title: Patient involvement in medical decision-making and pain among elders: physician or patient-driven?
abstract: BACKGROUND
  Pain is highly prevalent among older adults, but little is known about how patient involvement in medical decision-making may play a role in limiting its occurrence or severity. The purpose of this study was to evaluate whether physician-driven and patient-driven participation in decision-making were associated with the odds of frequent and severe pain.
  
  
  METHODS
  A cross-sectional population-based survey of 3,135 persons age 65 and older was conducted in the 108-county region comprising West Texas. The survey included self-reports of frequent pain and, among those with frequent pain, the severity of pain.
  
  
  RESULTS
  Findings from multivariate logistic regression analyses showed that higher patient-driven participation in decision-making was associated with lower odds (OR, 0.82; 95% CI, 0.75-0.89) of frequent pain, but was not significantly associated with severe pain. Physician-driven participation was not significantly associated with frequent or severe pain.
  
  
  CONCLUSIONS
  The findings suggest that patients may need to initiate involvement in medical decision-making to reduce their chances of experiencing frequent pain. Changes to other modifiable health care characteristics, including access to a personal doctor and health insurance coverage, may be more conducive to limiting the risk of severe pain.
authors.affiliation: Department of Health Management and Policy, University of North Texas School of Public Health, 3500 Camp Bowie Blvd,, Fort Worth, TX 76107, USA. tborders@hsc.unt.edu
authors.forename: Tyrone F
authors.initials: TF
authors.lastname: Borders
authors.forename: Ke Tom
authors.initials: KT
authors.lastname: Xu
authors.forename: James
authors.initials: J
authors.lastname: Heavner
authors.forename: Gina
authors.initials: G
authors.lastname: Kruse
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003657:Decision Making; D005260:Female; D006304:Health Status; D006801:Humans; D007348:Insurance, Health; D008297:Male; D016017:Odds Ratio; D010146:Pain / Q000453:epidemiology* / Q000503:physiopathology; D059408:Pain Management; D010358:Patient Participation / Q000706:statistics & numerical data*; D010817:Physician-Patient Relations; D011788:Quality of Life; D012044:Regression Analysis; D011795:Surveys and Questionnaires; D013781:Texas / Q000453:epidemiology