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We applied constructs from the transtheoretical model (TTM) of behavior change to identify modifiable determinants of patient participation in medical decision-making.We surveyed a convenience sample of 621 primary care patients at one Boston hospital (response rate 60.6%). With a random half of the sample, we examined the factor structure of a new Patient Attitudes and Beliefs Scale (PABS) that focused on issues about participation in medical decision-making, and with the other half we confirmed the factor structure and examined the association of patients’ stage of readiness to participate in decision-making with subscales of the PABS (pros, cons, and decisional balance), self-efficacy, and trust in physician.Patients were classified into 4 stages: precontemplation (don't participate and don't intend to, 17.2%), contemplation (don't participate but contemplating participating, 6.9%), preparation (participate to some degree, 36.1%), and action (participate fully, 39.8%). Factor analysis of the PABS items indicated 2 factors representing pros and cons of participation. Scores on the pros increased and cons decreased significantly from precontemplation to action (P < 0.001). Significant nonlinear associations of stage of readiness with self-efficacy (P < 0.01) and trust in physician (P < 0.01) were evident; self-efficacy scores were highest for those in action whereas trust scores were highest for those in precontemplation.To move people from precontemplation towards action in participating in medical decision-making, interventions focusing on increasing the pros and decreasing the cons of participation may be needed. The challenge is to balance advocacy for an active patient role with individual patients’ preference for participation.