Decision-Making Process Reported by Medicare Patients Who Had Coronary Artery Stenting or Surgery for Prostate Cancer
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.
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.
- President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. Making Health Care Decisions. Wash, DC: Government Printing Office, 1982: 2.
- American Medical Association. 2010 Strategic issues [database on the Internet]. Chicago: The Association (Getting the most for our health care dollars: Shared Decision Making) Available from http://www.ama-assn.org/resources/doc/health-care-costs/shared-decision-making.pdf. Accessed January 4, 2012.
- Moulton, B, King, J (2010) Aligning ethics with medical decision making: the quest for informed patient choice. J Law Med Ethics 38: pp. 85-97 CrossRef
- Braddock, CH, Fihn, SD, Levinson, W, Jonsen, AR, Pearlman, RA (1997) How doctors and patients discuss routine clinical decisions: informed decision making in the outpatient setting. J Gen Intern Med 12: pp. 339-45
- Braddock, CH, Edwards, KA, Hasenberg, NM (1999) Informed decision making in outpatient practice: time to get back to basics. JAMA 282: pp. 2313-20 CrossRef
- Patient-centered Primary Care Collaboration. Joint Principles of the Patient-Centered Medical Home (2007) Available from: www.pcpcc.net/content/joint-principles-patient-centered-medical-home. Accessed January 4, 2012
- Bill-Axelson, A, Homberg, L, Filen, F (2008) Radical prostatectomy versus watchful waiting in localized prostate cancer: the Scandinavian prostate cancer group-4 randomized trial. J Natl Cancer Inst 100: pp. 1144-1154 CrossRef
- Potosky, AL, Davis, WW, Hoffman, RM (2004) Five-year outcomes after prostatectomy or radiotherapy for prostate cancer: The Prostate Cancer Outcomes Study. J Natl Cancer Inst 96: pp. 1358-1367 CrossRef
- Fowler, FJ, Barry, MJ, Lu-Yao, G, Wasson, JH, Bin, L (1996) Outcomes of external beam radiation therapy for prostate cancer: A study of medicare beneficiaries in three seer areas. J Clin Oncol 14: pp. 2258-2265
- Fowler, FJ, Barry, MJ, Lu-Yao, G, Wasson, J, Roman, A, Wennberg, J (1995) The effect of radical prostatectomy for prostate cancer on patient quality of life: Results from a Medicare survey. Urology 45: pp. 1007-1013 CrossRef
- Bill-Axelson, A, Holmberg, L, Ruutu, M (2011) Radical prostatectomy versus watchful waiting in early prostate cancer. New Engl J Med 364: pp. 1708-1717 CrossRef
- Wilt TJ. The VA/NCI/AHRQ CSP #407: Prostate Cancer Prevention Versus Observation Trial (PIVOT): main results from a randomized trial comparing radical prostatectomy to watchful waiting in men with clinically localized prostate cancer. American Urological Association Web site. http://webcasts.prous.com/AUA2011/html/1-en/template.aspx?section=20&idl=18108&idcl=1&eid=802 Accessed January 4, 2012.
- Keeley, EC, Boura, JA, Grines, CL (2003) Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomized trials. Lancet 361: pp. 13-20 CrossRef
- Jeremias, A, Sanjay, K, Rosengart, TK, Gruberg, L, Brown, DL (2009) The impact of revascularization on mortality in patients with nonacute coronary artery disease. Am J Med 122: pp. 152-61 CrossRef
- Katritsis, DG, Ioannidis, JPA (2005) Percutaneous coronary intervention versus conservative therapy in nonacute coronary artery disease. Circulation 111: pp. 2906-2912 CrossRef
- Pfisterer, B, Buser, P, Osswald, S, Allemann, U, Amann, W, Angehrn, W (2003) Outcome of elderly patients with chronic symptomatic coronary artery disease with an invasive vs optimized medical treatment strategy: one-year results of the randomized TIME trial. JAMA 289: pp. 1117-1123 CrossRef
- Boden, WE, O'Rourke, RA, Teo, KK, Hartigan, PM, Maron, DJ, Kostuk, WJ (2007) Optimal medical therapy with or without PCI for stable coronary disease. New Engl J Med 356: pp. 1503-16 CrossRef
- Weintraub, WS, Spertus, JA, Kolm, P, Maron, DJ, Zhang, Z, Jurkovitz, C (2008) Effect of PCI on quality of life in patients with stable coronary disease. New Engl J Med 359: pp. 677-687 CrossRef
- Zikmund-Fisher BJ, Couper MP, Singer E, Levin C, Fowler Jr. FJ, Ziniel S, et al. The DECISIONS study: a nationwide survey of U.S. adults regarding nine common medical decisions. Med Decis Making. September/October 2010; 30: 20S- 34S.
- Zikmund-Fisher, B, Couper, M, Singer, E, Ubel, P, Fowler, F, Levin, C, Ziniel, S, Fagerlin, A (2010) Deficits and Variations in Patients’ Experience with Making 9 Common Medical Decisions: The DECISIONS Survey. Med Decis Making 30: pp. 85S-95S CrossRef
- Willis, GB (2005) Cognitive Interviewing. Sage, Thousand Oaks, CA
- Rose, G, McCartney, P, Reid, DD (1977) Self-administration of a questionnaire on chest pain and intermittent claudication. Brit J of Prev and Soc Med 31: pp. 42-48
- Lee, JH, Chuu, K, Spertus, J, O’Keefe, JH (2008) Widespread patient misconceptions regarding the benefits of elective percutaneous coronary interventions. Circulation 118: pp. S_1161 CrossRef
- Rothberg, MB, Sivalingam, SK, Ashraf, J, Visintainer, P, Joelson, J, Kleppel, R (2010) Patients’ and cardiologists’ perceptions of the benefits of percutaneous coronary intervention for stable coronary artery disease. Ann Intern Med 153: pp. 307-313
- Lin, GA, Dudley, RA, Redberg, RF (2007) Cardiologists use of percutaneous coronary interventions for stable coronary artery disease. Arch Int Med 167: pp. 1604-1609 CrossRef
- Hruby, M, Pantilat, SZ, Lo, B (2001) How do patients view the role of the primary care physician in inpatient care?. Am J Med 111: pp. 21-25 CrossRef
- Davis, K, Schoenbaum, SC, Audet, A (2005) A 2020 vision of patient-centered primary care. J Gen Int Med 20: pp. 953-957 CrossRef
- O’Connor, AM, Bennett, CL, Stacey, D, et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst. Rev. 2009;(3):CD001431.
- Decision-Making Process Reported by Medicare Patients Who Had Coronary Artery Stenting or Surgery for Prostate Cancer
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Journal of General Internal Medicine
Volume 27, Issue 8 , pp 911-916
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- shared decision making
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- Author Affiliations
- 1. Center for Survey Research, University of Massachusetts Boston, 100 Morrissey Blvd., Boston, MA, 02125, USA
- 2. Foundation for Informed Medical Decision Making, Boston, MA, USA
- 3. Department of General Internal Medicine, Dartmouth Hitchcock Medical Center, Hanover, NH, USA
- 7. The Dartmouth Institute, Dartmouth College, Hanover, NH, USA
- 4. General Medicine Division, Massachusetts General Hospital, Boston, MA, USA
- 5. Center for Outcomes Research, Maine Medical Center, Portland, ME, USA
- 6. Department of Economics, Dartmouth College, Hanover, NH, USA