When the patient chooses: describing unaided decisions in health care

Patients make health care decisions in a complex and alien environment with little, if any, insightful aid from health care professionals; such professionals may be well intentioned but naive about how to provide decisional support. The search for information is unstructured, and once information is obtained, it is not easily understood by the layperson who may have difficulty understanding ambiguous and uncertain information. This paper addresses issues and concerns pertaining to the representation of unaided decision making in clinical practice among patients in two clinical contexts (breast cancer and cardiovascular disease). An analysis of qualitative clinical interviews provides indicators of naturalistic rule-based approaches patients use when making a medical decision. The relative salience of the alternatives plays a key role in discriminating rapid, intuitive decisions from those that are more deliberative. Empirical descriptions of real-world decision-making processes support a theoretical model of unaided decisions in health care.