Patient-centered care encompasses the physician's response to the preferences of patients regarding treatment (1). Several studies have reported that patients generally prefer to be informed and involved in the decision-making (2, 3), and several medical specialties have evaluated patient preferences for participation in decision-making in their treatment management (4-9).

In the perioperative period, anesthesiologists have multiple options with regard to the choice of anesthetic method, monitoring and use of drugs to achieve the desired outcome. The choice of anesthesia depends on the patients' underlying disease, laboratory findings, general condition, surgery type and duration. Some patients have factors that could influence the choice of anesthesia, but some have no factors. Recently, anesthesiologists have made an effort to involve the patients or their families in the decision-making process regarding the anesthesia options, however there is a lack of data about the effect of patient involvement in the decision-making for the anesthetic method used for surgery.

The purpose of this prospective study was to evaluate the patients' decision-making preferences for selecting the anesthetic method, patient satisfaction regarding their involvement in the decision-making, and the preferred anesthetic methods of the patients. Additionally, we evaluated the change in the patients' decision-making preference after experiencing this decision-making process.

Of the 257 total patients, 179 (69.6%) preferred to play a collaborative role, 47 (18.3%) preferred an active role, and 31 (12.1%) preferred a passive role in the decision-making process in selecting their anesthetic method. Table 1 summarizes the demographic data of the subjects, the preferred decision-making role in selecting an anesthetic method, and the associations with age, sex, education level and past anesthetic history. These variables differed significantly with age. In contrast to patients aged 20-50 yr of age, those between 50 and 60 yr of age showed a tendency to prefer an active or passive role rather than a collaborative role. Other variables showed no significant differences.

Table 2 shows the degree of patient satisfaction, the feeling of being respected in the decision-making process. Although 31 (12.1%) patients chose a passive role, they were asked questions about satisfaction and feeling respected, also. Table 3 shows the preferred anesthetic methods of the patients who choose a collaborative role and an active role. Because 31 patients (18 upper extremity, 13 lower extremity patients) who chose a passive role were excluded, 226 patients was the total number of patients of this result. Table 4 shows the difference between the patients' preferred decision-making role for the current use of anesthesia and the changed preference for a role in selecting anesthesia in the future.

The pioneer of patient-centered care, Dr. Harvey Picker, stated that understanding and respecting patients' values, preferences, and expressed needs are the foundation of patient-centered care (12, 13). Patient-centered care customizes the treatment recommendations on the basis of informed shared decision-making, development of patient knowledge, enhancement of skills needed for self-management of illness and preventive behaviors (10). The traditional clinician-centered and disease-focused approaches to illness are believed to be less effective than patient-centered, biopsychosocial approaches, especially for patients with chronic disease (14).

To date, several studies of patient-centered care in the treatment of oncological diseases have been performed. In one study, only 44% of breast cancer patients preferred to select their treatment collaboratively, and 34% preferred to delegate the decision-making responsibility to their physicians (15). Davisons et al. (16) and Rotenbacher et al. (17) described high preferences for a passive role in decision-making in patients with cancer. In contrast, this study demonstrated that the majority of patients preferred a collaborative role (69.6%) to a passive role (12.1%) in the decision-making process for selecting an anesthetic method. Furthermore, 18.3% of patients preferred an active role. Although it is difficult to compare our results with those in previous studies that included cancer patients, these differences in decision-making roles might be influenced by the fact that we surveyed healthy patients, and their choices were not likely to affect their lives.

Over the last decade, preoperative anxiety has been studied as an important issue for patients scheduled for surgery. In non life-threatening procedures, anesthesia (62%) is the main source of preoperative anxiety in patients, rather than surgery (15%) (18). Preoperative anxiety and fear in patients can complicate the management of anesthesia and the postoperative period, which can be attributed mostly to the lack of information about anesthesia (19). A study evaluated patients' satisfaction about a preanesthetic interview by anesthesiology resident, and reported that 39% of patients were very satisfied and 50% of them were satisfied with the interview, even though the duration of the interview was relatively short (20). In the present study, our patients received detailed information about two anesthetic methods, had discussions with an anesthesiologist and were involved in the decision-making regarding the anesthetic method selected. Our patients were very satisfied (58%) and satisfied (35.4%), and felt very respected (70%) and respected (27.7%) after involvement in the decision-making process. Interestingly, a higher percentage of active role patients were very satisfied (78.7%) and felt very respected (76.6%) than collaborate or passive role patients. Furthermore, the patients expressed a change in preference for assuming an active role (49.4%) and a collaborative role (43.6%) in the decision-making process for their future anesthesia needs. These results suggest that an increase of an active role for their future anesthesia needs may mean an increase of very satisfied and felt very respected patients.

Most procedures on extremities can be performed using regional anesthesia with light sedation (21). However, Shevde and Panagopoulos (22) reported that 69% of patients expressed a preference for general anesthesia over regional anesthesia. Another study reported that 49.3% of all respondents expressed a preference for general anesthesia over regional anesthesia (23). Our study showed that 64.3% of patients requiring surgery on an upper extremity expressed a preference for general anesthesia over a brachial plexus block, and 51.3% of patients requiring surgery on a lower extremity preferred general anesthesia over spinal anesthesia. These results regarding general anesthesia preferences might reflect the patients' concern about pain at the puncture site and the fear of needles because many of them showed the fear during a discussion with the anesthesiologist, especially, when choosing between general anesthesia and the brachial plexus block. Moreover, our results underline the fact that there might be a difference in preference for anesthetic methods between healthy patients and anesthesiologists. Thus, to improve patient-centered care, anesthesiologists should understand and be aware of this difference when informing and discussing the options for anesthesia with patients.

In conclusion, almost all patients who were informed of their choices for anesthesia and involved in the decision-making process were satisfied and felt respected; the majority of patients preferred a collaborative role. Furthermore, a greater number of patients expressed a preference for assuming an active role in the decision-making process for future anesthesia needs. This study provides important information for anesthesiologists and other physicians regarding patient-centered care in a department of anesthesiology.