The effect of physician's explanations on patients' treatment preferences: five-year survival data.
OBJECTIVE
To evaluate the influence of physicians' explanations on patients' choices.


METHODS
A university-based Department of Veterans Affairs Medical Center.


METHODS
136 patients seen in a continuity-care general medicine clinic.


RESULTS
Patients were randomized to two groups [Limited Explanation (LE) and Extensive Explanation (EE)] and asked to choose between two alternative treatments (differing in short-term vs long-term survival benefits) for an unidentified medical condition, based on the information given in the explanations. LE consisted of a brief orientation to graphs summarizing the treatment results, while EE consisted of a detailed verbal description of the graphs. Significantly (p < 0.001) more patients receiving EE changed their preferences across the three pairs of five-year survival curves, compared with patients receiving LE. Of the patients receiving EE, 57% reported either medium-term (year 0-to-intercept or intercept-to-year 5) data or the average life expectancy for the five-year period contained in the curves (ALE-5) as most influencing their decision making; whereas 78% of patients receiving LE reported only endpoint (year 0 or year 5) data as most influencing their preferences.


CONCLUSIONS
The patients' treatment preferences for long-term vs short-term survival benefits were influenced by the amounts of verbal explanation provided to them about five-year survival graphs summarizing treatment results. The patients appeared to minimize the importance of medium-range data when those data were not specifically pointed out to them.
Mazur
D J
DJ
Medical Service, Department of Veterans Affairs Medical Center, Portland, OR 97207.
Hickam
D H
DH
D005260:Female; D006787:Hospitals, Veterans; D006801:Humans; D007258:Informed Consent; D008017:Life Expectancy; D008175:Lung Neoplasms / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009922:Oregon; D010342:Patient Acceptance of Health Care; D010353:Patient Education as Topic / Q000379:methods*; D010358:Patient Participation; D010817:Physician-Patient Relations; D011182:Postoperative Care; D015983:Selection Bias; D015996:Survival Rate