Floyd J. Fowler Jr., PhD
Not long ago, I was talking with a news reporter about an article we published on how surgical decisions are made. The paper reported that surgery patients too often were not given enough information about reasonable options. During our discussion the reporter remarked that the findings of the study were all well and good for some people, but didn’t apply to her elderly dad. Her dad would never have wanted to have information or be involved in medical decisions about his care. Instead, he would just look to his wife to tell him what to do.
Of course, I don’t know this reporter’s father, so I can’t speak for him. But the notion that older individuals and individuals with less education don’t want to be informed and involved in their medical decisions is something I’ve often heard. However, the evidence shows us this simply isn’t true. In fact, it is these two groups that benefit the most from well-presented information and are particularly positive about efforts to inform and involve them in their medical care.
In 2007, a national sample of adults were interviewed about their feelings toward shared decision making. While the overall ratings were quite positive, those over 65 and those with less education expressed more concerns about whether they could play an effective role in making decisions and whether their doctors would be okay with that. However, this was a cross-section of adults, most of whom had little experience with physicians trying to inform or involve them.
We get a different picture when we collect data from people who actually have experience with doctors who provide them with information in a user-friendly way and encourage them to participate in decision making. For example, at the Dartmouth-Hitchcock Medical Center in Hanover, N.H., patients facing surgery routinely are given DVDs that explain in detail their options and the pros and cons of those options before meeting with a physician to make a decision. We have ratings from over 2000 patients who were given those programs, and the ratings are overwhelmingly positive. Moreover, those 65 or older were slightly more likely (76% vs. 69%) than those who were younger to “strongly recommend” that others see decision aids before deciding on a surgical procedure.
Another concern I have heard is that the presentation of statistical information about risks and benefits does not benefit these groups. Again, the evidence shows us that this just isn’t the case. The key is presenting this type of information in a clear and user-friendly way. When information is well presented, those with less education and those who are older learn as much, and often more, than those with more education. It is just a matter of doing a good job of organizing and presenting what people need to know.
So the truth is that with encouragement and well-designed decision support tools, shared decision making is possible and beneficial to all patients regardless of education and age.
Floyd J. Fowler, Jr., PhD, is the Foundation’s senior scientific officer. He is the author of a series of Foundation Perspective white papers that look at common questions about shared decision making and provide our best answers based on the current available research.
