Mon, Feb 13, 2017, noon:
Daniel Almirall, "Getting SMART about adaptive interventions"
Zikmund-Fisher, B., Mick P. Couper, and A. Fagerlin. 2012. "Disparities in patient reports of communications to inform decision making in the DECISIONS survey." Patient Education and Counseling, 87(2): 198-205.
OBJECTIVE: To identify patient- and decision-type predictors of two key aspects of informed decision making: discussing the cons (not just the pros) of medical interventions and asking patients what they want to do. METHODS: Using data from 2473 members of the DECISIONS survey, a nationally representative sample of U.S. adults age 40+, we used logistic regression analysis to identify which patient characteristics predicted patient reports of healthcare providers discussing cons or eliciting preferences about one of 9 common medical decisions. RESULTS: Multiple demographic characteristics predicted both discussions of cons and elicitations of preferences, although the specific characteristics varied between decision contexts. In particular, African-American respondents reported being more likely to receive a discussion of the cons of cancer screening (OR=1.69, p<0.05) yet less likely to have been asked their opinion about either getting a cancer screening test (OR=0.56, p<0.05) or initiating medications (OR=0.53, p<0.05). Significant cross-decision variations remained even after controlling for patient characteristics. CONCLUSIONS: Important disparities in patient communication and involvement appear to exist both between different types of medical decisions and between different types of patients. PRACTICE IMPLICATIONS: Providers must make sure to consistently discuss the cons of treatment and to solicit input from all patients, especially African-Americans.