医患最优化决策特征组合对患者参与共享决策的影响

doi:10.3724/SP.J.1041.2026.2082

摘要/Abstract

摘要： 共享决策本质上是权力从医生向患者动态转移的过程, 其实现程度取决于医患特征组合对转移过程的具体影响。本研究基于权力转移视角和自我决定理论, 采用内容分析、追踪调查与即时模拟三种方法, 通过3项系列研究探讨了医患最优化决策特征组合对患者共享决策参与意愿的影响及可能的心理路径。研究发现, 医患最优化决策特征组合通过患者心理需求总体满足显著影响其共享决策参与意愿。具体而言, 面对满意型医生时, 最优化患者比满意型患者心理需求总体满足更高, 因而表现出更强的共享决策参与意愿; 面对最优化医生时, 两类患者的心理需求总体满足水平及共享决策参与意愿均显著降低。研究结果不仅从医患权力转移的角度增进了对共享决策的理解, 也为临床实践中推进共享决策的实施提供了改进策略。

关键词: 医患共享决策, 最优化决策特征组合, 权力转移, 自我决定理论

Abstract: Shared decision-making (SDM) is inherently a dynamic process of power transitioning from doctors to patients, and the degree to which this process is realized depends on how the combined characteristics of doctors and patients shape the transition. Nevertheless, few studies have systematically examined how doctor-patient characteristic combinations influence patients' willingness to engage in SDM from a power transition perspective. To address this gap, this study integrates the power transition perspective, maximization research, and self-determination theory to systematically investigate the effect of doctor-patient maximization combinations on patients' willingness to engage in SDM and the mediating role of overall satisfaction of patients' psychological needs in this process.
Employing content analysis of audio-recorded consultations, Study 1 explored whether doctor-patient maximization combinations influence patients' willingness to engage in SDM, combining patients' self-reported willingness with coded SDM behavioral data. With the support of the department head, one maximizing and one satisficing doctor were identified as target doctors. First-visit patients were randomly recruited from their clinics. After each consultation, patients completed a questionnaire assessing their maximizing tendencies, willingness to engage in SDM, and control variables. All consultations were audio-recorded, and the recordings were independently coded by trained research assistants on five behavioral indicators. Results confirm a significant interaction effect between doctor and patient maximizing tendencies on patients' willingness to engage in SDM. Specifically, when interacting with a satisficing doctor, maximizing patients exhibit stronger willingness to engage in SDM than satisficing patients. In contrast, a maximizing doctor significantly reduces engagement willingness among both maximizing and satisficing patients (supporting H1).
Using a multi-wave design with real-world, randomly matched doctor-patient dyads, Study 2 examined whether the overall satisfaction of patients' psychological needs mediates the relationship between doctor-patient maximization combinations and patients' willingness to engage in SDM. To reduce common method bias, data were collected from dyads at four separate time points. Before the consultation (T1), waiting patients reported their maximizing tendencies (independent variable) and demographic information. After the consultation (T2), these patients assessed their overall satisfaction of psychological needs (mediating variable) and immediate willingness to engage in SDM (dependent variable), along with control measures. Following the clinic session on the same day (T3), the attending doctors reported their own maximizing tendency and control variables. Two weeks after the consultation (T4), patients' delayed willingness to engage in SDM was measured through the hospital's routine telephone follow-up system. Replicating prior findings, this study further reveals that the overall satisfaction of patients' psychological needs mediates the relationship between doctor-patient maximization combinations and patients' willingness to engage in SDM —both immediately and two weeks later (supporting H2 and H3).
Using a hidden profile task in a SDM context, Study 3 used a 2 (doctor maximization: maximizing vs. satisficing) × 2 (patient maximization: maximizing vs. satisficing) between-subjects design to establish causal inferences for our theoretical model. Doctors and patients were first randomly assigned to either a maximizing or satisficing condition and subsequently paired to form four dyad types. Each dyad then completed a hidden profile task in a SDM context, after which we recorded behavioral data (final decisions and total preset messages exchanged). Finally, patients reported their willingness to engage in SDM, the overall satisfaction of psychological needs, and demographics. The results further validate the research hypotheses (supporting H1, H2 and H3), lending support to its causal inferences. By incorporating a hidden profile task into the SDM context, this research partially simulated the doctor-patient information exchange and SDM process, and objectively assessed SDM effectiveness based on both parties' decision outcomes.
Collectively, this study reveals that doctor-patient maximization combinations significantly influence patients' willingness to engage in SDM through the overall satisfaction of patients' psychological needs, thus providing valuable theoretical insights. First, it extends the theoretical perspective on SDM by systematically investigating the effect of doctor-patient maximization combinations. Second, by integrating maximizing theory with SDM research, it establishes an interdisciplinary bridge between behavioral decision science and clinical communication. Finally, it not only extends self-determination theory beyond its conventional boundaries but also develops a need-satisfaction-based theoretical model of SDM.

Key words: doctor-patient shared decision-making, maximization combinations, power transition, self-determination theory

中图分类号:

B849: C91

朱冬青, 秦璐瑶, 李纯鑫, 梁竹苑. (2026). 医患最优化决策特征组合对患者参与共享决策的影响. 心理学报, 58(10), 2082-2102.

ZHU Dongqing, QIN Luyao, LI Chunxin, LIANG Zhuyuan. (2026). The effect of doctor-patient maximization combinations on patient engagement in shared decision-making. Acta Psychologica Sinica, 58(10), 2082-2102.

参考文献

[1] Ahearne M., Mathieu J., & Rapp A. (2005). To empower or not to empower your sales force? An empirical examination of the influence of leadership empowerment behavior on customer satisfaction and performance.Journal of Applied Psychology, 90(5), 945-955.
[2] Alimohamad H., Yilmaz D., Hamming G. F., & Schepers A. (2020). Identifying factors influencing decision making in patients diagnosed with carotid body tumors: An exploratory study. Annals of Vascular Surgery, 68, 159-165.
[3] Anderson C., Hildreth J. A. D., & Howland L. (2015). Is the desire for status a fundamental human motive? A review of the empirical literature. Psychological Bulletin, 141(3), 574-601.
[4] Barry, M. J., & Edgman-Levitan, S. (2012). Shared decision making-pinnacle of patient-centered care.The New England Journal of Medicine, 366(9), 780-781.
[5] Becker, T. E. (2005). Potential problems in the statistical control of variables in organizational research: A qualitative analysis with recommendations.Organizational Research Methods, 8(3), 274-289.
[6] Bian W., Wan J., Tan M., Wu X., Su J., & Wang L. (2019). Patient experience of treatment decision making for wet age-related macular degeneration disease: A qualitative study in China.BMJ Open, 9(9), e031020.
[7] Charles C., Gafni A., & Whelan T. (1997). Shared decision- making in the medical encounter: What does it mean? (or it takes at least two to tango).Social Science & Medicine, 44(5), 681-692.
[8] Charles C., Gafni A., & Whelan T. (1999). Decision-making in the physician-patient encounter: Revisiting the shared treatment decision-making model.Social Science & Medicine, 49(5), 651-661.
[9] Cheek, N. N., & Schwartz, B. (2016). On the meaning and measurement of maximization. Judgment and Decision Making, 11(2), 126-146.
[10] Chen C., Liu, Y X., & Zhao C. (2020). The unidimensional basic psychological need satisfactions from the additive, synergistic and balanced perspectives.Advances in Psychological Science, 28(12), 2076-2090.
[陈晨, 刘玉新, 赵晨. (2020). 独立、协同和平衡视角下的单维式基本心理需要满足.心理科学进展, 28(12), 2076-2090.]
[11] Chen Y., Yang Y., & Lu J. (2023). The maximizing penalty: Maximizers are perceived as less warm and receive less social support.Social Psychological and Personality Science, 14, 825-834.
[12] Datu, J. A. D. (2016). The synergistic interplay between positive emotions and maximization enhances meaning in life: A study in a collectivist context.Current Psychology, 35, 459-466.
[13] Deci, E. L., & Ryan, R. M. (2000). The “what” and “why” of goal pursuits: Human needs and the self-determination of behavior.Psychological Inquiry, 11(4), 227-268.
[14] Deng X., Long S. Y., Shen Y. L., Zhao H. H., & He W. (2023). Influence and mechanisms of common ingroup identity on competitive victimhood in doctor-patient relationships.Acta Psychologica Sinica, 55(5), 752-765.
[邓洵, 龙思邑, 沈依琳, 赵欢欢, 贺雯. (2023). 共同内群体认同对医患竞争受害感的影响及其机制.心理学报, 55(5), 752-765.]
[15] Dorrough A. R., Leszczyńska M., Werner S., Schaeffer L., Galley A. S., Akin E., ... Simandi F. (2022). Equal Performance, different grade: Women's performance in discussion perceived worse than men's.Personality & Social Psychology Bulletin, 48(2), 222-238.
[16] Ellis, R. P., & McGuire, T. G. (1986). Provider behavior under prospective reimbursement: Cost sharing and supply.Journal of Health Economics, 5(2), 129-151.
[17] Elwyn G., Frosch D., Thomson R., Joseph-Williams N., Lloyd A., Kinnersley P., ... Barry M. (2012). Shared decision making: A model for clinical practice.Journal of General Internal Medicine, 27(10), 1361-1367.
[18] Epstein R. M., & Street R. L., Jr. (2011). The values and value of patient-centered care.Annals of Family Medicine, 9(2), 100-103.
[19] Fitzgerald I., Howe J., Maidment I., Wallace E., Zisman- Ilani Y., Højlund M., ... Sahm L. J. (2025). From idealist to realist—designing and implementing shared decision- making interventions in the choice of antipsychotic prescription in people living with psychosis (SHAPE): A realist review (Part 2—Designing SDM Interventions: Optimizing design and local implementation).Schizophrenia Bulletin, 51(4), 932-948.
[20] Gagné, M., & Deci, E. L. (2005). Self-determination theory and work motivation. Journal of Organizational Behavior, 26(4), 331-362.
[21] Gilal F. G., Zhang J., Paul J., & Gilal N. G. (2019). The role of self-determination theory in marketing science: An integrative review and agenda for research.European Management Journal, 37(1), 29-44.
[22] Goldfarb M. J., Saylor M. A., Bozkurt B., Code J., Di Palo K. E., Durante A., ... Gulati M. (2024). Patient-centered adult cardiovascular care: A scientific statement from the American Heart Association.Circulation, 149(20), e1176-e1188.
[23] Guo, G. X., & Cheng, B. (2021). Effects of customer empowering behaviors on employees' career growth: Perspective of self-determination theory.Acta Psychologica Sinica, 53(2), 215-228.
[郭功星, 程豹. (2021). 顾客授权行为对员工职业成长的影响: 自我决定理论视角.心理学报, 53(2), 215-228.]
[24] Hulbaek M., Petersen S. R., & Ibsen C. (2025). Psychometric properties of the Danish SDM-Q-9 questionnaire for shared decision-making in patients with pelvic floor disorders and low back pain: Item response theory modelling.BMC Medical Informatics and Decision Making, 25, 194.
[25] Iyengar, S. S., & Lepper, M. (2000). When choice is demotivating: Can one desire too much of a good thing?Journal of Personality and Social Psychology, 79(6), 995-1006.
[26] Iyengar S. S., Wells R. E., & Schwartz B. (2006). Doing better but feeling worse: Looking for the “best” job undermines satisfaction.Psychological Science, 17(2), 143-150.
[27] Jordan A., Joseph-Williams N., Edwards A., Holland-Hart D., & Wood F. (2019). “I'd like to have more of a say because it's my body”: Adolescents' perceptions around barriers and facilitators to shared decision-making.Journal of Adolescent Health, 65(5), 633-642.
[28] Joseph-Williams N., Elwyn G., & Edwards A. (2014). Knowledge is not power for patients: A systematic review and thematic synthesis of patient-reported barriers and facilitators to shared decision making.Patient Education & Counseling, 94(3), 291-309.
[29] Kim, Y. (2024). Exploring the Interplay of Psychological Need Satisfaction, Well-Being, and Behavioral Intentions in Tourism: A Self-Determination Theory Perspective.Journal of Travel Research, 65(1), 222-241.
[30] Kokkoris, M. D. (2020). Choice as a meaning-making device for maximizers: Evidence from reactance to restrictions of choice freedom during lockdown.Frontiers in Psychology, 11, 571462.
[31] Köther A. K., Büdenbender B., Grüne B., Holbach S., Huber J., von Landenberg N., ... Alpers G. W. (2022). Different patients, different preferences: A multicenter assessment of patients' personality traits and anxiety in shared decision making.Cancer Medicine, 11(15), 2999-3008.
[32] Kristof-Brown A. L., Zimmerman R. D., & Johnson E. C. (2005). Consequences of individual's fit at work: A meta- analysis of person-job, person-organization, person-group, and person-supervisor fit.Personnel Psychology, 58(2), 281-342.
[33] La Guardia J. G., Ryan R. M., Couchman C. E., & Deci E. L. (2000). Within-person variation in security of attachment: A self-determination theory perspective on attachment, need fulfillment, and well-being.Journal of Personality and Social Psychology, 79(3), 367-384.
[34] Lai, L. (2010). Maximizing without difficulty: A modified maximizing scale and its correlates.Judgment and Decision Making, 5(3), 164-175.
[35] Légaré F., Ratté S., Gravel K., & Graham I. D. (2008). Barriers and facilitators to implementing shared decision- making in clinical practice: Update of a systematic review of health professionals' perceptions.Patient Education and Counseling, 73(3), 526-535.
[36] Luan M., Fu L., & Li H. (2018). Do maximizers maximize for others? Self-other decision-making differences in maximizing and satisficing.Personality and Individual Differences, 121, 52-56.
[37] Luan M., Sun J., & Li H. (2023). Do maximizing consumers engage more in conspicuous consumption?Journal of Consumer Behavior, 22(5), 1146-1157.
[38] Luan, M., & Wu, S. (2022). How does decision making process signal social status? A maximizing decision making perspective.Advances in Psychological Science, 30(10), 2194-2205.
[栾墨, 吴霜. (2022). 消费决策过程如何彰显社会地位? 基于最优化决策策略的视角.心理科学进展, 30(10), 2194-2205.]
[39] Ma, J., & Roese, N. (2014). The maximizing mindset.Journal of Consumer Research, 41(1), 71-92.
[40] Ma, L. L. (2004). Cancer patients' participation in treatment and nursing decision-making: Status and influencing factors [Unpublished master's thesis]. Peking Union Medical College, Beijing.
[马丽莉. (2004). 癌症病人参与治疗护理决策现状及影响因素的研究 (硕士学位论文). 中国协和医科大学, 北京.]
[41] Mack D. P., Greenhawt M., Bukstein D. A., Golden D. B. K., Settipane R. A., & Davis R. S. (2024). Decisions with patients, not for patients: Shared decision-making in allergy and immunology.The Journal of Allergy and Clinical Immunology. In Practice, 12(10), 2625-2633.
[42] Mahapatra, S., & Mishra, A. (2022). ‘Crying over spilt milk?' Effect of post-consumption dissonance on coping behaviour for online purchases.International Journal of Consumer Studies, 46(3), 1035-1054.
[43] Makwero M., Muula A. S., Anyanwu F. C., & Igumbor J. (2022). An insight into patients' perspectives on barriers affecting participation in shared decision making among patients with diabetes mellitus in Malawi.BMC Primary Care, 23(1), 42.
[44] Mancin P., Malerba A., Doron G., Ghisi M., & Cerea S. (2024). “Can I have more than this?” The role of romantic relationship quality, maximization style, and social media addiction in relationship obsessive compulsive disorder symptoms.Cyberpsychology, Behavior, and Social Networking, 27(2), 119-126.
[45] Mao, W. (2016). When one desires too much of a good thing: The compromise effect under maximizing tendencies.Journal of Consumer Psychology, 26(1), 66-80.
[46] Maples N. J., Velligan D. I., Jones E. C., Espinosa E. M., Morgan R. O., & Valerio-Shewmaker M. A. (2022). Perspectives of patients and providers in using shared decision making in psychiatry. Community Mental Health Journal, 58(3), 578-588.
[47] Morris S. M., Gunter K. E., Jia J. L., & Baig A. A. (2025). Factors influencing shared decision-making between healthcare providers and lesbian, gay, bisexual, transgender, and queer people of color about intimate partner violence.Journal of Interpersonal Violence, 40(1-2), 489-509.
[48] Mühlbacher, A. C., & Juhnke, C. (2013). Patient preferences versus physicians' judgement: Does it make a difference in healthcare decision making?Applied Health Economics and Health Policy, 11(3), 163-180.
[49] Müller-Engelmann M., Keller H., Donner-Banzhoff N., & Krones T. (2011). Shared decision making in medicine: The influence of situational treatment factors.Patient Education and Counseling, 82(2), 240-246.
[50] Mulley A. G., Trimble C., & Elwyn G. (2012). Stop the silent misdiagnosis: Patients' preferences matter.BMJ, 345, e6572.
[51] Newman D. B., Schug J., Yuki M., Yamada J., & Nezlek J. B. (2017). The negative consequences of maximizing in friendship selection.Journal of Personality and Social Psychology, 114(5), 804-824.
[52] Niemiec, C. P., & Ryan, R. M. (2009). Autonomy, competence, and relatedness in the classroom: Applying self-determination theory to educational practice.Theory and Research in Education, 7(2), 133-144.
[53] Ousseine Y. M., Durand M. A., Bouhnik A. D., Smith A. B., & Mancini J. (2019). Multiple health literacy dimensions are associated with physicians' efforts to achieve shared decision-making.Patient Education and Counseling, 102(11), 1949-1956.
[54] Podsakoff P. M., MacKenzie S. B., Lee J. Y., & Podsakoff N. P. (2003). Common method biases in behavioral research: A critical review of the literature and recommended remedies.The Journal of Applied Psychology, 88(5), 879-903.
[55] Polman, E. (2012). Effects of self-other decision making on regulatory focus and choice overload.Journal of Personality and Social Psychology, 102(5), 980-993.
[56] Putrevu, S., & Ratchford, B. T. (1997). A model of search behavior with an application to grocery shopping.Journal of Retailing, 73(4), 463-486.
[57] Reyes K. R., Wong P., Petrofsky M., Dai A., Pelayo A., Brondfield S., & Kwon D. H. (2024). Shared decision- making needs, barriers, and facilitators of patients with newly diagnosed advanced cancer in the hospital: A multi- level, mixed-methods study.Supportive Care in Cancer, 32(5), 315.
[58] Ryan R. M.,& Deci, E. L. (2017). Self-determination theory: Basic psychological needs in motivation, development and wellness. New York: Guilford Press.
[59] Ryan, R. M., & Deci, E. L. (2000). Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being.The American Psychologist, 55(1), 68-78.
[60] Scherer L. D., Shaffer V. A., Caverly T., DeWitt J., & Zikmund-Fisher B. J. (2020). Medical Maximizing- Minimizing Predicts Patient Preferences for High- and Low-Benefit Care.Medical Decision Making, 40(1), 72-80.
[61] Schulz-Hardt S., Brodbeck F. C., Mojzisch A., Kerschreiter R., & Frey D. (2006). Group decision making in hidden profile situations: Dissent as a facilitator for decision quality.Journal of Personality and Social Psychology, 91(6), 1080-1093.
[62] Schwartz B., Ward A., Monterosso J., Lyubomirsky S., White K., & Lehman D. R. (2002). Maximizing versus satisficing: Happiness is a matter of choice.Journal of Personality and Social Psychology, 83(5), 1178-1197.
[63] Simon, H. A. (1955). A behavioral model of rational choice.Quarterly Journal of Economics, 69, 99-118.
[64] Simon, H. A. (1956). Rational choice and the structure of the environment.Psychological Review, 63(2), 129-138.
[65] Simon, H. A. (1957). Models of man, social and rational: Mathematical essays on rational human behavior in a social setting. New York: Wiley.
[66] Simpkin, A. L., & Schwartzstein, R. M. (2016). Tolerating uncertainty - The next medical revolution?The New England Journal of Medicine, 375(18), 1713-1715.
[67] Sinnott C., Mc Hugh S., Boyce M. B., & Bradley C. P. (2015). What to give the patient who has everything? A qualitative study of prescribing for multimorbidity in primary care.The British Journal of General Practice, 65(632), e184-e191.
[68] Song, Q., & Chen, Y. (2021). The impact of the fit between needed and received empowering leadership on followers' job-related outcomes: The mediating role of emotional exhaustion.Acta Psychologica Sinica, 53(8), 890-903.
[宋琪, 陈扬. (2021). 需求和接受的授权型领导匹配对下属工作结果的影响: 情绪耗竭的中介作用.心理学报, 53(8), 890-903.]
[69] Stacey D., Légaré F., Lewis K., Barry M. J., Bennett C. L., Eden K. B., ... Trevena L. (2017). Decision aids for people facing health treatment or screening decisions. The Cochrane Database of Systematic Reviews, 4(4), CD001431.
[70] Tetlock P. E., Kristel O. V., Elson S. B., Green M. C., & Lerner J. S. (2000). The psychology of the unthinkable: Taboo trade-offs, forbidden base rates, and heretical counterfactuals.Journal of Personality and Social Psychology, 78(5), 853-870.
[71] Tian, Y. P., & Lu, C. Z. (2024). Reflection on clinician's practice of shared decision-making. Medicine & Philosophy, 45(10), 16-19.
[田云朋, 卢成志. (2024). 临床医生实践医患共同决策的思考.医学与哲学, 45(10), 16-19.]
[72] Trope, Y., & Liberman, N. (2010). Construal-level theory of psychological distance.Psychological Review, 117(2), 440-463.
[73] van Beek-Peeters, J. J. A. M., van Noort, E. H. M., Faes, M C., de Vos, A. J. B. M., van Geldorp, M. W. A., Minkman M. M. N., & van der Meer, N. J. M. (2020). Shared decision making in older patients with symptomatic severe aortic stenosis: A systematic review. Heart, 106(9), 647-655.
[74] van Eick M. D., Binnendijk M., van Laarhoven H. W., Smets E. M., Timmermans D. R., van Berge Henegouwen, M. I., ... Damman O. C. (2025). Less shared decision-making in consultations with lower health literate cancer patients: An observational mixed-methods study.Health Literacy and Communication Open, 3(1), 2515081.
[75] Veatch, R. M. (1972). Models for Ethical Medicine in a Revolutionary Age.The Hastings Center Report, 2(3), 5-7.
[76] Vermeir I., Van Kenhove P., & Hendrickx H. (2002). The influence of need for closure on consumer's choice behaviour.Journal of Economic Psychology, 23(6), 703-727.
[77] Von Neumann, J., & Morgenstern, O. (1944). Theory of games and economic behavior. Princeton University Press..
[78] Weaver K., Daniloski K., Schwarz N., & Cottone K. (2015). The role of social comparison for maximizers and satisficers: Wanting the best or wanting to be the best?Journal of Consumer Psychology, 25(3), 372-388.
[79] Webster, D. M., & Kruglanski, A. W. (1994). Individual differences in need for cognitive closure.Journal of Personality and Social Psychology, 67(6), 1049-1062.
[80] Xu Z. H., Zhu D. Q., & Yan X. M. (2026). Why are maximizing patients more vigilant toward doctors? The mediation role of moral disengagement.Acta Psychologica Sinica, 58(1), 57-73.
[徐梓豪, 朱冬青, 闫小敏. (2026). 为何最优化患者对医生更警惕? 道德推脱的中介作用.心理学报, 58(1), 57-73.]
[81] Yang L. N., Zheng H. Y., Wang B. B., & Yang Y. (2022). The influencing factors of doctor-patient shared decision making: A qualitative study.Chinese Medical Ethics, 35(7), 755-763.
[杨林宁, 郑红颖, 王贝贝, 杨艳. (2022). 医患共享决策影响因素的质性研究. 中国医学伦理学, 35(7), 755-763.]
[82] Yang Y., Yao M., Yang Y., Ye Q., & Lin T. (2021). Reliability and validity of the Chinese nine-item basic psychological need satisfaction scale based on self-determination theory with older adults.Frontiers in Psychology, 12, 751631.
[83] Yuan X. E., Zhao R. W., & Zhu D. Q. (2023). Effect of doctors' and patients' individual characteristics on shared decision-making and its psychological mechanism: A perspective from implicit prototype theory.Advances in Psychological Science, 31(6), 1044-1054.
[袁香儿, 赵睿雯, 朱冬青. (2023). 医患个体特征影响共享决策的心理路径: 基于内隐原型视角.心理科学进展, 31(6), 1044-1054.]
[84] Zhu D., Li X., Yang S., & Xie X. F. (2019). More accurate or less accurate: How does maximization orientation affect task completion predictions?Personality and Individual Differences, 137, 173-183.