Patient Input in Medical Decision-Making Process

In the past 10 years, according to researchers, the concept of physicians informing and involving patients in medical decisions has begun to take hold, at least in policy circles. The American Medical Association has endorsed the concept of shared decision-making as an important part of quality medical care when there are options for best possible treatment. The idea has had particular traction in primary care as part of the developing care model of a patient-centered medical home.

Researchers recently conducted a survey to determine how patients describe the decision-making process for 10 common medical decisions, including 6 that are most often made in primary care. In 2011, a cross section of US adults ≥40 years of age was asked whether they made 1 of 10 medical decisions and to outline their interactions with healthcare providers regarding those decisions. Survey results were reported online in JAMA Internal Medicine [doi:10.1001/jamaintermed.2013.6172].

The survey participants had, in the preceding 2 years, either experienced or discussed with a healthcare provider ≥1 of 10 decisions: medication for hypertension, elevated cholesterol, or depression; screening for breast, prostate, or colon cancer; knee or hip replacement for osteoarthritis; and cataract or low back pain surgery.

Of the 5682 survey recipients, 59.8% (n=3396) answered the questions about discussing care decisions with their healthcare providers. Of those, 2788 said they made ≥1 of the target decisions and 2718 completed the entire survey.

Patients who reported having discussions about cataract survey were much older than those making other decisions and those who made decisions about mammograms and medication for depression were much younger. For decisions other than those regarding mammograms and prostate-specific testing, sex was evenly split; however, discussions about medication for depression were much more common among women. Patients making decisions about cancer screening were slightly more likely to be college graduates than those making other decisions.

For all decisions, the patients noted that discussions with physicians included more emphasis on the pros rather than the cons of a particular decision. For medications, approximately twice as many respondents reported a lot or some discussion of the pros as those who reported similar amounts of discussions of cons. For cancer screening, the discussion of cons was nearly nonexistent. Discussions about surgical procedures tended to be more balanced than those about medications to reduce cardiac risks and cancer screening.

The majority of respondents (60%-78%) said they were asked for input for all but 3 of the target decisions: medications for hypertension and elevated cholesterol and having mammograms.

Overall, the most patient-centered decision-making processes were for back or knee replacement surgery and the least for breast and prostate cancer screening.

In summary, the researchers stated, “Discussions about their common tests, medications, and procedures as reported by patients do not reflect a high level of shared decision-making, particularly for 5 decisions most often made in primary care.”