Certain personality traits can affect healthcare decision-making. Personality traits such as neuroticism, extroversion, agreeableness, conscientiousness, and openness to experience can influence the patients’ perception of their health status and treatment plans. This paper explores how the aforementioned personality traits help to determine patients’ willingness to participate in making decisions concerning their healthcare.
Personality refers to a set of psychological attributes and systems organized within an individual that influences their adaptation and relationship with the social and physical environments.1 At a time of unprecedented emphasis on effective healthcare decision-making, understanding the role of personality is crucial, as healthcare decisions made by patients often determine the quality and safety of the services they will receive. This paper examines the relationship between personality and healthcare decision-making.
Research indicates that when patients are involved in their own care, they show higher satisfaction with their care and frequently experience better health outcomes.2,3,4,5 Several studies have found that personality traits determine patients’ willingness to participate in making decisions concerning their healthcare.6 Flynn and Smith indicated that there are numerous personality characteristics that determine the nature and direction of a patient’s decision.7 Naroo, Shahsavarzehi, and Karazee highlighted five specific personal traits – neuroticism, extroversion, agreeableness, conscientiousness and openness – that affect patients’ decision-making in healthcare.8
Individuals who possess the trait of neuroticism have higher tendencies for depressive moods and negative feelings such as guilt, worry, fear, envy, anger and anxiety.9 According to a study conducted by Friedman, neuroticism has major ramifications on an individual’s attitude toward illness and can potentially affect the patient in two different ways.10 Neuroticism causes some patients to abandon intervention regimens and give up on any interpersonal help that can potentially improve their health. Alternatively, neurotic patients who are hypervigilant about germs and the need for medical attention tend to be more involved in their healthcare decision-making and push their providers for more aggressive therapies. Similarly, Flynn and Smith concluded that patients with neuroticism are likely to prefer a less active role in healthcare decision-making. Insufficient participation was typically attributable to the patient attempting to avoid interactions with the clinician or due to increased anxiety and distress around taking personal responsibility for important health decisions.7
Weston, Hill and Jackson also carried out an analysis of the effects of neuroticism on healthcare decision-making participation and found that neurotic individuals are more inclined to find discussions concerning medical interventions distressing and anxiety-provoking.11 Consequently, capitalizing on the patient’s decisional control becomes a daunting task. In a similar vein, Lauriola and Levin argued that neurotic individuals might prefer less risk in healthcare decisions focused on achieving a gain while preferring more risk in decisions involving avoiding a loss.12
Conscientious individuals are characterized as self-disciplined9 and are known to take an active role in avoiding risky health behaviours and participating in beneficial ones.13 Williams and Brown argue that conscientious individuals are more likely to make more sound healthcare decisions when compared to people who lack self-discipline.14 Similarly, a study by Friedman and Kern revealed that conscientious individuals proactively plan their health behaviours instead of being spontaneous.15 In contrast, unconscientious individuals have trouble coping with stress, which prevents them from participating in medical decisions. Flynn and Smith also found that conscientious individuals prefer to take an active role in their healthcare decision-making.9
According to Djanatliev, Anatoli and Reinhard, patient’s personality traits of openness or rigidity to new ideas largely influence the preference of the patient to actively engage in healthcare decisions, with those who are more open to new ideas assuming more active participation in their healthcare decisions.16 Similarly, a study by Epstein revealed that an individual’s personality trait of openness to experience has a correlation with active participation in healthcare decisions.17 In the study, the investigators postulated that an individual who is open to new ideas has a likelihood of being more active in healthcare decision-making compared to patients who are ideologically rigid. These results are aligned with Alam’s argument that open individuals are acceptant of new ideas and, therefore, more comfortable in discussing healthcare issues with their practitioners.6 Likewise, Joseph-Williams, Elwyn and Edwards indicated that a patient’s ability to make decisions concerning healthcare depends on their capacity to open up and acquire new treatment experiences, and individuals who are open to new experiences have enhanced confidence in their personal competence to make significant medical decisions.18 However, while the aforementioned studies indicate that enhancing a patient’s openness to new ideas is critical in fostering one’s ability to take part in crucial healthcare decisions, Terracciano and Paul assert that such attempts to enhance the patient’s openness capability can trigger harmful psychological reactions such as degraded patient’s satisfaction, anxiety and antisocial behaviour notably towards healthcare providers.19
The personality trait of agreeableness is characterized by cooperativeness and tolerance9; consequently, individuals who are more agreeable tend to take on a more passive role when it comes to making healthcare decisions with their healthcare providers. Similarly, Flynn and Smith found that patients with high levels of agreeableness prefer not to participate in deliberations over their healthcare decisions.7
According to Couët et al., individuals’ personality trait of either introversion or extroversion can have a major influence on healthcare decision-making.20 The study suggested that those traits actively enhance or alter patient-practitioner interaction. While extroverted individuals are more likely to be sociable and participatory with a healthcare provider, introverts, on the other hand, tend to have difficulties in social interactions with the practitioner, thereby limiting their participation in medical decision-making. In addition, Shay, Aubree and Jennifer found that introverted individuals are likely to feel dependent on the provider’s expertise.21 Such psychological dependency limits the patient’s ability to question their health options, as they tend to often completely trust the assertions made by their health experts.
Personality colours the lenses through which patients view and perceive the world. This literature review suggests that personality plays a major role in healthcare decision making as patients receive and perceive medical information and their diagnosis differently based on their personality traits. Personality- trait-based individual differences result in differences in the levels of participation in healthcare decision-making and, frequently, in varying levels of compliance with recommended treatments.
The applicability of this research in healthcare is paramount as a better understanding of the impact of personality traits on healthcare decision-making may help providers tailor and personalize diagnosis and treatment conversations to the needs and preferences of individual patients. Healthcare organizations and providers should not assume that every patient wishes to participate in healthcare decision-making equally and should assess each patient individually prior to the initiation of healthcare-related conversations. As patient satisfaction with the amount of information received plays a significant role in patients’ compliance with prescribed treatments22, the importance of assessing for personality traits and tailoring healthcare-related conversations accordingly cannot be underestimated.
Available studies indicate that patients with high levels of personality traits such as conscientiousness, extraversion and openness to new experiences tend to be more actively engage in decisions involving their healthcare. At the same time, patients with high levels of neuroticism and agreeableness tend to be less participatory in their healthcare decision-making.
As patients’ active participation is essential in delivering high-quality patient care and improved patient outcomes, further research is recommended to assess how patients’ personality traits can be adapted to enhance patient-provider communication and promote active healthcare decision-making.
- Figueredo, Aurelio J., Sefcek Jon A., Vasquez Geneva, Brumbach Barbara H. , King James E. & Jacobs William J. Evolutionary personality psychology. The handbook of evolutionary psychology, 851-877. 2015.
- Alston, Chuck, Paget Lyn, Halvorson George, Novelli Bill, Guest Jim, McCabe Patrick, Hoffman Karen, Koepke Christopher, Simon Melissa, Sutton Sharyn, Okun Sally, Wicks Paul, Undem Tresa, Rohrbach Valerie & Von Kohorn Isabelle. Communicating with patients on health care evidence: Discussion paper. 2012. [March 28, 2013]. http://www.iom.edu/~/media/Files/Perspectives-Files/2012/Discussion-Papers/VSRT-Evidence.pdf.
- Hibbard, Judith H. & Greene Jessica. What the evidence shows about patient activation: Better health outcomes and care experiences; fewer data on costs. Health Affairs (Millwood). 32, no. 2 (2013) : 207–214.
- Maurer, Maureen, Dardess Pam, Carman Kristin L., Frazier Karen & Smeeding Lauren. (2012). Guide to patient and family engagement: Environmental scan report. (Prepared by American Institutes for Research under contract HHSA 290-200-600019). AHRQ Publication No. 12-0042-EF. Rockville, MD: Agency for Healthcare Research and Quality.
- Roseman, Deborah, Osborne-Stafsnes Jessica, Helwig Amy Christine, Boslaugh Summer & Slate-Miller Kellie. Early lessons from four “Aligning Forces for Quality” communities bolster the case for patient-centered care. Health Affairs (Millwood). 32. No. 2 (2013): 232–2.
- Monzurul. Alam. (2013). “The strategic decision-making process and influence of personality.” Master Thesis. Swedish University of Agricultural Sciences.
- Flynn, Kathryn E., & Smith Maureen A. “Personality and health care decision-making style”. The journals of gerontology. Series B, Psychological sciences and social sciences, 62, no. 5 (2007): 1-14.
- Narooi, Zahra Shahsavarzehi & Karazee Farhad . “Investigating the Relationship among Personality Traits, Decision-making Styles, and Attitude to Life (Zahedan Branch of Islamic Azad University as Case Study in Iran).” Mediterranean Journal of Social Sciences 6, no. 6 S6 (2015): 311.
- McCrae, Robert R. & Costa Paul T. Jr .Personality in adulthood: A five-factor perspective. 2. New York: Guilford Press; 2003.
- Friedman, Howard S. “Long-term relations of personality and health: Dynamisms, mechanisms, tropisms”. Journal of Personality. 68 (2000) :1089–1107.
- Weston, Sara J., Hill Patrick L. & Jackson Joshua J. “Personality traits predict the onset of disease.” Social Psychological and Personality Science 6, no. 3 (2015): 309-317.
- Lauriola, Marco & Irwin Levin. Personality traits and risky decision-making in a controlled experimental task: An exploratory study. Personality and Individual Differences. 31 no. 2 (2001) :215–226.
- Bogg, Tim & Roberts Brent. Conscientiousness and health-related behaviors: A meta-analysis of the leading behavioral contributors to mortality. Psychological Bulletin. 130, no. 6 (2004): 887–919.
- Williams, Iestyn & Brown Hilary. Factors influencing decisions of value in health care: a review of the literature. Health Services Management Centre. The University of Cambridge. (2014).
- Friedman, Howard S., & Kern Margaret L. “Personality, well-being, and health.” Annual review of psychology 65 (2014): 719-742.
- Djanatliev, Anatoli, & Reinhard German. “Prospective healthcare decision-making by combined system dynamics, discrete-event, and agent-based simulation.” In Proceedings of the 2013 Winter Simulation Conference: Simulation: Making Decisions in a Complex World, pp. 270-281. IEEE Press, 2013.
- Epstein, Ronald Mark. “Whole mind and shared mind in clinical decision-making.” Patient education and counseling 90, no. 2 (2013): 200-206.
- Joseph-Williams, Natalie, Elwyn Glyn & Edwards Adrian. “Knowledge is not power for patients: a systematic review and thematic synthesis of patient-reported barriers and facilitators to shared decision making.” Patient education and counseling 94, no. 3 (2014): 291-309.
- Terracciano, Antonio & Costa Paul T. Jr. “Smoking and the Five‐Factor Model of personality.” Addiction 99, no. 4 (2004): 472-481.
- Couët, Nicolas, Desroches Sophie, Robitaille Hubert, Vaillancourt Hugues, Leblanc Annie, Turcotte Stéphane, Elwyn Glyn & Légaré France. “Assessments of the extent to which health‐care providers involve patients in decision making: a systematic review of studies using the OPTION instrument.” Health Expectations 18, no. 4 (2015): 542-561.
- Shay, L. Aubree & Elston Lafata Jennifer. “Where is the evidence? A systematic review of shared decision making and patient outcomes.” Medical Decision Making 35, no. 1 (2015): 114-131.
- Husson, Olga, Mols, Floortjie & LV van de Poll-Franse, L. V. The relation between information provision and health-related quality of life, anxiety and depression among cancer survivors: a systematic review. Annals of oncology : official journal of the European Society for Medical Oncology, 22 no.4 (2010): 761-72.
About the Author
Dana Borgen is a sophomore at Rutgers University/New Brunswick in New Jersey. She is a passionate individual who loves to learn more about recent developments in the field of psychology and healthcare. Outside of school Dana took several classes in psychology and biotechnology. In her free time, she enjoys reading, painting and volunteering at the animal rescue organization.