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Deficits and Variations in Patients’ Experience with Making 9 Common Medical Decisions: The DECISIONS Survey

Author

Listed:
  • Brian J. Zikmund-Fisher
  • Mick P. Couper
  • Eleanor Singer
  • Peter A. Ubel
  • Sonja Ziniel
  • Floyd J. Fowler Jr.
  • Carrie A. Levin
  • Angela Fagerlin

Abstract

Background Although many researchers have examined patient involvement and patient-provider interactions within specific clinical environments, no nationally representative data exist to characterize patient perceptions of decision making and patient-provider communications across multiple common medical decisions. Objective To identify deficits and variations in the patient experience of making common medical decisions about initiation of prescription medications for hypertension, hypercholesterolemia, or depression; screening tests for colorectal, breast, or prostate cancer; and surgeries for knee or hip replacement, cataracts, or lower back pain, as well as to identify factors associated with patient confidence in the decisions. Setting National sample of US adults identified by random-digit dialing. Design Cross-sectional survey conducted from November 2006 to May 2007. Participants Included 2473 English-speaking adults age 40 and older who reported undertaking 1 or more of the above 9 medical actions or discussing doing so with a health care provider within the past 2 years. Measurements Patients reported who initiated discussions and made the final decisions, how much discussion of pros and cons occurred, whether they were asked about their preferences, and their confidence that the decision “was the right one.†Results The proportion of patient-driven decisions varied significantly across decisions (range: blood pressure: 16% to knee/hip replacement: 48%). Most patients (78%–85%) reported that providers made a recommendation, and such recommendations generally favored taking medical action. Fewer patients reported that providers asked them about their preferences (range: colon cancer screening: 34% to knee/hip replacement: 80%) or discussed reasons not to take action (range: breast cancer screening: 20% to lower back surgery: 80%). Decision confidence was higher among patients who reported primarily making the decision themselves (odds ratio [OR] = 14.6, P

Suggested Citation

  • Brian J. Zikmund-Fisher & Mick P. Couper & Eleanor Singer & Peter A. Ubel & Sonja Ziniel & Floyd J. Fowler Jr. & Carrie A. Levin & Angela Fagerlin, 2010. "Deficits and Variations in Patients’ Experience with Making 9 Common Medical Decisions: The DECISIONS Survey," Medical Decision Making, , vol. 30(5_suppl), pages 85-95, September.
    • Handle: RePEc:sae:medema:v:30:y:2010:i:5_suppl:p:85-95
    DOI: 10.1177/0272989X10380466
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    References listed on IDEAS

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    1. Brian J. Zikmund-Fisher & Mick P. Couper & Eleanor Singer & Carrie A. Levin & Floyd J. Fowler Jr. & Sonja Ziniel & Peter A. Ubel & Angela Fagerlin, 2010. "The DECISIONS Study: A Nationwide Survey of United States Adults Regarding 9 Common Medical Decisions," Medical Decision Making, , vol. 30(5_suppl), pages 20-34, September.
    2. Blumberg, S.J. & Luke, J.V. & Cynamon, M.L., 2006. "Telephone coverage and health survey estimates: Evaluating the need for concern about wireless substitution," American Journal of Public Health, American Public Health Association, vol. 96(5), pages 926-931.
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