Disparities in patient reports of communications to inform decision making in the DECISIONS survey

To identify patient- and decision-type predictors of two key aspects of informed decision making: discussing the cons (not just the pros) of medical interventions and asking patients what they want to do.

Using data from 2473 members of the DECISIONS survey, a nationally representative sample of U.S. adults age 40+, we used logistic regression analysis to identify which patient characteristics predicted patient reports of healthcare providers discussing cons or eliciting preferences about one of 9 common medical decisions.

Multiple demographic characteristics predicted both discussions of cons and elicitations of preferences, although the specific characteristics varied between decision contexts. In particular, African-American respondents reported being more likely to receive a discussion of the cons of cancer screening (OR=1.69, p<0.05) yet less likely to have been asked their opinion about either getting a cancer screening test (OR=0.56, p<0.05) or initiating medications (OR=0.53, p<0.05). Significant cross-decision variations remained even after controlling for patient characteristics.

Important disparities in patient communication and involvement appear to exist both between different types of medical decisions and between different types of patients.

Providers must make sure to consistently discuss the cons of treatment and to solicit input from all patients, especially African-Americans.