A randomized trial of decision-making in asymptomatic carotid stenosis

Neurology. 2012 Jan 31;78(5):315-21. doi: 10.1212/WNL.0b013e31824528df. Epub 2012 Jan 4.


Objective: We sought to evaluate whether different presentation formats, presenter characteristics, and patient characteristics affect decision-making in asymptomatic carotid stenosis.

Methods: Subjects included individuals presenting to a neurology clinic. Participants included those over age 18 without known carotid stenosis. Subjects were randomized to a 30-second video with 1 of 5 presentation formats (absolute risk, absolute event-free survival, annualized absolute risk, relative risk, and a qualitative description) delivered by 1 of 4 presenter physicians (black woman, white woman, black man, white man). Subjects then completed a one-page form regarding background demographics and their decision regarding treatment choice.

Results: A total of 409 subjects watched the video and completed the survey. Overall, 48.4% of subjects chose surgery. Presentation format strongly predicted choice of surgery (qualitative [64%], relative risk [63%], absolute risk [43%], absolute event-free survival [37%], and annualized absolute risk [35%], p < 0.001). There was a trend for younger age (mean age 52 vs 55, p = 0.054), male gender (53% vs 45%, p = 0.08), and advanced education (42% for high school education or less vs 52% for more than high school education, p = 0.052) to predict surgery choice. Gender and race of presenter, and race of subject, had no influence on the choice of treatment.

Conclusions: Presentation format (information framing) strongly determines patient decision-making in asymptomatic carotid stenosis. Subject age, gender, and education level may also influence the decision. Clinicians should consider the influence of these variables when counseling patients.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Age Factors
  • Aged
  • Aging / psychology
  • Carotid Stenosis / psychology*
  • Carotid Stenosis / surgery
  • Decision Making
  • Disease-Free Survival
  • Educational Status
  • Ethnic Groups
  • Female
  • Humans
  • Male
  • Middle Aged
  • Neurosurgical Procedures / psychology*
  • Odds Ratio
  • Patient Education as Topic
  • Risk Reduction Behavior
  • Sex Factors
  • Socioeconomic Factors