title: How doctors and patients discuss routine clinical decisions. Informed decision making in the outpatient setting.
abstract: OBJECTIVE
  To characterize the informed consent process in routine, primary care office practice.
  
  
  METHODS
  Cross-sectional, descriptive evaluation of audiotaped encounters.
  
  
  METHODS
  Offices of primary care physicians in Portland, Oregon.
  
  
  METHODS
  Internists (54%) and family physicians (46%), and their patients.
  
  
  RESULTS
  Audiotapes of primary care office visits from a previous study of doctor-patient communication were coded for the number and type of clinical decisions made. The discussion between doctor and patient was scored according to six criteria for informed decision making: description of the nature of the decision, discussion of alternatives, discussion of risks and benefits, discussion of related uncertainties, assessment of the patient's understanding and elicitation of the patient's preference. Discussions leading to decisions included fewer than two of the six described elements of informed decision making (mean 1.23, median 1.0), most frequent of these was description of the nature of the decision (83% of discussion). Discussion of risks and benefits was less frequent (9%), and assessment of understanding was rare (2%). Discussions of management decisions were generally more substantive than discussions of diagnostic decisions (p = .05).
  
  
  CONCLUSIONS
  Discussions leading to clinical decisions in these primary care settings did not fulfill the criteria considered integral to informed decision making. Physicians frequently described the nature of the decision, less frequently discussed risks and benefits, and rarely assessed the patient's understanding of the decision.
authors.affiliation: Department of Medicine, University of Washington, Seattle, USA.
authors.forename: C H
authors.initials: CH
authors.lastname: Braddock
authors.forename: S D
authors.initials: SD
authors.lastname: Fihn
authors.forename: W
authors.initials: W
authors.lastname: Levinson
authors.forename: A R
authors.initials: AR
authors.lastname: Jonsen
authors.forename: R A
authors.initials: RA
authors.lastname: Pearlman
mesh_terms: D000704:Analysis of Variance; D016009:Chi-Square Distribution; D003142:Communication; D003430:Cross-Sectional Studies; D003657:Decision Making; D004992:Ethics, Medical; D005260:Female; D006801:Humans; D007258:Informed Consent; D008297:Male; D015588:Observer Variation; D010045:Outpatients; D010358:Patient Participation; D010817:Physician-Patient Relations; D011320:Primary Health Care; D012189:Retrospective Studies; D018709:Statistics, Nonparametric