Received: 22 October 2021 | Accepted: 18 June 2022

DOI: 10.1111/nuf.12775

ORIGINAL ARTICLE

Decision‐making styles of patients and general population

in health care: A scoping review

Hitomi Danya RN, MSN | Kazuhiro Nakayama PhD

Department of Nursing Informatics, Graduate

School of Nursing Science, St. Luke's
International University, Chuo‐ku,
Tokyo, Japan
Correspondence
Hitomi Danya, RN, MSN, Department of
Nursing Informatics, Graduate School of
Nursing Science, St. Luke's International
University, 10‐1 Akashi‐cho, Chuo‐ku,
Tokyo 104‐0044, Japan.
Email: danya.hitomi.suzuki@gmail.com
Abstract
Objective: Decision‐making styles form the backbone of effective decision‐making
and show promise as an important construct that warrants further attention. We
investigated what is known about decision‐making styles among patients and the
general population in a health care setting.
Methods: We used Arksey and O'Malley's framework and searched PubMed and
CINAHL databases using relevant combinations of keywords and subject headings.
Articles were limited to those published in English up to February 2020.

Funding information
Japan Society for the Promotion of Science,
Grant/Award Number: 20H03967
Results: Sixteen articles met the inclusion criteria. We found that decision‐making
styles were described as role preferences or personality, psychological, and cognitive
factors that influence decision‐making. In the identified studies, the evidence was
scarce regarding decision‐making styles as the foundation for effective decision‐
making. Moreover, most studies were vague in the description of decision‐making
styles, offered little explanation of the concept, and varied substantially in the
terminology, numbers, and types of decision‐making styles and measurement
methods.
Conclusions: Decision‐making styles, as a dynamic process, have received little
attention in health care and are rarely addressed in health communication research
or investigations of decision‐making support. Other frameworks that are not directly
related to decision‐making styles were used in most analyzed studies.
Practice Implications: Decision‐making styles in health care should be reinterpreted
as a dynamic process that can be developed or changed.

KEYWORDS
cognitive styles, decision‐making process, decision‐making styles, scoping review

1 | INTRODUCTION evaluation of alternatives, and the intuitive style is characterized by

Generally, there are variations in the way that people make decisions.
Some individuals engage in lengthy deliberation whereas others rely on
intuition or emotion. Such individual differences related to decision‐
making are referred to as decision‐making styles and reflect the typical
way people make decisions.1–3 Five main decision‐making styles have
1
been reported: rational, intuitive, dependent, avoidant, and spontaneous.
For example, the rational style is characterized by a search for and logical
attention to detail and a tendency to rely on feelings. According to
previous studies, decision‐making styles show better prediction of self‐
rated decision quality above and beyond personality traits.4 To illustrate,
some studies have identified that people who engage in rational decision‐
making make better decisions and feel greater satisfaction than people
who use a more intuitive approach.4,5 Such decision‐making styles
encompasses one's personality, which is highly correlated to needs,
values, and self‐concept,6,7 and is related to ability, engagement, and

1012 | © 2022 Wiley Periodicals LLC. wileyonlinelibrary.com/journal/nuf Nurs Forum. 2022;57:1012–1025.


DANYA AND NAKAYAMA
thinking style in decision‐making.8 Therefore, decision‐making styles can
be considered to form the backbone of effective decision‐making.6–8
However, owing to individuals' complexity, most people do not have one
decision‐making style that is always best for them and are therefore
flexible in that they modify their style to suit a specific situation.1,6–9 In
other words, decision‐making styles are situational.
The decision‐making style is an essential consideration in
supporting patients' decision‐making in health care settings. How-
ever, to the best of our knowledge, no studies have examined
patients' decision‐making styles in the context of decision‐making
support and health communication in the health care setting.
Moreover, there have been no comprehensive reviews of how
decision‐making styles are characterized and their impact, and what is
known about decision‐making styles remains unclear. Therefore, we
focused on the context of decision‐making support and communica-
tion in the health care setting, using a scoping review framework.10
We also focused on patients and the general population as potential
targets in nursing so as to capture a broad range of findings. The
following three research questions were addressed: (RQ1) How are
decision‐making styles in patients and in the general population
explored in the literature? (RQ2) What are the functions or features
of various decision‐making styles? (RQ3) What theoretical issues
exist in relation to the evidence regarding decision‐making styles?
There has been increasing interest in the process by which patients
and healthcare professionals cooperatively make decisions about tests or
treatments, based on clinical evidence and the patient's values or
11,12
preferences, that is, shared decision‐making (SDM). This process is
based on a foundation of clinical communication processes and is
described using the term collaborative deliberation.13 In SDM, healthcare
professionals and patients must discuss all options and compare the pros
and cons of each option together to help the patient clearly understand
what is of importance.12 This communication process applies the
principles of health communication, that is, the study and use of
communication strategies to inform and influence individual decisions
that enhance health.14 A communication strategy is needed to support
deliberation, that is, a rational decision‐making process, and to make the
information easy to understand. Therefore, clarifying patient's decision‐
making styles can provide insight into their approach to decision‐making
and communicates information that supports effective decision‐making.
In particular, nurses have an important role in integrating patients'
medical, social, and life experiences through dialogue and knowledge
sharing.15,16 Consequently, nurses can support patient participation and
17
can provide care according to the patient's preferences. The findings of
the present study can provide an opportunity for nurses to recognize
patients' decision‐making styles and the factors that influence them, and
can serve as a resource in considering ways to create an environment that
is conducive to better SDM.
1.1 | Decision‐making styles
The concept of decision‐making styles is different to that of role
preferences, which is defined as “the degree of control an individual
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| 1013
wants to assume when decisions are being made about medical
treatment,”18,p.21 or patient‐centeredness, which is preference toward
patient‐centered communication.19 In the cognitive field, decision‐making
style is defined as “the learned, habitual response pattern exhibited by an
individual when confronted with a decision situation.”1,p.820 Decision‐
making styles are also different from cognitive styles or psychological
types, which do not change with the situation.1,9,20,21
Current debate focuses on the positioning of the concept, with views
ranging from decision‐making styles being interchangeable with cognitive
styles22 to decision‐making styles being a subset of cognitive styles,23
cognitive styles being a subset of decision‐making styles,9 or decision‐
making styles being personality traits.24,25 Kahneman26 and Epstein27
suggested that decision‐making styles were not continuous traits but
rather cognitive systems. From these varying perspectives, the number of
constructs ranges from 1 to 7, depending on the study, and there is
overlapping content8 as well as a lack of organization, and therefore the
lack of a comprehensive conceptual framework.8,28
There is also a lack of consensus among researchers as to
whether decision‐making styles are stable over time or whether they
can be altered. However, in recent discussions, it has been proposed
and is increasingly recognized that decision‐making styles involve a
multidimensional “dynamic” component that changes over a person's
lifetime.1,8,29,30 This proposal is based on the assumption that most
people adopt the style that best fits their environmental and
contextual circumstances,8 which include the available decision‐
making time, degree of pressure in the decision‐making environ-
ment,3 and proficiency in decision‐making,31 as well as the
individual's personal circumstances when making a particular deci-
sion. Therefore, people can choose to change their style or learn
other forms of behavior, and can develop another style.32
On the basis of these multifaceted considerations, decision‐
making style refers to how individuals use the decision‐making skills
that they have acquired over the course of their lifetime and can be
viewed from two perspectives: a dynamic concept that involves
cultivated learning,18,29,30,32 and a dynamic concept that changes in
response to changes in the environment.3,8,31
2 | METHODS
In this study, we followed the process described by Arksey and
O'Malley10: (1) identifying the research question; (2) identifying
relevant previous studies; (3) selecting studies for inclusion;
(4) mapping data; and (5) collating and summarizing the findings.
The Preferred Reporting Items for Systematic Reviews and
Meta‐Analyses reporting guideline for scoping reviews (PRISMA ScR)
was used to verify the completeness of the review.33
2.1 | Data sources
We searched the PubMed and CINAHL databases for articles using
the terms “decision‐making style” or “decision style” in the

1014 | DANYA
publication title. Articles were limited to those published in
English‐language journals up to February 2020, when the search
was undertaken. Limiting the search to these two databases was
necessitated by constraints of time and cost. Additionally, by not
including “health care” in the search terms, we identified a wide
range of published articles on decision‐making styles in different
fields. However, this process was not included in this study and
also not included in the flowchart.
2.2 | Study selection
The inclusion criteria were broadly defined to enable us to capture all
potentially relevant studies. Study selection was based on the
following inclusion criteria: (1) studies on decision‐making support
and health communication in health care, (2) studies conducted
among patients or in the general population, and (3) studies written in
English. Papers eligible for review included original articles and
review articles. Unpublished dissertations, conference abstracts, and
data‐driven papers were excluded.
A selection flowchart (Figure 1) was created based on the
PRISMA ScR.33 Following the removal of duplicates, 78 potentially
relevant articles remained. These articles were further screened for
relevance to decision‐making styles in health communication. This
step was necessary, because during the initial screening, we found
that a large number of articles discussed decision‐making styles but
did not specifically mention patients or the general population, and
thus did not meet our inclusion criteria. The full texts of the
remaining 18 articles were then evaluated for eligibility by two
reviewers.
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AND NAKAYAMA
Fifteen articles met the inclusion criteria and one more study was
added following a manual search. No additional research studies,
reviews, or meta‐analyses were identified in the reference lists of the
selected articles. Therefore, 16 articles were finally included in
the review. The data were then extracted using a form developed by
the reviewers to capture the aims, study design, location, sample,
measures used to determine decision‐making styles, and major
findings in the included articles.
3 | RESULTS
Table 1 presents details of the 16 articles that met the selection
criteria. All articles were published between 2001 and 2019, with
seven originating in the United States and two in Australia. One study
targeted three countries: the United Kingdom, United States, and
New Zealand. Another cross‐sectional survey was based in the
United States and Japan. These two studies also investigated cultural
differences. The remaining articles originated in a variety of
countries. Among the 16 studies, four used qualitative methods
and 12 used quantitative methods.
3.1 | Descriptions of decision‐making styles
Decision‐making styles were described in terms of five main
perspectives: preferences in a decision‐making role, psychological
factors, personality traits, decision‐making process, and decision
approach. These five perspectives were classified into two main ones:
(1) role preferences of the decision‐maker;34–36,39–45,50 in other
FIGURE 1 Scoping review process
 DANYA
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TABLE 1 Design, methods, and results of reviewed articles

Our assessment of how

NAKAYAMA

the study categorized

First author, Decision‐making style the decision‐making
year [ref. no.] Country Study method Sample Aims measurement Major findings styles

McVea, 200134 USA Qualitative 25 breast cancer To explore the process by Based on the women's (1) More than half of the women Role and process in
survivors. which low‐income women descriptions, these (n = 16) adopted a passive role in decision‐making.
make decisions about decision‐making styles decision‐making. Even when
early‐stage breast cancer were labeled offered a choice, many women did
treatment. “passive,” “avoidant,” not fully understand the options
“panicked,” and presented to them or were unable
“rational.” to rationally compare the options.
Many women were overwhelmed
and felt unable to process
information or to take responsibility
for decision‐making. Fear, intense
emotional reactions to their cancer
diagnosis and time pressure
contributed to womens' difficulties
in participating in determining their
plan of treatment. For these
women, decision‐making appeared
to have been so colored by their
affective response that it was
difficult to identify a reason for
their choice. (2) The women who
did engage in a rational decision‐
making process (n = 9) based their
choices on concerns about body
image and fear of recurrence.

Budden, Australia Quantitative 377 women who To identify womens' The MADS. Many women obtained higher scores Tendency or preference
200335 were seeking prediagnostic decision‐ on Deliberation, Deferring to be personally
routine making styles, decision Responsibility, and Information involved in the
mammography processes, and influencing Seeking, but lower scores on decision‐making.
screening at a sociodemographic Avoidance among the decision‐
breast clinic. variables relating to making style factors.
choosing early breast
cancer treatment.
|

(Continues)
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 TABLE 1 (Continued)
| 1016

Our assessment of how

the study categorized
First author, Decision‐making style the decision‐making
year [ref. no.] Country Study method Sample Aims measurement Major findings styles

Alden, 201136 Japan, USA Quantitative 363 university To investigate preferences Question to indicate their Japanese respondents evaluated Decision‐making role.
students in Japan for patient–physician own attitudes toward autonomous interactions most
and 345 decision‐making styles each of the three positively. US respondents
university among young adults in the decision‐making styles evaluated the SDM scenario most
students in the context of a primary care (passive, shared, and positively.
United States. clinic visit for an upper autonomous) on a
respiratory infection in seven‐point agree/
Japan and the United disagree scale.
States.

Black, 201137 USA Quantitative 1304 sexually active To test the moderating effects The Adolescent Decision Decision‐making self‐confidence and (1) Self‐confidence:
adolescents and of decision‐making style Making decision‐making approach confidence in one's
young adults. and gender on the Questionnaire. significantly moderated the effect ability to make a
relationship between of CUSE on condom use. The decision (e.g., I think
CUSE and condom‐use positive relationship between CUSE that I am a good
behavior among sexually and condom use was relatively decision‐maker);
active adolescents and stronger for males and females (2) approach: the
young adults. reporting high vs. low decision‐ degree to which one
making self‐confidence. Among approaches rather
females, the relationship between than avoids decision‐
CUSE and condom use at last making (e.g., I prefer
participation in sex was weaker for to leave decisions to
those reporting a high vs. low others); (3) general
decision‐making approach. Both of disposition and
these effects were observed at high relative stability.
levels of CUSE.

Shaghaghy, Iran Quantitative 81 addicted and 90 To compare decision‐making Decision‐making style (1) Addicts are less rational in decision‐ How a person responds
201138 nonaddicted styles and attributional questionnaire making. (2) There was a negative to a decision‐making
men. styles between addicted developed by Scott relationship between rational DMS situation or interpret
and nonaddicted men in an and Bruce1: this and internal attribution of positive the situation.
attempt to recognize their questionnaire events. (3) There was a negative
role in addiction. assesses four styles of relationship between rational DMS
decision‐making and stable attribution for positive
(rational, intuitive, events. (4) There was a direct
dependent, and relationship between leaned
avoidant). helplessness and rational DMS in
DANYA

addicted men (greater scores

AND

correspond to higher levels of learned

helplessness). So, addicts who are less
rational are more likely to develop
learned helplessness.
NAKAYAMA

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 TABLE 1 (Continued)
DANYA

Our assessment of how

AND

the study categorized

First author, Decision‐making style the decision‐making
year [ref. no.] Country Study method Sample Aims measurement Major findings styles

Mandelblatt, USA Quantitative 1174 women with To examine associations Item developed by (1) 30% of women preferred to make Decision‐making role.
NAKAYAMA

201239 invasive between patient and Llewellyn‐Thomas40 their chemotherapy decisions alone
nonmetastatic oncologist decision‐ (e.g., The doctor or primarily alone with some input
breast cancer. making styles and should make all the from the physician and 41% stated
chemotherapy use. decisions using all that they preferred equally SDM.
that's known about (2) Women who preferred less
the treatments: “The physician input had lower odds of
doctor and I should chemotherapy than women who
make the decisions preferred more input. (3) Patients
together on an equal whose oncologists had a high
basis”).61 chemotherapy preference had
higher odds of receiving
chemotherapy than those who saw
oncologists with a low preference
for chemotherapy.

Naik, 201241 USA Quantitative older multimorbid To characterize the One‐item measure of (1) Those with inadequate FHL were Preferred role when
patients. association between patients' preference more likely (p = .01) to prefer participating in
functional health literacy for decision‐making passive rather than active decision‐ decision‐making
and older, multimorbid developed by Deber42 making styles even after controlling (active vs. passive)
patients' preferences for for age, education, and numeracy.
involvement in decision‐ (2) 40% of patients preferring
making about complex passive styles had adequate FHL
drug regimens. To and these patients were
determine the affect of significantly more likely to change
FHL on patients' their preference to more active
willingness to switch from styles (odds ratio = 7.17, p < .01) if
a passive to active their physician “was more
decision‐making style if supportive or encouraged
their clinician supported participation.”
and encouraged
participatory decision‐
making.

Dieng, 201343 Australia Quantitative Public: 1279 women. To investigate Australian Control preferences (1) 53% of women preferred an active Decision‐making role.
women's cervical questionnaire. decision‐making approach (i.e., to
screening preferences, decide themselves or to decide
information needs, and after considering their GP's
decision‐making styles. opinion), 33% preferred sharing the
|

decision with their GP, and 13%

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 1018

(Continued)
|

TABLE 1

Our assessment of how

the study categorized
First author, Decision‐making style the decision‐making
year [ref. no.] Country Study method Sample Aims measurement Major findings styles

preferred to defer the decision to

their GP (passive decision‐making
approach). (2) The majority of
women wanted information on
screening risks (70%) and benefits
(77%); of these, 81 (85%) wanted
this information before screening.

Weber, 201344 USA Qualitative 44 breast cancer To identify patterns in how (1) Five decision‐making styles were Role and factors
survivors. the weighting of these identified during the open coding influencing decision‐
fundamental factors (e.g., phase of our analysis: (a) medical making.
information preferences, expert decision‐making style,
comprehension, patient (b) self‐efficacy decision‐making
and practitioner style, (c) relationship‐embedded
involvement in the decision‐making style, (d) inhibition
selection of a treatment) decision‐making style, and
shapes patient decision‐ (e) constellation‐of‐information
making styles. decision‐making style. (2) Two
continuous dimensions (i.e., low to
high information needs and self to
other focused) underlined the five
decision‐making styles.

Braun, 201445 USA Qualitative Patients: 44 male To describe the self‐reported (1) Patients described two main Role and factors
veterans with decision‐making styles decision‐making styles, deciding for influencing decision‐
serious illness experienced by seriously ill oneself and letting others decide, making.
(e.g., congestive patients, how these leading to five variants that we
heart failure, affected their end‐of‐life labeled Autonomists, Altruists,
cancer of the decision‐making, and to Authorizers, Absolute Trusters, and
lung, Stage III or generate hypotheses Avoiders. (2) Except for Avoiders,
IV, any metastatic about the relationship patients across all racial/ethnic
solid‐tumor between race and groups were equally represented in
cancer). ethnicity, and that the different preferred decision‐
experience. making variants. However, some
fluidity and overlap was observed
DANYA

among the different variants and

thus they should not be seen as
AND

“silos.”
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 TABLE 1 (Continued)
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Our assessment of how

AND

the study categorized

First author, Decision‐making style the decision‐making
year [ref. no.] Country Study method Sample Aims measurement Major findings styles

Kadmon, Israel Quantitative, Patients: 70 breast To address decision‐making The MADS No correlation was found between four Specific personality
NAKAYAMA

201646 descriptive cancer survivors styles among breast cancer Questionnaire. main decision‐making styles and traits.
considering survivors considering patient age or the extent of patient
breast breast reconstruction. decision‐making involvement
reconstruction. and age.

Dean, 201747 USA Qualitative Patients: 20 women To investigate how women (1) Two decision‐making styles (logical Particular decision‐
who (1) received make decisions regarding and emotional) emerged from making approaches.
positive BRCA family planning after conversations about family
genetic test testing positive for a BRCA planning. (2) Logical decision‐
results before the genetic mutation. makers prioritized decreasing their
completion of personal risk of HBOC, and thus
family planning, undergoing preventative surgeries
(2) were at least over having any (or more) children,
18 years old, whereas emotional decision‐makers
(3) had a prioritized having children by
committed extending their preventative
partner, and surgery timeline, thereby
(4) had a risking HBOC.
conversation
with a partner
about family
planning.

Ghanouni, UK Quantitative, Public: 275 (breast), To explore the extent to which Decision‐making style Higher rational decision‐making scores Psychological factors,
201748 descriptive 309 (cervical), screening behavior, measurement using were associated with reading more approach to or
and 556 (bowel) demographic 25 items designed by of the cervical and bowel screening engagement with
cancer screening characteristics, and DMS Scott and Bruce1: leaflets (OR: 1.13, p < .0005 and health information.
participants. were associated with rational, intuitive, OR: 1.11, p = .045, respectively).
reading information spontaneous, People with a rational decision‐
leaflets for the breast, avoidant, or making style read health screening
cervical, and bowel cancer dependent. leaflets more often and were more
screening programs in involved in seeking information.
England.

Phillips, 201749
New Quantitative, Public: 233 To investigate the relationship The MDMQ (1) Psychological distress was Psychological factors.
Zealand descriptive participants (114 between cannabis use and associated with lower decisional
men, 119 decision‐making styles. self‐esteem and higher levels of
women). procrastination and buck‐passing.
(2) There were gender differences
|

associated with cannabis use.

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 TABLE 1 (Continued)
| 1020

Our assessment of how

the study categorized
First author, Decision‐making style the decision‐making
year [ref. no.] Country Study method Sample Aims measurement Major findings styles

Female cannabis users reported

higher levels of hypervigilance,
whereas male cannabis users
reported lower levels of buck‐
passing.

FitzPatrick, UK, USA, Quantitative, Public: UK (n = 407), To investigate the decision‐ Original tool: researchers (1) Identified three key decision‐making Decision‐making role.
201950 and descriptive USA (n = 313), making styles of patients in developed items for styles that served as the basis for
New and New Zealand relation to online health the proposed patient unique and stable segments of
Zealand (n = 276): information and decision‐making styles patients with distinctive decision‐
Total (N = 996). interactions with associated with online making styles: the Collaborators
healthcare practitioners health information‐ (23.0%), the Autonomous‐
and to develop a typology seeking approaches Collaborators (38.7%), the
of patients based on (collaborative, Assertive‐Collaborators (11.1%),
similarities and differences autonomous, and and the Passives (27.2%). (2) Most
in those decision‐making assertive). patients (72.8%) showed significant
styles. collaboration in their decision‐
making with healthcare
professionals, and a substantial
number of patients adopted a
distinctly passive decision‐making
style (27.2%).

Turner, 201951 Italy Quantitative, Patients: 54 women To investigate the level of The GDMS scale. (1) For the entire sample, the frequency Cognitive style, the
descriptive with epilepsy. empowerment, decision‐ distribution of decision‐making individual's
making styles, and styles is equally allocated across all characteristic mode
perceived relationship five components. However, of perceiving and
with the clinician, of significant differences were found responding to
women of childbearing after taking into account age as a decision‐making
age, in relation to clinical covariate: younger women (aged tasks.
variables. 15–24 years) showed less
avoidance style than older women
(F = 4.22; p = .02).

Abbreviations: BRCA, breast cancer susceptibility; CUSE, condom‐use self efficacy; DMS, decision making styles; FHL, functional health literacy; GDMS, General Decision Making Style; GP, general physician;
HBOC, hereditary breast ovarian cancer; MADS, Michigan Assessment of Decision Style; MDMQ, Melbourne Decision Making Questionnaire; OR, odds ratio; SDM, shared decision‐making.
DANYA
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DANYA AND NAKAYAMA
words, how people want to be involved in decisions when they have
a choice to make; and (2) factors that influence the decision‐making
process or approach (e.g., personality, psychological, or cognitive
factors).37,38,46–49,51 However, most studies were vague in terms of
the description of decision‐making styles and offered little
explanation regarding the concept. Studies also varied substantially
in terms of terminology, numbers, and types of decision‐making
styles, as well as measurement methods. Therefore, some included
studies focused on decision‐making role preferences, whereas
others focused on personality, psychological, and cognitive factors
influencing decision‐making.
Three qualitative studies34,44,45 investigated how participants
make decisions in decision‐making tasks using narratives, so these
results included broad viewpoints. These studies not only showed
decision‐making styles to be role preferences but revealed
influencers of role preferences, such as personality, psychological,
and cognitive, and contextual factors. These studies also identified
novel decision‐making styles. Braun et al.45 interviewed patients
regarding end‐of‐life decision‐making and identified two main
decision‐making styles: deciding for oneself and letting others
decide, leading to five categories of decision‐maker denoted
autonomists, altruists, authorizers, absolute trusters, and avoiders.
34
McVea et al. interviewed people about their experiences in
selecting treatment options, in an effort to identify how women
make decisions regarding breast cancer treatment; on the basis of
the women's descriptions, these decision‐making styles were
labeled “passive,” “avoidant,” “panicked,” and “rational.” Weber
et al.44 conducted semistructured interviews with cancer survivors
and gained insight into the various factors that influenced their
treatment decisions. For example, women following a “self‐efficacy
decision‐making style” wanted to make their own decisions, but also
wanted access to various information sources so that they were
fully informed when making decisions. These women took pride in
their ability to weigh the information they received from various
sources, including the Internet, books, journal articles, clinical trials,
and doctors. The functions or features of the various decision‐
making styles are addressed in the following section.
3.2 | Functions and features of various decision‐
making styles
We classified the five main perspectives in Section 3.1 into two
classes as follows: (1) role preferences of the decision‐maker and
(2) factors that influence the decision‐making process or approach,
from similarities of view. We then extracted the functions and
features of each decision‐making style from these two perspectives.
For functions, we extracted the functions of each decision‐making
style, namely how to engage in or approach various decision‐making
tasks. For features, we extracted what factors influence each
decision‐making style described in each study, such as personal
factors and contextual factors.
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| 1021
3.2.1 | Preferred decision‐making role
The preferred decision‐making role influences the degree of
communication with health care providers, information‐seeking
behavior, and level of engagement with the information that is
found. For example, people with lower functional health literacy tend
to play more passive roles and are more likely to depend on
others.39–43,50 Role preferences also vary with educational history
and numeracy.41 One study34 found that more than half of low‐
income women making decisions about their breast cancer treatment
had a passive role in their decision‐making, with choices determined
by medical factors and alternatives not offered by their physicians.
The findings of that study suggested the possibility that differences in
patients' income levels altered the doctor–patient power dynamic in
relation to control over decision‐making, as well as the possibility that
low‐income women were less prepared or able to engage in a rational
deliberative process.34
Conversely, a cross‐sectional survey50 identified four decision‐
making styles in patients as follows: (1) collaborators; (2) autonomous
collaborators; (3) assertive collaborators; and (4) passive patients.
That study also found that most patients (72.8%) showed collabora-
tion in their decision‐making with healthcare professionals, among
collaborators (23.0%), autonomous collaborators (38.7%), and asser-
tive collaborators (11.1%). However, a significant number of patients
(27.2%) adopted a distinctly passive decision‐making style.50 The
possibility was raised that although these patients had hoped to
participate in the decision‐making process, their healthcare profes-
sionals may not have provided them with sufficient support in doing
so. Another cross‐sectional survey found that Japanese respondents
evaluated autonomous interactions most positively, whereas respon-
dents in the United States evaluated SDM most positively.36
Therefore, despite significant cultural differences, individuals in many
countries favor higher levels of participation in the decision‐making
process.
3.2.2 | Personality, psychological, and cognitive
factors influencing decision‐making
Decision‐making styles have been shown to vary by age51 and
gender,49 but the findings are inconsistent.45,46 Decision‐making
styles are also associated with contextual factors such as psychologi-
cal stress,49 time pressure,34 and anxiety and fear surrounding
illness,34 and even people who adopt rational decision‐making styles
can be affected by these factors. Therefore, people will tend to either
make decisions based on their emotions or experiences, or postpone
decisions, even when they exhibit a rational decision‐making style.
Generally, people with rational or deliberative decision‐making
styles prefer to obtain information from various sources and compare
this information. These people have been shown to have greater
informational needs, greater levels of involvement, and to engage in
more active information‐seeking behavior.35,44,48 These individuals

1022 | DANYA
also strive to calmly understand the information obtained34 and to
make decisions after thoughtfully balancing the potential risks and
benefits of the various options.47 Furthermore, their locus of control
is stable38 and there is a high degree of autonomy involved in making
decisions for oneself.38,44 Conversely, people who tend to make
decisions impulsively based on their emotions and experiences are
easily influenced by various external factors such as bias. These
individuals tend to be vague about the reasons for their decisions34
and blame external factors, such as other people, for the conse-
quences of their decisions.38 Additionally, people with an emotional
decision‐making style often do not display traditional decision‐
making behavior in which various options are compared but rather
focus on negative outcomes, including pain, regret, fear, or death.44
As shown in Table 1, a variety of measurement tools were used in
the selected studies, including the Michigan Assessment of Decision
Style, Melbourne Decision Making Questionnaire, Adolescent
Decision Making Questionnaire, and the General Decision Making
Style (GDMS). Studies that used the GDMS described four or five
decision‐making styles. However, in each study, the reason for
choosing this measurement tool was not clearly described, so the
theoretical interpretation of decision‐making styles was weak.
3.3 | Theoretical issues regarding the evidence on
decision‐making styles
Evidence and discussions on decision‐making styles in the context of
decision‐making support and health communication are scarce. The
decision‐making styles that the authors of each study sought to
identify were poorly conceptualized, and there was a lack of
consistency regarding the type and number of decision‐making styles
and their measurement.
Concretely, among studies focusing on the role of personality,
psychological, or cognitive factors in the decision‐making process, no
articles included the theoretical framework. For frameworks that
were described in an article, a concept that is not directly related to
decision‐making styles, namely “decision‐making role preferences,”
was used and described as a decision‐making style.
4 | DISC US SION
4.1 | The concept of decision‐making styles
The concept of decision‐making styles continues to be discussed
from various perspectives, but it is increasingly recognized that this
concept indicates differences in how people perceive and process
information based on individual characteristics.
In the context of decision‐making support and health communi-
cation, however, decision‐making styles seem to be related to
decision‐making role preferences. Moreover, from another perspec-
tive, decision‐making styles seem to be based primarily on
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AND NAKAYAMA
personality, psychological, and cognitive factors that influence
information gathering and involvement in making decisions, with
insufficient attention paid to their dynamic nature. Specifically, the
possibility that decision‐making styles may change in response to
negative environmental and contextual factors34,49 but that positive
factors also influence changes in decision‐making styles has not been
adequately addressed. Additionally, research regarding making
decisions in a particular context using a particular decision‐making
style has not considered habit‐based skills. Therefore, the view that
decision‐making styles can be developed or changed appears to be
lacking. Thus, findings from other fields have not been integrated
with health care decision support research.
4.2 | Relationship between decision‐making styles
and role preferences, health literacy, and health
Viewing decision‐making role preferences as “states” influenced by
various variables, such as context, may be a common concept that is
interrelated with dynamic decision‐making styles. Conceptually, role
preferences may be partly explainable by decision‐making styles,
which may be antecedent to role preference. When we view
decision‐making role preference as a “state” that changes with
individual literacy, context, and familiarity with a health care decision‐
making task, this role preference shares commonalities with dynamic
decision‐making styles that change with habits, learning, and
environment, and may be an interrelated concept. Thus, changing
decision‐making styles may also change role preferences.
Decision‐making style is similar to the concept of health literacy,
which is also based on two conceptual models, one viewing health
literacy in terms of clinical risk and the other viewing it as a personal
asset.52 The conceptualization of health literacy as an asset has its
roots in educational research into literacy, concepts of adult learning,
and health promotion and is focused on the development of skills and
capacities intended to enable people to exert greater control over
their health and the factors that shape health. This suggests that
health literacy can change, that is, it is not static but rather dynamic.
From this point of view, the features of decision‐making styles are
also similar to those of health literacy as an asset, something that is
dynamically formed through an individual's interactions with their
surrounding environment. However, decision‐making styles are
formed in a broader context than health literacy and could be seen
as an antecedent to health literacy and a health‐related locus of
control, which involves the use of various resources to control one's
behavior and environment. A decision‐making style is also similar to
Huber's definition of health as a dynamic process rather than a
temporary state, “the ability to adapt and to self‐manage in the face
of social, physical, and emotional problems.”53,p.1 Therefore, these
dimensions may be seen as necessary for the empowerment of
patients and the general population, that is, making decisions about
health care and enabling a sense of control have the potential to be
mutually enhancing.

DANYA AND NAKAYAMA
4.3 | Measurement tools of decision‐making styles
In this scoping review, various measures of decision‐making styles
were used, making it difficult to compare the results across
studies. It was also often unclear what the various measures of
decision‐making styles were attempting to capture. We believe
that there are several explanations for this. First, many decision‐
making style measures have been developed based on different
perspectives, given the lack of consensus regarding the concept of
decision‐making styles. Second, there was considerable variation
regarding terminology, numbers, and types of decision‐making
styles, as well as measurement methods among studies. The
measures used exhibit several shortcomings, including a lack of
2,54,55
evidence regarding construct validity and psychometric
weaknesses.1,31,56
4.4 | Strengths and limitations
This study has several strengths and limitations. One strength is that,
to our knowledge, this study is the first scoping review to address
decision‐making styles among patients and the general population in
the context of decision‐making support and health communication in
health care settings.
One limitation of this study is that the sample was only
obtained from two databases and was restricted to articles,
including the term “decision‐making style” or “decision style” in
the title. This may have resulted in some articles about decision‐
making styles being excluded from our analysis. Moreover, it was
beyond the scope of this study to assess the quality of the
reviewed articles based on the standard guidelines for observa-
tional studies. Another limitation of this study was the diversity of
methods, measurement tools, and outcome variables used in the
reviewed articles, which made comparisons difficult.
We also found that studies on decision‐making styles were
generally based on one of two perspectives, decision‐making role
preferences or personality, psychological, or cognitive factors
influencing the decision‐making process. However, in terms of
decision‐making styles as personality, psychological, or cognitive
factors, the analyzed articles varied in terms of context and
measurement tools used. Thus, it was often unclear how the
authors identified various decision‐making styles, which made
comparisons difficult.
Finally, with expanded interest in evidence‐based medicine, one
focal point in medical decision‐making situations is discussions about
relationships between patients and healthcare professionals based on
the decision‐making model, which describes three ways to make a
decision: paternalism, shared, and informed.57 However, some
literature on decision‐making models may have been omitted
because of our focus on the term “decision‐making style” in this
study. It is possible that some included articles contained references
referring to decision‐making styles rather than decision‐making
models, but these may have been overlooked. However, it is possible
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| 1023
that recent literature on decision‐making is relatively scarce, because
discussions on the promotion or implementation of SDM have
become more predominant than discussions regarding decision‐
making models.58
5 | CONCLUSION
In this scoping review, we analyzed 16 studies that investigated
decision‐making styles. The studies focused on decision‐making
styles from the perspective of either (1) decision‐making role
preferences or (2) personality, psychological, or cognitive factors
that influence the decision‐making process. According to our review,
most studies used other frameworks that are not directly related to
decision‐making styles. Therefore, decision‐making styles have
received little attention as a dynamic and situational concept and
are rarely addressed in health communication or decision‐making
support research.
Among healthcare professionals, nurses are central to improving
decision‐making support. As nurses support patient autonomy and
assume a role in maintaining and improving the quality of life of those
under their care, nurses can improve active patient communication
(e.g., “two participants are involved,”59 or “announcement that there
is a decision to be made”60 or “encouragement to talk”61) to a greater
degree than doctors. Therefore, by recognizing patient's decision‐
making styles and their functions and features, nurses can help to
create an environment that elicits a rational decision‐making process
and clarifies the patient's actual preferences or values. Consequently,
nurses can assume an essential role as an advocate in patient‐
centered care.
Our study serves as a window to recognizing previously
unidentified points at the intersection of decision‐making support,
health communication, and decision‐making styles. Elucidating
decision‐making style as an important concept can help to direct
research moving forward and provide strategic avenues for decision‐
making support and health communication.
ACKNOWLEDGME NT S
We thank Geoff Whyte, MBA, from Edanz Group (https://jp.edanz.
com/ac) for editing a draft of this manuscript. Sarah E. Porter, PhD,
RN, provided the finale copyediting. This study was supported by a
Grant‐in‐Aid for Scientific Research from the Japan Society for the
Promotion of Science (JSPS) KAKENHI (grant number 20H03967).
CONFLIC TS OF I NTERES T
The authors declare no conflicts of interest.
DATA AVAILABILITY STATEMENT
Data sharing is not applicable to this article, as no data sets were
generated or analyzed during the current study.
ORC I D
Hitomi Danya https://orcid.org/0000-0002-4922-0958

1024 | DANYA
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How to cite this article: Danya H, Nakayama K.
Decision‐making styles of patients and general population in
health care: a scoping review. Nurs Forum. 2022;57:1012‐1025.
doi:10.1111/nuf.12775