When Decision-Making Styles Do Not Predict Communication Preferences

Background: Healthcare systems increasingly attempt to personalize risk communication by matching messages to patients’ decision-making styles. This approach is resource intensive, yet evidence that it improves patient experience or decision quality remains limited. Methods: We conducted a cross-cultural experimental study with adults from the UK (n=330, recruited via Prolific) and Singapore (n=220, recruited via professional networks). Participants viewed three healthcare scenarios with risks of 1%, 10%, and 20%, presented in either positive (“99% no complications”) or negative (“1% complications”) frames displayed side-by-side in randomized order. Decision-making styles were assessed using the Control Preferences Scale, categorizing participants as information-seeking, shared decision-making, or paternalistic. The primary outcome was likelihood of accepting the proposed option; secondary outcomes were perceived framing helpfulness and decision satisfaction. Results: Among 550 participants who completed all measures, decision-making style did not predict framing preferences at any risk level or in either country (all p>.05). Risk magnitude strongly shaped preferences. Positive framing was preferred at 1% risk (50.0%, p<.001), declined at 10% risk (43.5%, p=.002), and showed no advantage at 20% risk, where preferences were evenly split. Age predicted decision-making style, with older adults favouring physician-directed care (p=.004). UK participants reported higher willingness to proceed with interventions, although this pattern may reflect sampling differences rather than systematic cultural variation. Decision satisfaction did not differ by style or framing. Conclusions: Decision-making styles did not guide framing preferences, suggesting limited value in style-based personalization. Risk-responsive, universally clear communication strategies may more effectively enhance comprehension, trust, and satisfaction.