Choosing where to have major surgery: who makes the decision?
OBJECTIVE
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.


METHODS
Telephone interviews.


METHODS
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).


CONCLUSIONS
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.
Wilson
Chad T
CT
Department of Veterans Affairs Medical Center, VA Outcomes Group, White River Junction, VT, USA. ctwilson@partners.org
Woloshin
Steven
S
Schwartz
Lisa M
LM
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D013504:Cardiovascular Surgical Procedures; D015653:Cystectomy; D003657:Decision Making; D005260:Female; D005743:Gastrectomy; D006801:Humans; D008297:Male; D010820:Physicians / Q000523:psychology*; D012189:Retrospective Studies; D012737:Sex Factors; D011795:Surveys and Questionnaires