How patient centered are medical decisions?

A national survey sample of adults who had discussions with their physicians in the preceding two years about common medical tests, medications and procedures often did not reflect a high level of shared decision making, according to an article published online by JAMA Internal Medicine.

Floyd J. Fowler, Jr., Ph.D., from the Informed Medical Decisions Foundation and the University of Massachusetts, Boston, conducted a 2011 survey of a cross section of U.S. adults 40 years or older and asked them to indicate whether they reported making one of 10 medical decisions and to describe their interactions with their physicians concerning those decisions. The decisions included: medication for hypertension, elevated cholesterol, or depression; screening for breast, prostate or colon cancer; knee or hip replacement for osteoarthritis, or surgery for cataract or low back pain.

"…we saw great variation in the extent to which patients reported efforts to inform them about and involve them in 10 common decisions," the authors write in their conclusion. "Although there was variation within decision types, decisions concerning four surgical procedures were much more shared than decisions about cancer screening and two very common long-term medications for cardiac risk reduction. If share decision making is to be one defining characteristic of primary care as delivered in medical homes, primary care physicians and other health care providers will need to balance their discussions of pros and cons to a greater degree and ask patients for their input more consistently."