HOW DOES FEELING INFORMED RELATE TO ACTUALLY BEING INFORMED?

 Purpose: To examine patients’ perceptions about how informed they were for nine common health care decisions and compare that to their responses to specific factual knowledge questions.

    Method: The DECISIONS survey was a nationwide random digit dial telephone interview survey of adults age 40 and older. Participants completed one or two modules for medical decisions made within the past 2 years about starting prescription medications (for high blood pressure, cholesterol, or depression), cancer screening (for colorectal, breast, or prostate cancer), and/or elective surgery (for cataract, knee/hip replacement, or back pain). For each module, respondents were asked how informed they felt, on a scale of 0 to 10 where 0 was not at all informed and 10 was extremely well-informed. Respondents also answered 4 or 5 specific knowledge questions for each condition, standard demographic questions, and other related items.

   Results:  2,575 survey respondents were included in analyses. Overall, 36% of patients felt extremely well-informed (response: 10), 41% felt well-informed (7-9), and 22% felt less informed (0-6). Perceptions varied across decision type, with 44% of patients feeling extremely well-informed about surgical decisions as compared to 35% for medication and 35% for screening decisions (F(3.76, 9628)=2.59, p=0.038). In ordered logistic regression analyses, controlling for decision type, there was no significant relationship between patients’ perceptions and the number of specific knowledge items answered correctly (OR=0.98, 95% CI 0.49, 1.01; p=0.21). Patients were more likely to overestimate their knowledge (48%, CI: 45.7%, 50.3%), than assess it accurately (31%, CI: 28.7%, 32.5%) or underestimate it (21%, CI: 19.8%, 23.2%). Controlling for condition, patient factors significantly associated with feeling informed were education, race and trust in doctor. Participants with some college (OR=0.59, CI 0.38, 0.95; p=0.021) or college degree (OR=0.55, CI 0.35, 0.89; p=0.014) were less likely to feel informed compared to those with some high school education or less. African Americans were more likely to feel informed compared to Whites (OR=1.60, CI 1.17, 2.19; p=0.003). Patients who had complete trust in their doctors were more likely to feel informed (OR=2.64¸ CI 1.80, 3.87; p<0.001).
    Conclusions:  Patients perceived themselves to be extremely well-informed, despite significant gaps in factual knowledge.  If patients cannot accurately assess their information needs, then they may miss important opportunities to gather information and make informed decisions.