Background: Patient participation in clinical decision-making is valuable and has an effect on quality of care. However, there is limited knowledge about patient preferences for participation and how doctors perceive their patients’ preferences.

Objectives: The aim of this study was to compare the degree of concordance between patients' and doctors' attitudes and perceptions of patients' preferences for participation in clinical decision-making in China. A further aim was to compare patients' experiences of participation with their preferred participatory role.

Methods: We adopted a comparative design with a representative sample from 10 hospitals in China and more than 1000 doctors – patient dyads were involved. We used a modified version of the Control Preference Scale in conjunction with a questionnaire developed to elicit the patient's experience of participation.

Results: A majority of doctors perceived that their patients preferred a higher degree of participation in decision-making than did the patients. We found differences in patient preferences in relation to age and social status but not to gender. Patients often experienced having a different role than what was initially preferred, e.g. a more passive role concerning needs related to communication, breathing and pain and a more active role related to activity and emotions/roles.

Conclusions: Doctors are not always aware of their patients' perspectives and tend to overestimate their willingness to assume an active role. Doctors do not successfully involve patients in clinical decision-making in medical care according to their own perceptions and not even to the patients’ more moderate preferences for participation.

Patient or healthcare consumer involvement: Yes, patients were the main research object.