Decision roadblock? Physicians fail to list treatment alternatives

Study: Patients not actively involved in medical decision-making process

A study in the Journal of General Internal Medicine found that many Medicare patients who received a stent or prostate surgery were unaware of their medical options before undergoing the procedure.

For the study, University of Massachusetts Boston researchers and colleagues surveyed 472 Medicare beneficiaries who received stents for coronary disease and 685 who underwent prostate cancer surgery about their medical decision-making process. Although the conditions are "clinically really different," study author Floyd Fowler notes that "completely conservative treatment is a reasonable option for both."

The survey found that 76% of prostate surgery patients recalled being asked which treatment they preferred, compared with 16% of stent recipients. Meanwhile, 64% of patients who received prostate surgery said their physicians discussed alternatives to surgery, compared with 10% of patients who received stents.

"The core of a good decision-making process is to know what the options are, hear the pros and cons, and that someone should ask you what you think," Fowler said. To increase patient involvement in medical decision-making, the authors suggest engaging primary care physicians in the discussion process and pointing patients to decision aids, such as pamphlets, DVDs, or Web-based information (Hobson, "Health Blog," Wall Street Journal, 3/2; Fowler, et al., Journal of General Internal Medicine, 2/28).

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