Original Research

Journal of General Internal Medicine

, Volume 27, Issue 8, pp 911-916

First online:

Open Access This content is freely available online to anyone, anywhere at any time.

Decision-Making Process Reported by Medicare Patients Who Had Coronary Artery Stenting or Surgery for Prostate Cancer

  • Floyd J. FowlerJrAffiliated withCenter for Survey Research, University of Massachusetts BostonFoundation for Informed Medical Decision Making Email author 
  • , Patricia M. GallagherAffiliated withCenter for Survey Research, University of Massachusetts Boston
  • , Julie P. W. BynumAffiliated withDepartment of General Internal Medicine, Dartmouth Hitchcock Medical CenterThe Dartmouth Institute, Dartmouth College
  • , Michael J. BarryAffiliated withFoundation for Informed Medical Decision MakingGeneral Medicine Division, Massachusetts General Hospital
  • , F. Leslie LucasAffiliated withCenter for Outcomes Research, Maine Medical Center
  • , Jonathan S. SkinnerAffiliated withDepartment of Economics, Dartmouth CollegeThe Dartmouth Institute, Dartmouth College



Patients facing decisions should be told about their options, have the opportunity to discuss the pros and cons, and have their preferences reflected in the final decision.


To learn how decisions were made for two major preference-sensitive interventions.


Mail survey of probability samples of patients who underwent the procedures.


Fee-for-service Medicare beneficiaries who had surgery for prostate cancer or elective coronary artery stenting in the last half of 2008.

Main measurements

Patients’ reports of which options were presented for serious consideration, the amount of discussion of the pros and cons of the chosen option, and if they were asked about their preferences.


The majority (64%) of prostate cancer surgery patients reported that at least one alternative to surgery was presented as a serious option. Almost all (94%) said they and their doctors discussed the pros, and 63% said they discussed the cons of surgery “a lot” or “some”. Most (76%) said they were asked about their treatment preferences. Few who received stents said they were presented with options to seriously consider (10%). While most (77%) reported talking with doctors about the reasons for stents “a lot” or “some”, few (19%) reported talking about the cons. Only 16% said they were asked about their treatment preferences.


While prostate cancer surgery patients reported more involvement in decision making than elective stent patients, the reports of both groups document the need for increased efforts to inform and involve patients facing preference-sensitive intervention decisions.

Key words

shared decision making decision quality patient-centered care