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Who Makes the Decision?

Chad T. Wilson, MD; Steven Woloshin, MD, MS; Lisa M. Schwartz, MD, MS

Arch Surg. 2007;142(3):242-246.

Hypothesis  Efforts are under way to distribute hospital performance data directly to patients to inform their decisions about where to go for major surgery, but patients are not always involved in making the decision of where they will have surgery.

Design  Telephone interviews.

Participants  Five hundred ten randomly selected Medicare patients who had undergone 1 of 5 elective high-risk operations approximately 3 years earlier: abdominal aneurysm repair (n = 103), heart valve replacement surgery (n = 96), or resections for bladder (n = 119), lung (n = 128), or stomach (n = 64) cancer.

Main Outcome Measure  Proportion of patients who responded that their physician was the main decision maker of where they would have surgery.

Results  Thirty-one percent of patients said their physician was the main decision maker about where the patient would have surgery (42% said they decided equally with their physician, 22% said they were the main decision maker, and 5% said their family helped make the decision for them). This proportion was similar across patient age, income, and educational attainment. Men were more likely to say the physician was the main decision maker (34% vs 24%; P = .02), as were patients in poor to fair health compared with those in good to excellent health (37% vs 28%; P = .05). The physician was significantly more likely to be the main decision maker for cardiovascular operations compared with cancer operations (39% vs 26%; P = .001).

Conclusion  Although most patients participated in the decision of where they would have major surgery, one third said the decision was made mainly by their physician.

Author Affiliations: Department of Veterans Affairs Medical Center, VA Outcomes Group, White River Junction, Vt (Drs Wilson, Woloshin, and Schwartz); the Center for the Evaluative Clinical Sciences, Dartmouth Medical School, Hanover, NH (Drs Wilson, Woloshin, and Schwartz); and Department of Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH (Drs Woloshin and Schwartz). Dr Wilson is now with Massachusetts General Hospital, Boston.

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