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Purpose. Variability in reports of patients' preferences to participate in decision making may be due in part to a lack of understanding about how patients conceptualize their participation. The authors sought to learn more about how patients view their involvement in decisions related to their health care. Methods. The authors conducted individual interviews to allow patients to frame the decision-making process from their own perspective. The constant comparative-method approach to analysis was employed to ensure that the analysts defined the codes in a consistent manner. Results. Twenty-six persons were interviewed. The main themes discussed by the participants reflecting how they viewed their involvement in medical decision making are the following: 1) decision making is often an ongoing process in which patient participation may change over time, 2) decision making is performed within an extended social context, 3) the decisions patients report being involved in are often distinct from those traditionally studied (choice of treatment or screening strategies), 4) patient involvement in decision making occurs in response to physicians' recommendations, and 5) patients make choices in the context of their specific illness perceptions. Conclusions. Participants in this study view their participation in decision making as including ideas distinct from those traditionally discussed by researchers. These findings suggest that the variability in patient participation noted in previous studies may be due in part to limitations in study design. Key words: medical decision making; qualitative study; patient participation. (Med Decis Making 2007;27:533-538), Patient participation in decision making fulfills the ethical principle of patient autonomy and the legal requirement of informed consent. Studies published to date, however, have reported significant variability in how [...]

Objective. To determine if 1) patients have distinct affective reaction patterns to medication information, and 2) whether there is an association between affective reaction patterns and willingness to take medication. Methods. We measured affect in real time as subjects listened to a description of benefits and side effects for a hypothetical new medication. Subjects moved a dial on a handheld response system to indicate how they were feeling from “Very Good” to “Very Bad”. Patterns of reactions were identified using a cluster-analytic statistical approach for multiple time series. Subjects subsequently rated their willingness to take the medication on a 7-point Likert scale. Associations between subjects’ willingness ratings and affect patterns were analyzed. Additional analyses were performed to explore the role of race/ethnicity regarding these associations. Results. Clusters of affective reactions emerged that could be classified into 4 patterns: “Moderate” positive reactions to benefits and negative reactions to side effects (n = 186), “Pronounced” positive reactions to benefits and negative reactions to side effects (n = 110), feeling consistently “Good” (n = 58), and feeling consistently close to “Neutral” (n = 33). Mean (standard error) willingness to take the medication was greater among subjects feeling consistently Good 4.72 (0.20) compared with those in the Moderate 3.76 (0.11), Pronounced 3.68 (0.14), and Neutral 3.62 (0.26) groups. Black subjects with a Pronounced pattern were less willing to take the medication compared with both Hispanic (P = 0.0270) and White subjects (P = 0.0001) with a Pronounced pattern. Conclusion. Patients’ affective reactions to information were clustered into specific patterns. Reactions varied by race/ethnicity and were associated with treatment willingness. Ultimately, a better understanding of how patients react to information may help providers develop improved methods of communication. [ABSTRACT FROM AUTHOR]

Background. Order and amount of information influence patients’ risk perceptions, but most studies have evaluated patients’ reactions to written materials. The objective of this study was to examine the effect of 4 communication strategies, varying in their order and/or amount of information, on judgments related to an audible description of a new medication and among patients who varied in subjective numeracy. Methods. We created 5 versions of a hypothetical scenario describing a new medication. The versions were composed to elucidate whether order and/or amount of the information describing benefits and adverse events influenced how subjects valued a new medication. After listening to a randomly assigned version, perceived medication value was measured by asking subjects to choose one of the following statements: the risks outweigh the benefits, the risks and benefits are equally balanced, or the benefits outweigh the risks. Results. Of the 432 patients contacted, 389 participated in the study. Listening to a brief description of benefits followed by an extended description of adverse events resulted in a greater likelihood of perceiving that the medication’s benefits outweighed the risks compared with 1) presenting the extended adverse events description before the benefits, 2) giving a greater amount of information related to benefits, and 3) sandwiching the adverse events between benefits. These associations were only observed among subjects with average or higher subjective numeracy. Conclusion. If confirmed in future studies, our results suggest that, for patients with average or better subjective numeracy, perceived medication value is highest when a brief presentation of benefits is followed by an extended description of adverse events. [ABSTRACT FROM AUTHOR]

Background. Numerous studies have found that cost strongly influences patients’ decision making. The objective of this study was to explore the impact of varying cost formats on patients’ preferences. Methods. Mechanical Turk workers completed a choice-based conjoint (CBC) survey. The CBC survey was designed to examine stated preferences for the use of second-line agents to treat diabetes across 5 attributes: route of administration, efficacy, risk of low blood sugar, frequency of checking blood sugar levels, and cost. We developed 7 versions of the CBC survey that were identical except for the cost attribute. We described cost in terms of: Affordability, Monthly Co-pay, Dollar Sign Rating, How Expensive, or How Cheap compared with other medications, Working Hours Equivalent (per mo) and Percent of Monthly Income. The resulting part-worth utilities were used to calculate the relative importance of cost and to estimate treatment preferences for exenatide, a sulfonylurea, and insulin. Results. The relative impact of cost varied significantly across the 7 formats. Cost had the greatest influence on participants’ decisions when framed in terms of Affordability [mean (SD) relative importance, 37.3 (0.9)] and the lowest influence when framed in terms of How Cheap (compared with other drugs) [12.1 (0.9)]. A sulfonylurea was strongly preferred across 4 of the 7 formats. Preference for insulin, the most effective, albeit riskiest, option was low across all cost formats. Conclusions. The format used to describe cost affects how the attribute impacts patients’ preferences. Individuals are most cost-sensitive when cost is framed in terms of affordability and least cost-sensitive when cost is described in terms of how cheap the medication is compared with others. [ABSTRACT FROM AUTHOR]

Background. Annual lung cancer screening using low-dose computed tomography (LDCT) scans is associated with a survival benefit, but it is also associated with potential harm. Unlike descriptive probability formats, experienced tasks have been shown to decrease perceptions of rare events. The objective of this study was to compare descriptive versus experienced probability formats on patients’ knowledge, beliefs, endorsement of screening for heavy smokers, and preference (choice predisposition) to undergo screening. Methods. A total of 276 patients attending an outpatient pulmonary practice were randomized to learn about screening using 1 of 3 formats: numbers only, numbers + icon arrays, numbers + a set of slides illustrating LDCT scans of 250 people in random order that displayed the number of normal scans, false-positive lung nodules, cancers found leading to a life saved, and cancers found leading to death despite treatment. Results. Knowledge differed between the 3 formats (P = 0.001), with participants randomized to the numbers + icon array format having the highest knowledge score. Beliefs were more favorable among participants randomized to the numbers + experienced format compared with the numbers + icon array format (difference between means [95% confidence interval]= 1.6 [0.4–2.8]). Differences in participants’ endorsement of screening (P = 0.4) and choice predisposition (P = 0.6) across probability format mirrored those of beliefs but were not statistically significant. Discussion. Contrary to what we expected, the experienced format increased propensity toward screening compared with the numbers + icon array format, as indicated by more favorable beliefs and nonsignificant trends toward stronger choice predisposition and endorsement. Experienced risk formats may not be a practical approach to improve risk communication for patients deciding whether or not to undergo annual lung cancer screening. [ABSTRACT FROM AUTHOR]

Background. The objective of this study was to ascertain patient preferences for treatment of hepatitis C virus (HCV). Methods. The authors recruited consecutive patients eligible for treatment of HCV and used adaptive conjoint analysis (ACA), a hybrid approach of conjoint analysis that uses both self-explicated ratings and pairwise comparisons, to elicit preferences for pegylated-interferon and ribavirin. They examined the association between patient characteristics and treatment preferences using the Mann-Whitney U test and χ² statistic for continuous and categorical variables, respectively, and subsequently calculated adjusted odds ratios and 95% confidence intervals using logistic regression. Results. A total of 140 subjects completed the ACA task. The mean (± SD) age of the sample was 51 ± 8 y; 85% were male, and 59% were white. When described as being associated with mild side effects, 67% (n=94) of subjects preferred treatment for HCV. The percentage of subjects preferring therapy decreased to 51% (n=72) when it was described as being associated with severe side effects. Preferences for treatment of HCV were stronger among subjects with a higher perceived risk of developing cirrhosis, more severe underlying liver disease, and worse HCV-related quality of life. Subjects having more severe disease placed greater weight on the importance of expected benefits and less on the risk of toxicity compared with those with mild or no fibrosis. Conclusions. Whether to choose treatment for HCV is a difficult decision for many patients. Treatment is usually recommended for those with moderate to severe liver disease, and these results demonstrate that most patients' preferences are concordant with this practice. [ABSTRACT FROM AUTHOR]