Making decisions about prescription drugs: A study of doctor–patient communication

Effective communication between doctors and their patients is essential to successful medication choices and treatments. Our interest in this exploratory paper lies in the quality of communication between doctors and patients: what both parties seek to explain and what they commonly understand, what opportunities and what frictions occur as a result of their respective goals, what gaps exist in their knowledge bases, and how information of different types influences health risks and medication choices. The data reported in this paper come from conversations with doctors about how they communicate with patients when discussing the benefits and risks of prescription medications, and from patients who talked with us about their concerns and the perceived quality of their communications with physicians. Overall, we were surprised by the failure of the assumed decision-making models to explain much of what we heard and observed. In response, we advance a structured decision-making framework, based on decision analysis and value-focused thinking, that provides both descriptive and prescriptive models of physician–patient communication intended to assist in the development of improved communication standards concerning health risk assessments and medication choices.

[1]  P. Slovic The Construction of Preference , 1995 .

[2]  R. Ruiz-Moral The role of physician–patient communication in promoting patient–participatory decision making , 2010, Health expectations : an international journal of public participation in health care and health policy.

[3]  Ellen Peters,et al.  Beyond information: exploring patients' preferences. , 2009, JAMA.

[4]  James C. Felli,et al.  A Multiattribute Model for Evaluating the Benefit-Risk Profiles of Treatment Alternatives , 2009, Medical decision making : an international journal of the Society for Medical Decision Making.

[5]  Dawn Stacey,et al.  Decision aids for people facing health treatment or screening decisions. , 2009, The Cochrane database of systematic reviews.

[6]  Chenjie Xia,et al.  How Doctors Think , 2008, McGill Journal of Medicine : MJM.

[7]  S. Srivastava Negotiation Analysis , 2008 .

[8]  G. Gigerenzer Rationality for Mortals: How People Cope with Uncertainty , 2008 .

[9]  Judith H Hibbard,et al.  Consumer Competencies and the Use of Comparative Quality Information , 2007, Medical care research and review : MCRR.

[10]  Sam Salek,et al.  A quantitative approach to benefit‐risk assessment of medicines – part 1: the development of a new model using multi‐criteria decision analysis , 2007, Pharmacoepidemiology and drug safety.

[11]  Robin Gregory,et al.  What’s bad is easy: Taboo values, affect, and cognition , 2007, Judgment and Decision Making.

[12]  P. Slovic,et al.  Numeracy skill and the communication, comprehension, and use of risk-benefit information. , 2007, Health affairs.

[13]  C. K. Mertz,et al.  Less Is More in Presenting Quality Information to Consumers , 2007, Medical care research and review : MCRR.

[14]  Paul Slovic,et al.  The affect heuristic , 2007, Eur. J. Oper. Res..

[15]  P. Slovic,et al.  Risk Perception of Prescription Drugs: Results of a National Survey , 2007 .

[16]  Ellen Peters,et al.  The Functions of Affect in Health Communications and in the Construction of Health Preferences , 2006 .

[17]  A. Iltis Lay Concepts in Informed Consent to Biomedical Research: The Capacity to Understand and Appreciate Risk , 2006, Bioethics.

[18]  Paul Slovic,et al.  The Construction of Preference: The Construction of Preference: An Overview , 2006 .

[19]  S. Thorne,et al.  Is there a cost to poor communication in cancer care?: a critical review of the literature , 2005, Psycho-oncology.

[20]  L. Siminoff,et al.  A communication model of shared decision making: accounting for cancer treatment decisions. , 2005, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[21]  P. Butow,et al.  Communicating prognosis in cancer care: a systematic review of the literature. , 2005, Annals of oncology : official journal of the European Society for Medical Oncology.

[22]  M. F. Luce,et al.  Decision making as coping. , 2005, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[23]  Baruch Fischhoff,et al.  Acceptable Input: Using Decision Analysis to Guide Public Policy Deliberations , 2005, Decis. Anal..

[24]  Ralph L. Keeney,et al.  Selecting Attributes to Measure the Achievement of Objectives , 2005, Oper. Res..

[25]  Melissa L. Finucane,et al.  Risk as Analysis and Risk as Feelings: Some Thoughts about Affect, Reason, Risk, and Rationality , 2004, Risk analysis : an official publication of the Society for Risk Analysis.

[26]  Mitchell J. Small,et al.  Risk Analysis and Society , 2004 .

[27]  L. Fallowfield,et al.  Enduring impact of communication skills training: results of a 12-month follow-up , 2003, British Journal of Cancer.

[28]  R. Gregory,et al.  Risk Analysis and Society: Valuing Risk Management Choices , 2003 .

[29]  D. Kahneman MAPS OF BOUNDED RATIONALITY: A PERSPECTIVE ON INTUITIVE JUDGMENT AND CHOICE , 2003 .

[30]  R. Thomson,et al.  Decision aids for people facing health treatment or screening decisions. , 2003, The Cochrane database of systematic reviews.

[31]  C. Berg,et al.  Contexts, functions, forms, and processes of collaborative everyday problem solving in older adulthood , 2002 .

[32]  C P Bradley,et al.  Doctor-patient communication about drugs: the evidence for shared decision making. , 2000, Social science & medicine.

[33]  Gary Klein,et al.  Sources of Power: How People Make Decisions , 2017 .

[34]  Glyn Elwyn,et al.  General practice registrar responses to the use of different risk communication tools in simulated consultations: a focus group study , 1999, BMJ.

[35]  C. Charles,et al.  Decision-making in the physician-patient encounter: revisiting the shared treatment decision-making model. , 1999, Social science & medicine.

[36]  Ralph L. Keeney,et al.  Book Reviews : Scientific Opportunities and Public Needs: Improv ing Priority Setting and Public Input at the National Institutes of Health. Institute of Medicine. Washington, DC: National Academy Press, 1998, 136 pages, $26.00 , 1998 .

[37]  Amiram Gafni,et al.  Decision-making in the physician-patient encounter , 1998 .

[38]  P. Slovic,et al.  A psychological study of the inverse relationship between perceived risk and perceived benefit. , 1994, Risk analysis : an official publication of the Society for Risk Analysis.

[39]  F. B. Vernadat,et al.  Decisions with Multiple Objectives: Preferences and Value Tradeoffs , 1994 .

[40]  Eric J. Johnson,et al.  The adaptive decision maker , 1993 .

[41]  Ralph L. Keeney,et al.  Value-Focused Thinking: A Path to Creative Decisionmaking , 1992 .

[42]  Gordon Miller,et al.  Decision Making: Descriptive, Normative, and Prescriptive Interactions , 1990 .

[43]  Ralph L. Keeney,et al.  Feature Article - Decision Analysis: An Overview , 1982, Oper. Res..

[44]  A. Tversky,et al.  On the elicitation of preferences for alternative therapies. , 1982, The New England journal of medicine.

[45]  R. Keeney Decision analysis: an overview. , 1982, Operations research.

[46]  R. L. Keeney,et al.  Decisions with Multiple Objectives: Preferences and Value Trade-Offs , 1977, IEEE Transactions on Systems, Man, and Cybernetics.

[47]  L. Ogilvie What's the Trouble? , 1979 .

[48]  John B. Kidd,et al.  Decisions with Multiple Objectives—Preferences and Value Tradeoffs , 1977 .

[49]  T. Covington,et al.  Drug defaulting. II. Analysis of noncompliance patterns. , 1974, American journal of hospital pharmacy.

[50]  A. Tversky,et al.  On the psychology of prediction , 1973 .