Unobserved heterogeneity in trauma patients' desire for autonomy in medical decision making in an emergency department.

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 level, 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 variance 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 substance use showed a negative association with patients' DAD. CONCLUSIONS: Apart from a negative association with substance use and the known associations with sex and level of education, trauma patients' DAD showed substantial variability between individuals, and this variability could not be explained by these factors.

Hazardous alcohol consumption and sense of coherence in emergency department patients with minor trauma.

BACKGROUND: The concept of sense of coherence (SOC) measures the extent to which people are able to cope with stressful life events. Since excessive alcohol consumption may be, in part, the result of failed coping strategies, further investigations between hazardous alcohol consumption and SOC are necessary. METHODS: Survey in an Emergency Department in an inner city university hospital. Overall, 1,833 patients were screened for hazardous alcohol consumption, illicit drug use, smoking status, socioeconomic status and sense of coherence. RESULTS: Mean age of participants was 34+/-12 years and 62% were male. Overall, 23% of patients showed a pattern of hazardous alcohol consumption, 23% had abused illicit drugs and 46% were smokers. Mean SOC score was 48.9+/-8.6 points, with no difference between genders. Lower SOC-quartiles were associated with significantly higher prevalence of hazardous alcohol consumption as well as illicit drug abuse and smoking. Lower SOC-quartiles were associated with significantly lower values on socioeconomic variables (e.g. lower income, less education). The negative association between SOC and alcohol consumption was independent of age, gender, smoking, illicit drug use and all socioeconomic variables. CONCLUSION: SOC and hazardous alcohol consumption were significantly associated. Our data support Antonovsky's original concept of increased alcohol consumption as a result of failed coping strategies.