Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 1997 Jun;12(6):339-45.
doi: 10.1046/j.1525-1497.1997.00057.x.

How doctors and patients discuss routine clinical decisions. Informed decision making in the outpatient setting

C H Braddock 3rd  1 , S D Fihn, W Levinson, A R Jonsen, R A Pearlman
Affiliations

How doctors and patients discuss routine clinical decisions. Informed decision making in the outpatient setting

C H Braddock 3rd et al. J Gen Intern Med. 1997 Jun.

Abstract

Objective: To characterize the informed consent process in routine, primary care office practice.

Design: Cross-sectional, descriptive evaluation of audiotaped encounters.

Setting: Offices of primary care physicians in Portland, Oregon.

Participants: Internists (54%) and family physicians (46%), and their patients.

Measurements and main 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.

PubMed Disclaimer

Figures

FIGURE 1
FIGURE 1
How frequently each element of informed decision making was part of physician-patient discussion.
See this image and copyright information in PMC

Comment in

References

    1. Joint Commission for the Accreditation of Healthcare Organizations. Accreditation Manual for Hospitals. Oakbrook Terrace, Ill: Joint Commission; 1993.
    1. Appelbaum PS, Lidz CW, Meisel A. New York, NY: Oxford University Press; 1987. Informed Consent: Legal Theory and Clinical Practice.
    1. President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. Making Health Care Decisions: A Report on the Ethical and Legal Implications of Informed Consent in the Patient-Practitioner Relationship. Washington, DC: US Government Printing Office; 1982.
    1. Katz J. New York, NY: Free Press; 1984. The Silent World of Doctor and Patient.
    1. Ubel P. Informed consent: from bodily invasion to the seemingly mundane. Arch Intern Med. 1996;156:1262–3. - PubMed

Publication types