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Patients More Cautious When Personally Making Medical Decisions

By December 2, 2009Commentary

More patient involvement in health care decisions is promoted as a consumer-centric approach that will lead to enhanced quality and potentially  lower costs, because patients will likely be more satisfied when more involved in decision-making and some research has demonstrated that patients are more likely to want less-intensive, less costly care than that which physicians will often order.

A new piece of research reported in the journal Arthritis Care & Research provides some interesting new insights on this topic.  (Arthritis Article) The study had patients review videos in which a physician describes a new drug, which is described as effective and safe except for one very serious but rare side effect.  The patients were told this was a hypothetical scenario.  The patients were then first told that the physician decided they should take the drug and wrote them a prescription, and in a second scenario told that the physician tells them that whether or not they take the drug was totally up to them and asks the patient to decide.  After each of these two cases the patients were asked how worried they were about the drug and then to decide if they would take it.

The patients were more worried when they had to decide and they decided to take the drug less often when the decision was completely up to them.  While this was a limited study, what it illustrates is the potential for anxiety that accompanies decision-making to influence the decision.  So while more patient involvement is hard to argue with, giving them decision-making authority may lead to patients not undergoing care that may be good for them, largely because the patient was fearful in regard to the decision.  What is needed, and has been shown in some research, is clear evidence that patients who are more accountable for their care decisions have better health outcomes.  The research also contributes to designing methods of patient interaction that reduce anxiety and promote rational assessment of treatment alternatives.

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