How Patient Centered Are Medical Decisions?: Results of a National Survey

Importance: Informing and involving patients in their medical decisions is increasingly becoming a standard for good medical care, particularly for primary care physicians.

Objective: To learn how patients describe the decision-making process for 10 common medical decisions, including 6 that are most often made in primary care.

Design: A survey of a national sample of adults 40 years or older who in the preceding 2 years had either experienced or discussed with a health care provider 1 or more of 10 decisions: medication for hypertension, elevated cholesterol, or depression; screening for breast, prostate, or colon cancer; knee or hip replacement for osteoarthritis, or surgery for cataract or low back pain.

Setting: Adults living in households in the United States in 2011.

Participants: A national sample of adults drawn from a probability sample-based web panel developed by Knowledge Networks.

Main Outcomes And Measures: Patients' perceptions of the extent to which the pros and cons were discussed with their health care providers, whether the patients were told they had a choice, and whether the patients were asked for their input.

Results: Responses were obtained from 2718 patients, with a response rate of 58.3%. Respondents reported much more discussion of the pros than the cons of all tests or treatments; discussions about the surgical procedures tended to be more balanced than those about medications to reduce cardiac risks and cancer screening. Most patients (60%-78%) said they were asked for input for all but 3 decisions: medications for hypertension and elevated cholesterol and having mammograms (37.3%-42.7%). Overall, the reported decision-making processes were most patient centered for back or knee replacement surgery and least for breast and prostate cancer screening.

Conclusions And Relevance: Discussions about these 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.