The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #65846

Marla L. Clayman, PhD, MPH¹, Lawrence S. Wissow, MD, MPH², and Debra Roter, DrPH². (1) Division of Cancer Control and Population Sciences, Outcomes Research Branch, National Cancer Institute, 6130 Executive Boulevard, Room 4005, MSC 7344, Bethesda, MD 20892-7344, 301 435 4986, claymanm@mail.nih.gov, (2) Health Policy and Management, Johns Hopkins University, 624 North Broadway, Room 750, Baltimore, MD 21205

Objective: To determine to what extent decisions in geriatric primary care visits are made according to autonomy-based informed decision-making criteria and to what extent patients and companions are active in that process. Design/Methods: Videotapes of a cross-sectional sample (n=94) of accompanied non-cognitively-impaired geriatric patients were coded for absence or presence of seven specific characteristics of autonomous decision-making: clinical issue, choices, benefits, risks, uncertainties, patient understanding, and patient preference. A person was considered “active” in decision-making if he or she asked for a specific remedy or test or participated in at least 3 autonomy elements in a decision. Results: There were 302 decisions made in this sample (mean: 3.2 decisions per visit; range: 0-13). Decisions related to medications were the most common (n=126, 40%). The mean autonomy score (range: 0-7) was 3.5, while the mean decision autonomy score excluding the companion’s contribution is 3.1. The autonomy score using all three participants and the autonomy score counting only the doctor’s and patient’s contributions were highly correlated (r=.82). The average number of autonomy elements in which doctors, patients, and companions participated was 3.3, 2.3, and 1.0, respectively. Thirty-four companions (40% of visits with decisions) and 66 (78%) of patients were considered active in decision-making. There was no relationship, however, between the patient’s and companion’s decision-making activity. Conclusions: Geriatric patients, and to a lesser extent, companions, are relatively active in primary care decision-making when three people are present. Most decisions in geriatric primary care visits do not fulfill the criteria for autonomous decision-making.

Learning Objectives:

• At the conclusion of the session, the participant (learner) in this session will be able to:
• Identify criteria necessary for autonomous, informed decision-making.
• Articulate the level of participation in decision-making by patients, companions, and physicians in geriatric primary care visits with companions
• Discuss the correlates of autonomous decison-making.

Keywords: Decision-Making, Elderly

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.