PERSONAL USE ONLY Unobserved heterogeneity in trauma patients’ desire for autonomy in medical decision making in an emergency department Bruno Neuner 1 ABCDEF, Claudia Spies 1 ADEG, Peter Miller 2 DE, Edith Weiss-Gerlach 1 ABE, Tim Neumann 1 ABEG, Helge Schoenfeld 1 D, Dorothea Eisenmann 1 BF, Andrea Maulhardt 1 BF, Elmar Braehler 3 DE, Peter Schlattmann 4 CDE 1 Department of Anesthesiology and Intensive Care Medicine, Charité-Universitaetsmedizin Berlin, Campus Virchow-Klinikum and Campus Charité Mitte, Berlin, Germany 2 Center for Drug and Alcohol Programs, Medical University of South Carolina, Charleston, SC, U.S.A. 3 Independent Department of Medical Psychology and Medical Sociology, University Leipzig, Leipzig, Germany 4 Institute of Biometry and Clinical Epidemiology, Charité-Universitaetsmedizin Berlin, Campus Charité Mitte, Berlin, Germany Source of support: This study was sponsored by the German Ministry of Health (BMG 217-43794-5/5) Summary Background: To evaluate unobserved heterogeneity in trauma patients’ desire for autonomy in medical decision making (DAD). Material/Methods: This cross-sectional study at an inner-city emergency department screened 1009 patients for DAD (using the Decision Making Preference Scale of the Autonomy Preference Index), education lev- el, and substance use. To investigate unobserved heterogeneity, a covariate adjusted finite mixture model was established. Model fit was evaluated with the Bayesian Information Criterion. Results: The median age of participants was 32 years (range, 18–84 years) and 62% were male. Unobserved heterogeneity explained more variance in DAD than did sex, age, or substance use, but less vari- ance than level of education. The best overall model fit was found with 3 latent subpopulations: 53.3% of patients with low DAD, 35.6% of patients with medium DAD, and 11.1% of patients with high DAD. Female sex and level of education showed a positive association; higher age and sub- stance use showed a negative association with patients’ DAD. Conclusions: Apart from a negative association with substance use and the known associations with sex and lev- el of education, trauma patients’ DAD showed substantial variability between individuals, and this variability could not be explained by these factors. key words: substance use • patient’s desire for autonomy • medical decision making • emergency department Full-text PDF: http://www.medscimonit.com/fulltxt.php?ICID=863665 Word count: 2714 Tables: 2 Figures: 1 References: 31 Author’s address: Bruno Neuner MD MSE, Charité – Universitaetsmedizin Berlin, Department of Anesthesiology and Intensive Care Medicine, Campus Virchow-Klinikum and Campus Charité Mitte, Charitéplatz 1, 10117 Berlin, Germany, e-mail: bruno.neuner@charite.de Authors’ Contribution: A Study Design B Data Collection C Statistical Analysis D Data Interpretation E Manuscript Preparation F Literature Search G Funds Collection Received: 2007.08.02 Accepted: 2008.01.29 Published: 2008.07.01 CR366 Clinical Research WWW. MEDS CI MONIT.COM © Med Sci Monit, 2008; 14(7): CR366-371 PMID: 18591918 Current Contents/Clinical Medicine • IF(2007)=1.607 • Index Medicus/MEDLINE • EMBASE/Excerpta Medica • Chemical Abstracts • Index Copernicus Electronic PDF security powered by ISL-science.com opy is for personal use only - distribution prohibited. This copy is for personal use only - distribution prohibited. This copy is for personal use only - distribution prohibited. This copy is for personal use only - distribution prohibited. This copy is for personal use only - distribu