How patients make medical decisions

by Diane Swanbrow

Sooner or later, everyone faces decisions about whether or not to have surgery, take a new medication or have a cancer-screening test.

A new University of Michigan study published in Health Expectations explores the costs and benefits say are important in making these kinds of medical decisions, and how those costs and benefits explain what they actually decide to do.

"Many decisions in life can be understood in terms of people's assessments of costs and benefits, and this study finds that this is also true of medical decisions," said Eleanor Singer, a researcher at the U-M Institute for Social Research and lead author of the study.

Singer and colleagues surveyed 3,010 English-speaking adults ages 40 and older who reported having made a within the last two years.

"The importance attached to specific costs and benefits varies greatly from one person to another," Singer said. "For example, in discussing a decision about surgery, one patient may give high importance to being able to function better, but may attach even greater importance to the possibility of serious side effects. For another patient, this calculus may be reversed."

The study also found that while patient assessment of costs and benefits predicts what they decide to do, it does not necessarily indicate that they are well-informed.

"So physicians must take time to discover not only how a particular patient facing a particular decision evaluates its specific benefits and costs, but also whether perceptions of benefits and are accurate," Singer said.

Only then, she says, can truly informed shared decision-making come about.

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