HOW DO PATIENTS RESOLVE CONFLICTING MEDICATION RELATED INFORMATION?

Purpose: To determine the decision-making strategies patients use to resolve conflicting medication information.

Methods: Qualitative telephone interviews were conducted with 20 men and women with arthritis. Interview vignettes posed scenarios involving conflicting information from different sources (e.g., doctor, pharmacist, Internet). Respondents were asked how they would resolve the conflicting information. The 30-minute interviews were conducted over the telephone. Data analysis was guided by grounded theory. Emergent decision-making strategies were categorized using a dual process framework.

Results: Study respondents were 31-84 years old (mean age=55.5), predominantly female (n=13), and white (n=12). To resolve conflicting medication information, patients used System 1 (quick, effort-reductive) and System 2 (slow, deliberate, analytical) strategies. System 1 decisions included trial and error and three heuristics: the representative heuristic, the affect heuristic, and a process we named the “call-the-doctor heuristic.” Trial and error was used more often in response to the first (primer) vignette, which involved no conflicting information, and the heuristics were used only to resolve conflicting information in the second, third and fourth vignettes. System 2 decision-making strategies included weighing benefits and risks, making trade-offs, and seeking more information, and were generally used less than System 1 processing. The most commonly used System 2 strategy was seeking more information, and trade-offs were observed when risks were highest and expert sources were involved in the conflict.

Conclusions: By identifying the scope of variability in how patients resolve conflicting medication information, our findings lay the groundwork for future studies aiming to: 1) quantify the use of decision-making strategies for resolving conflicting information, and 2) determine the effect of such strategies on health outcomes. In this study we found that patients resolved conflicting information using both effort-reductive and analytical strategies. Our findings suggest that patients’ decisional strategies may be an area to target towards improving health behaviors such as medication adherence. For example, patients may benefit from assistance from their provider in employing effortful, analytical System 2 strategies (e.g., weighing benefits against risks) when a health decision calls for careful deliberation. Alternatively, fostering the use of “good heuristics” (such as the call-the-doctor heuristic) and discouraging the use of less productive ones may be a useful for decision aids to help patients effectively and appropriately resolve conflicting medication information.