The Impact of Screening, Medical Treatment and Invasive Interventions on Patients' Medical Decision-Making Styles: A Cross-Sectional Study with Inferences to the United States Population

Abstract

Background: Although positive benefits are associated with shared decision making, no previous studies have evaluated the impact of condition on how shared decision making is implemented.Objective: To compare decision-making preferences across three conditions associated with screening, medical treatment, and invasive interventions: Screening tests for colorectal cancer, initiation of prescription medication for hypertension, and surgical treatment for hip or knee osteoarthritis. Methods:We made use of the publicly available National Survey of Medical Decisions (the DECISIONS study) data and our sample comprised of all subjects who completed the following three specific modules of the decisions study: Colorectal cancerscreening tests, high blood-pressure medication, and knee or hip replacement surgery. Our primary outcomes of interest were (1) Who made the final decision? (2) Extent of patients' involvement in the decision, and (3) How confident they were about their decision.Results: When comparing baseline characteristics across the three conditions, the group undergoing screening was youngest with a mean age of 58.7 years compared to the medication group (61.27 years), while the group undergoing surgery was oldest (63.14 years). Females constituted over half of all three groups (greater than 50%). In the invasive interventions, decisions were made mainly by the patients, unlike the other groups where shared decision making was predominant. Most patients in all three groups preferred high levels of participation in decision making. Patients undergoing surgery were significantly more likely to have greater confidence in their decisions, followed by patients with medication for hypertension. Conclusion:Shared decision making is less predominant among invasive interventions. Further research should describe the reasons for the limited use of shared decisions among conditions with invasive interventions, along with its consequences for healthcare quality.