Patients' knowledge about 9 common health conditions: the DECISIONS survey.
BACKGROUND
To make informed decisions, patients must have adequate knowledge of key decision-relevant facts.


OBJECTIVE
To determine adults' knowledge about information relevant to common types of medication, screening, or surgery decisions they recently made.


METHODS
National sample of US adults identified by random-digit dialing.


METHODS
Cross-sectional survey conducted between November 2006 and May 2007.


METHODS
A total of 2575 English-speaking adults aged 40 y or older who reported having discussed the following medical decisions with a health care provider within the previous 2 y: prescription medications for hypertension, hypercholesterolemia, or depression; screening tests for colorectal, breast, or prostate cancer; or surgeries for knee/hip replacement, cataracts, or lower back pain.


METHODS
Participants answered knowledge questions and rated the importance of their health care provider, family/friends, and the media as sources of information.


RESULTS
Accuracy rates varied widely across questions and decision contexts. For example, patients considering cataract surgery were more likely to correctly estimate recovery time than those patients considering lower back pain or knee/hip replacement (78% v. 29% and 39%, P < 0.001). Similarly, participants were more knowledgeable of facts about colorectal cancer screening than those who were asked about breast or prostate cancer. Finally, respondents were consistently more knowledgeable on comparable questions about blood pressure medication than cholesterol medication or antidepressants. The impact of demographic characteristics and sources of information also varied substantially. For example, blacks had lower knowledge than whites about cancer screening decisions (odds ratio [OR] = 0.57; 95% confidence interval [CI] = 0.43, 0.75; P = 0.001) and medication (OR = 0.77; 95% CI = 0.60, 0.97; P = 0.03) even after we controlled for other demographic factors. The same was not true for surgical decisions.


CONCLUSIONS
The questions did not measure all knowledge relevant to informed decision making, were subject to recall biases, and may have assessed numeracy more than knowledge.


CONCLUSIONS
Patient knowledge of key facts relevant to recently made medical decisions is often poor and varies systematically by decision type and patient characteristics. Improving patient knowledge about risks, benefits, and characteristics of medical procedures is essential to support informed decision making.
Fagerlin
Angela
A
VA Health Services Research & Development Center of Excellence, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA. fagerlin@med.umich.edu
Sepucha
Karen R
KR
Couper
Mick P
MP
Levin
Carrie A
CA
Singer
Eleanor
E
Zikmund-Fisher
Brian J
BJ
D000328:Adult; D000368:Aged; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D003657:Decision Making; D055088:Early Detection of Cancer; D004521:Educational Measurement; D004522:Educational Status; D005260:Female; D013502:General Surgery; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery; D016017:Odds Ratio; D010353:Patient Education as Topic; D010358:Patient Participation; D055553:Prescription Drugs; D012306:Risk
D055553:Prescription Drugs