthcare. The Welsh Population Health Survey offers a unique opportunity to explore this. This survey collected patient-reported outcomes and experiences, including involvement in decision-making. This allows for assessment of how well healthcare systems deliver shared decision-making and to identify associated individual, relational, and systemic factors. We aimed to examine which patient characteristics are most strongly associated with perceived involvement in healthcare decisions.
METHODS: We applied feature selection (Boruta), followed by a decision tree to identify variables most predictive of perceived involvement in decision making. These were entered into a generalized linear model alongside known confounders (N=10,915).
RESULTS: Those who are not as involved as they want in decisions about their care are more likely to report feeling less like a whole person and more like just a disease/condition in relation to their care, felt less likely to receive useful, timely health information, felt less confident in managing their own health and rated their medical care less favourably. Socially, they also reported finding it harder to get help from friends, neighbours and co-workers when needed.
CONCLUSIONS: Perceived involvement in care decisions is shaped by personal, relational, and systemic factors. This helps build a picture of patient groups who could benefit from intervention to improve their healthcare experiences and provides potentially modifiable variables that could guide efforts to promote more inclusive, empowering healthcare experiences in Wales.
METHODS: We applied feature selection (Boruta), followed by a decision tree to identify variables most predictive of perceived involvement in decision making. These were entered into a generalized linear model alongside known confounders (N=10,915).
RESULTS: Those who are not as involved as they want in decisions about their care are more likely to report feeling less like a whole person and more like just a disease/condition in relation to their care, felt less likely to receive useful, timely health information, felt less confident in managing their own health and rated their medical care less favourably. Socially, they also reported finding it harder to get help from friends, neighbours and co-workers when needed.
CONCLUSIONS: Perceived involvement in care decisions is shaped by personal, relational, and systemic factors. This helps build a picture of patient groups who could benefit from intervention to improve their healthcare experiences and provides potentially modifiable variables that could guide efforts to promote more inclusive, empowering healthcare experiences in Wales.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
PCR125
Topic
Epidemiology & Public Health, Patient-Centered Research
Topic Subcategory
Patient Engagement, Patient-reported Outcomes & Quality of Life Outcomes
Disease
No Additional Disease & Conditions/Specialized Treatment Areas