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

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• 作者：Floyd J. Fowler Jr PhD (1) (2)
  Patricia M. Gallagher PhD (1)
  Julie P. W. Bynum MD (3) (7)
  Michael J. Barry MD (2) (4)
  F. Leslie Lucas PhD (5)
  Jonathan S. Skinner PhD (6) (7)
  
• 关键词：shared decision making ; decision quality ; patient ; centered care
• 刊名：Journal of General Internal Medicine
• 出版年：2012
• 出版时间：August 2012
• 年：2012
• 卷：27
• 期：8
• 页码：911-916
• 全文大小：158KB
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• 作者单位：Floyd J. Fowler Jr PhD (1) (2)
  Patricia M. Gallagher PhD (1)
  Julie P. W. Bynum MD (3) (7)
  Michael J. Barry MD (2) (4)
  F. Leslie Lucas PhD (5)
  Jonathan S. Skinner PhD (6) (7)
  
  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
  

文摘

Background 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. Objectives To learn how decisions were made for two major preference-sensitive interventions. Design Mail survey of probability samples of patients who underwent the procedures. Participants 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. Results 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. Conclusions 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.