A randomized trial of decision-making in asymptomatic carotid stenosis.
OBJECTIVE
We sought to evaluate whether different presentation formats, presenter characteristics, and patient characteristics affect decision-making in asymptomatic carotid stenosis.


METHODS
Subjects included individuals presenting to a neurology clinic. Participants included those over age 18 without known carotid stenosis. Subjects were randomized to a 30-second video with 1 of 5 presentation formats (absolute risk, absolute event-free survival, annualized absolute risk, relative risk, and a qualitative description) delivered by 1 of 4 presenter physicians (black woman, white woman, black man, white man). Subjects then completed a one-page form regarding background demographics and their decision regarding treatment choice.


RESULTS
A total of 409 subjects watched the video and completed the survey. Overall, 48.4% of subjects chose surgery. Presentation format strongly predicted choice of surgery (qualitative [64%], relative risk [63%], absolute risk [43%], absolute event-free survival [37%], and annualized absolute risk [35%], p < 0.001). There was a trend for younger age (mean age 52 vs 55, p = 0.054), male gender (53% vs 45%, p = 0.08), and advanced education (42% for high school education or less vs 52% for more than high school education, p = 0.052) to predict surgery choice. Gender and race of presenter, and race of subject, had no influence on the choice of treatment.


CONCLUSIONS
Presentation format (information framing) strongly determines patient decision-making in asymptomatic carotid stenosis. Subject age, gender, and education level may also influence the decision. Clinicians should consider the influence of these variables when counseling patients.
Department of Neurology, Rhode Island Hospital, Providence, RI, USA. bsilver@lifespan.org
B
B
Silver
I F
IF
Zaman
K
K
Ashraf
Y
Y
Majed
E M
EM
Norwood
L A
LA
Schuh
B J
BJ
Smith
R E
RE
Smith
L R
LR
Schultz
D000367:Age Factors; D000368:Aged; D000375:Aging / Q000523:psychology; D016893:Carotid Stenosis / Q000523:psychology* / Q000601:surgery; D003657:Decision Making; D018572:Disease-Free Survival; D004522:Educational Status; D005006:Ethnicity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000523:psychology*; D016017:Odds Ratio; D010353:Patient Education as Topic; D040242:Risk Reduction Behavior; D012737:Sex Factors; D012959:Socioeconomic Factors