Increasing patient responsibility in medical decisions may decrease their willingness to accept risky treatment options

September 22, 2015

Video A discussed a new medication to prevent heart disease where patients have the rare risk of developing jaw necrosis. Video B described a new medication to treat chronic pain where there was a risk of progressive multifocal leukoencephalopathy relevant to patients with rheumatic diseases. Participants were provided 2 consecutive sets of instructions following the video viewing. The first set of instructions was designed to minimize choice, "The doctor decides that you should take this medication and she writes you a prescription for it." The second set of instructions maximized choice: "The doctor tells you that it is completely up to you whether or not you take this medication and then asks you to make a decision."

"We found that highlighting the perception of having a choice increases patients' worry about the risks of adverse events and decreases their willingness to accept treatment," said Dr. Fraenkel. Results showed the willingness of patients to take the proposed medication was lower (mean - SD 4.2 - 3.7 versus 5.3 - 3.7) and their worry about the risk of the adverse event was greater in the high compared with the low involvement condition (mean - SD 6.1 - 3.7 versus 5.5 - 3.8). "Clinicians should be aware that promoting increased patient responsibility for decisions involving their health care may be associated with lower uptake of risky procedures or interventions," advised Dr. Fraenkel

Source: Wiley-Blackwell