To have or not have surgery? To start treatment or wait? To prescribe medicine or not? In the past, many of these decisions were in the hands of physicians. But today, more providers recognize that, in many cases, the best care is really a matter of patient preference.
Early data from a survey of more than 3,000 patients revealed that some physicians tend to offer their opinion to patients while neglecting to inquire about the patients’ own views. For example, only about half of the respondents on blood pressure medications said their physicians had asked them their opinion about going on these prescription drugs (Zikmund-Fisher, B.J., et al., National Survey of Medical Decisions, not yet published).
The potential result is that medical decisions aren’t always being made by those most affected, experts say. Treatment becomes a matter of physician, rather than patient, choice.
This could be one reason why standards of treatment often vary from community to community, reformers argue. The Dartmouth Atlas of Health Care has documented wide variations in treatment patterns in different regions of the country—for example, the likelihood of having a hysterectomy can be two to five times greater from one section of the country to another.
Preliminary data suggest that informed patients tend to make more conservative treatment decisions. For example, a 2007 study found that shared decision making improved patient knowledge and increased watchful waiting as a treatment option in men diagnosed with prostate cancer. These patients opted to postpone surgery to avoid potential complications, such as incontinence and erectile dysfunction (Volk, R.J., et al, “Trials of Decision Aids for Prostate Screening: A Systematic Review,” American Journal of Preventive Medicine, November 2007, vol. 33, no. 5, pp 428-434).
“There are many well-informed policy-makers who believe there could be significant savings in avoiding interventions that people, if they are fully informed, don’t want,” says Richard Wexler, MD, director of patient support strategies at the Foundation for Informed Medical Decision Making, which funds research in this area (www.informedmedicaldecisions.org).
“Others see this as an extension of patient safety initiatives. In addition to focusing on doing care right—such as performing a surgery with low complications—the effort is on providing surgery to the appropriate patient, or the one who really wants it.”
In fact, some policymakers are looking to adopt laws that foster more patient involvement—and require providers to offer more guidance on medical decision making to consumers. One state that is serving as a model in this area is Washington. The state has passed legislation that endorses the use of shared decision-making tools, such as online questionnaires, DVDs, and handouts, to help patients make important treatment choices. The law states that “improved communication leads to more fully informed patient decisions.”
Two other states, Vermont and Maine, recently passed legislation that promotes shared decision making. At press time, shared decision-making projects were included in proposed healthcare legislation in the U.S. House and Senate.