Background Culturally diverse older adults may prefer varying control over medical decisions. Decision control preferences (DCPs) may profoundly affect decision making and communication.

Aim To determine the DCPs of diverse, older adults and whether DCPs are associated with participant characteristics, advance care planning (ACP), and communication satisfaction.

Methods 146 participants were recruited from clinics and senior centres in San Francisco. We assessed DCPs using the Control Preference Scale: doctor makes all decisions (low), shares with doctor (medium), makes own decisions (high). We assessed associations between DCPs and demographics; prior advance directives; ability to make in-the-moment goals-of-care decisions; prior asked questions, self-efficacy, and readiness; and satisfaction with patient-doctor communication (5-pt Likert) using Chi-square and Kruskal-Wallis analysis of variance.

Results Mean age was 71 ± 10 years, 53% were non-white, 47% completed an advance directive, and 70% made goals-of-care decisions. 18% had low DCPs, 33% medium, and 49% high. Older age was the only characteristic associated with DCPs (low: 75 years ±11, medium: 69 ± 10, high: 70 ± 9, p = 0.003). DCPs were not associated with ACP, in-the-moment decisions, or communication satisfaction. Readiness was the only question-asking behaviour associated (low: 3.8 ± 1.2, medium: 4.1 ± 1.2, high: 4.3 ± 1.2, p = 0.05).

Discussion Nearly 1/5 of diverse, older adults want doctors to make their medical decisions. Low DCPs were associated with older age and lower readiness to ask questions, but not race/ethnicity. Yet, older adults with low DCPs still engaged in ACP, asked questions, and reported communication satisfaction.

Conclusion Regardless of DCPs, clinicians can encourage ACP and questions, but need to assess DCPs to provide the desired amount of decision support.