Taylor et al assess the effectiveness of two 2 decision aids in helping men make informed prostate cancer screening decisions. Reuland and Pignone provide an Invited Commentary.
This review of US statutes and legal cases concerning guardianship of impaired adults seeks to provide multidisciplinary guidance to physicians and guardians about end-of-life treatment decisions.
This cross-sectional analysis found that informed decision making is often incomplete in conversations between cardiologists and patients with stable angina.
This interview study found that institutional cultures and policies might influence how physician trainees make decisions regarding do-not-resuscitate orders.
Torke et al describe the scope of surrogate decision making, the hospital course, and outcomes for older adults. See also the invited commentary by Schenker and Barnato.
To examine the relationship between patient preferences for participation in medical decision making and health care utilization among hospitalized patients, Tak et al administered a survey to all patients admitted to the University of Chicago Medical Center general internal medicine service between 2003 and 2011. See the Invited Commentary by Lipkin.
Clinicians are caring for an increasing number of older patients with multiple diseases in the face of uncertainty concerning the benefits and harms associated with guideline-directed interventions. Understanding how primary care clinicians approach treatment decision making for these patients is critical to the design of interventions to improve the decision-making process.
Focus groups were conducted with 40 primary care clinicians (physicians, nurse practitioners, and physician assistants) in academic, community, and Veterans Affairs–affiliated primary care practices. Participants were given open-ended questions about their approach to treatment decision making for older persons with multiple medical conditions. Responses were organized into themes using qualitative content analysis.
The participants were concerned about their patients' ability to adhere to complex regimens derived from guideline-directed care. There was variability in beliefs regarding, and approaches to balancing, the benefits and harms of guideline-directed care. There was also variability regarding how the participants involved patients in the process of decision making, with clinicians describing conflicts between their own and their patients' goals. The participants listed a number of barriers to making good treatment decisions, including the lack of outcome data, the role of specialists, patient and family expectations, and insufficient time and reimbursement.
The experiences of practicing clinicians suggest that they struggle with the uncertainties of applying disease-specific guidelines to their older patients with multiple conditions. To improve decision making, they need more data, alternative guidelines, approaches to reconciling their own and their patients' priorities, the support of their subspecialist colleagues, and an altered reimbursement system.