Control Preferences Scale
Control Preferences Scale (CPS) · Also known as: Desired Role in Decision Making, Decision Role Preference
The Control Preferences Scale (CPS) is a five-item measure that assesses a patient's preferred role in healthcare decision making, ranging from a passive (physician-directed) to active (patient-directed) or shared approach. Developed by Lois Degner and colleagues in 1997, the CPS measures the degree of control patients wish to exercise in treatment decisions: whether they prefer to leave decisions to the clinician, collaborate with the clinician, or make the final decision themselves. The scale is widely used to understand patient preferences for decision-making involvement and to evaluate the alignment between preferred and actual roles.
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When to use it
The CPS is used in research to characterize patient preferences for decision involvement, in studies evaluating shared decision-making implementation, and in quality improvement to assess alignment between patient preference and actual clinical practice. It is appropriate for literate adults facing healthcare decisions with multiple options and choices about the depth of their involvement. Useful in oncology, surgical planning, chronic disease management, and end-of-life care. Less relevant for emergency or highly time-constrained decisions.
Strengths & limitations
- Captures preference diversity: recognizes that not all patients want the same level of involvement; respects autonomy by assessing rather than imposing a particular decision model.
- Simple conceptual framework: the five-role spectrum (active to passive) is intuitive and easily understood by patients, clinicians, and researchers.
- Validated across populations: widely used in oncology, surgery, primary care, and other specialties; consistent psychometric properties across languages and cultures.
- Alignment measurement: enables assessment of whether actual decision-making practice matches patient preference—a key quality indicator for shared decision-making.
- Prognostic utility: patient preference-practice alignment correlates with satisfaction, adherence, and health outcomes; low alignment predicts dissatisfaction.
- Preference stability: patient preferences for involvement can change over time, with new information, or depending on the specific decision; a single assessment may not reflect dynamic preferences.
- Context-dependence: a patient might prefer an active role for some decisions (e.g., medication choice) and a passive role for others (e.g., technical surgical decisions); CPS typically assesses global preference.
- Limited to preference, not actual behavior: CPS measures what patients say they want, not what they actually do when presented with real decisions; stated preference may differ from revealed preference.
- No severity or intensity metric: the scale identifies preference category but does not measure strength of preference or intensity of desire for involvement.
- Assumes preference clarity: some patients may not have thought clearly about their preference; responses may reflect immediate mood or limited understanding of decision complexity.
Frequently asked
What should I do if a patient's preference is for a passive role?
Respect the preference. Provide information and ask if they wish to be involved, but honor their choice to delegate decision-making to you. Ensure they understand the recommendation and have agreed (informed consent), even if they are not actively choosing among options. Document the preference and your recommendation.
Can CPS be used in emergency or urgent care?
CPS is less applicable in emergencies where time does not permit discussion of preference. However, in urgent (but non-emergency) situations, a brief verbal version ('Do you want to decide this together with me, or would you prefer I make the recommendation?') can be used to gauge preference and shape the approach.
Is a patient's CPS preference the same for all healthcare decisions?
Not necessarily. Patients may prefer active involvement in some decisions (e.g., medication side effects they care about) and passive involvement in others (e.g., technical surgical details). Ideally, re-assess preference for each major decision, or ask patients explicitly if their preference differs for this particular decision.
How do I measure actual decision-making role to compare with CPS preference?
Observe clinical consultations and rate whether the actual approach matched patient preference using a coding tool. Alternatively, ask the patient immediately after the encounter ('Did the clinician's approach match what you wanted?'). Compare preference (CPS) to actual role perception (patient report or observation).
What percentage of patients should prefer each role?
There is no 'correct' distribution. Research shows wide variation by context: cancer patients often prefer active or shared roles (50-70%), while older or sicker patients may prefer more passive roles (30-50%). Use your own population baseline to track changes and benchmark against similar settings.
Sources
- Degner, L. F., Sloan, J. A., & Venkatesh, P. (1997). The Control Preferences Scale. Canadian Journal of Nursing Research, 29(3), 21-43. link ↗
- Brace, C., Keating, N. L., Hemminki, K., et al. (2006). Informed decision making and cancer screening: the role of the physician. American Journal of Medical Genetics Part A, 140A(20), 2256-2264. link ↗
How to cite this page
ScholarGate. (2026, June 3). Control Preferences Scale (CPS). ScholarGate. https://scholargate.app/en/patient-centered-care/control-preferences-scale
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