The DECISIONS study: a nationwide survey of United States adults regarding 9 common medical decisions

Med Decis Making. Sep-Oct 2010;30(5 Suppl):20S-34S. doi: 10.1177/0272989X09353792. Epub 2010 Apr 14.

Abstract

Background: Patient involvement is required before patients' preferences can be reflected in the medical care they receive. Furthermore, patients are a vital link between physicians' assessments of patients' needs and actual implementation of appropriate care. Yet no study has specifically examined how and when a representative sample of patients considered, discussed, and made medical decisions.

Objective: To identify decision prevalence and decision-making processes regarding 1) initiation of prescription medications for hypertension, hypercholesterolemia, or depression; 2) screening tests for colorectal, breast, or prostate cancer; and 3) surgeries for knee or hip replacement, cataracts, or lower back pain.

Design: Computer-assisted telephone interview survey.

Setting: Nationally representative sample of US adults in households with telephones.

Participants: 3010 English-speaking adults age 40 and older identified using a stratified random sample of telephone numbers.

Measurements: Estimated prevalence of medical decisions, defined as the patient having initiated medications, been screened, or had surgery within the past 2 years or having discussed these actions with a health care provider during the same interval, as well as decision-specific data regarding patient knowledge, attitudes and patient-provider interactions.

Results: 82.2% of the target population reported making at least 1 medical decision in the preceding 2 years. The proportion of decisions resulting in patient action varied dramatically both across decision type (medications [61%] v. screening [83%] v. surgery [44%]; P < 0.001), and within each category (e.g., blood pressure medications [76%] v. cholesterol medications [55%] vs. depression medications [48%]; P < 0.001). Respondents reported making more decisions if they had a primary care provider or poorer health status and fewer decisions if they had lower education, were male, or were under age 50. Limitations. Retrospective self-reports may incorporate recall biases.

Conclusions: Medical decisions with significant life-saving, quality of life, and cost implications are a pervasive part of life for most US adults. The DECISIONS dataset provides a rich research environment for exploring factors influencing when and how patients make common medical decisions.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Aged
  • Communication*
  • Confidence Intervals
  • Female
  • Health Care Surveys
  • Health Knowledge, Attitudes, Practice*
  • Humans
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Patient Satisfaction / statistics & numerical data*
  • Patient-Centered Care / methods*
  • Patient-Centered Care / statistics & numerical data
  • Physician-Patient Relations*
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Quality of Life
  • Regression Analysis
  • United States