What is the future of research on medical decision making? (And is it bright?): A response to Drewniak and colleagues

Spencer, Karen Lutfey

doi:10.1016/j.socscimed.2016.09.017

Cited by 1 publication

(1 citation statement)

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“…This type of research is often able to make unconfounded estimates of the relative contributions of provider, patient, and system-level attributes on the types of medical diagnoses and recommendations that are made (Drewniak et al 2016; McKinlay, Potter, and Feldman 1996; McKinlay et al 2006). While this type of contribution is critical, it leaves unanswered many questions about processes and how multiple aspects of social systems interact with one another (Spencer 2016). Our present study does not address how such quantifiable influences of provider demographics (e.g., race), patient characteristics (e.g., race or socioeconomic status), or patient-provider concordance may predict decision-making outcomes.…”

Section: Discussionmentioning

confidence: 99%

A Qualitative Investigation of Cross-domain Influences on Medical Decision Making and the Importance of Social Context for Understanding Barriers to Hospice Use

Spencer

Mrig

Matlock

et al. 2017

Journal of Applied Social Science

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Hospice utilization has the potential to improve quality of life for patients while also decreasing healthcare costs at end of life. Barriers to hospice utilization have been identified, but less is known about how patient, provider, and system domains influence one another. We use in-depth interviews with physicians to examine the social, cultural, and economic contexts of decision making and how physician and organizational domains influence patient decision making around hospice. We identify sources of delay in physicians advocating for hospice referrals for their late-life patients that show how patient, physician, and system factors interact. Our results reveal incentives to postpone discussion of hospice that are not fully captured in policy perspectives, clinical guidelines, or current research paradigms focused on individual domains of influence. Opportunities to address previously identified barriers to hospice will benefit from consideration of how seemingly separate domains function in an integrated social context.

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