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The role of perceived benefits and costs in patients' medical decisions
Eleanor Singer1, Mick P Couper, Angela Fagerlin
1Research Professor Emerita, Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MIResearch Professor, Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MIAssociate Professor, Department of Internal Medicine, University of Michigan and Research Scientist, VA Ann Arbor Center for Clinical Management Research, Ann Arbor, MISenior Scientific Advisor to the Foundation for Informed Medical Decision Making and Senior Research Fellow at the Survey Research Center, University of Massachusetts, Boston, MAResearch Director, Foundation for Informed Medical Decision Making, Boston, MAJohn O. Blackburn Professor of Business, Fuqua Business School and Professor of Public Policy, Duke University, Durham, NCSenior Research Associate, Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MIAssistant Professor, Department of Health Behavior and Health Education, and Research Assistant Professor, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
Background:
Many decisions can be understood in terms of actors' valuations of benefits and costs. The article investigates whether this is also true of patient medical decision making. It aims to investigate (i) the importance patients attach to various reasons for and against nine medical decisions; (ii) how well the importance attached to benefits and costs predicts action or inaction; and (iii) how such valuations are related to decision confidence.
Methods:
In a national random digit dial telephone survey of U.S. adults, patients rated the importance of various reasons for and against medical decisions they had made or talked to a health-care provider about during the past 2 years. Participants were 2575 English-speaking adults age 40 and older. Data were analysed by means of logistic regressions predicting action/inaction and linear regressions predicting confidence.
Results:
Aggregating individual reasons into those that may be regarded as benefits and those that may be regarded as costs, and weighting them by their importance to the patient, shows the expected relationship to action. Perceived benefits and costs are also significantly related to the confidence patients report about their decision.
Conclusion:
The factors patients say are important in their medical decisions reflect a subjective weighing of benefits and costs and predict action/inaction although they do not necessarily indicate that patients are well informed. The greater the difference between the importance attached to benefits and costs, the greater patients' confidence in their decision.
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