Does it matter whether physicians' recommendations are given early or late in the decision-making process? An experimental study among patients with schizophrenia.

Objectives: Physicians' recommendations are seen as an essential component in many models of medical decision-making, including shared decision-making. It is, however, unclear at what time in the decision-making process the recommendation is best given, not to adversely influence patient preferences. Within the present study we wanted to evaluate at what time in the decision-making process a doctor's recommendation is best given, not to adversely influence patient preferences. Design: We performed an experimental study involving hypothetical decisions vignettes and compared the influence of 3 conditions (no advice, early advice, late advice) on patients' decision-making. Setting: N=21 psychiatric hospitals in Germany. Participants: N=208 inpatients suffering from schizophrenia. Primary and secondary outcome measures: The main outcome was the number of patients choosing the option in each experimental condition that had been less preferable to most patients during pretests. Additional outcome measures were patient satisfaction and reactance. Results: Patients in the 'late advice' condition more often (n=49) accepted an advice that was against their preferences compared with the other conditions (n=36 for 'early advice', p=0.024). Conclusions: Although giving advice is an important part of every doctor's daily practice and is seen as an essential element of shared decision-making, hitherto there has been little empirical evidence relating to the influence of physicians' advice on patients' decision-making behaviour. With our study we could show that the point in time an advice is given by a physician does have an influence on patients' decisional behaviour even if the mechanism of this effect is not yet understood.