SHARING DIFFICULT CHOICES

Purpose:

Our research aims to bridge the gap between clinical evidence from studies in medical domain and consumer studies for complex decisions. In this paper, we examine how the shared decision mode between patient and doctor affects emotional outcomes of the decision, specifically post-decision regret (PDR).

Method:

369 medical decisions reported by 285 female US respondents, 18 to 50 y.o., with children, via an online questionnaire. Participants were recruited through a paid online panel. For decisions described as “preference-based,” respondents evaluated emotional difficulty of each decision. Participants reported a decision mode that best described their decision-making experience (patient-made, doctor-made , shared), and evaluated emotional outcome of the decision (PDR and liking decision process).

Result:

With 25% response rate, analysis focused on three selected target procedures: Trial of Labor After C-Section, planned C-Section, Epidural anesthesia. All participants were women (mean age = 37.2) who have given birth to one or more children. Average age of the youngest child was 8.6 years. Median HH income was between $40,000 and $59,999.  Out of all reported childbirth decisions, ony 17.7% were preference-based (MD explained that multiple alternatives were possible and choice depended on patient preference).

We hypothesized that higher emotional difficulty of a preference-sensitive medical decision leads to higher post-decision regret, and that this link is moderated by a decision mode: for shared and patient-made decision, effect of emotional difficulty on PDR is reduced, compared to doctor-made decisions. These hypotheses were confirmed. We also hypothesized that the effect of emotional difficulty on PDR is mediated by certainty in the right choice at the moment when decision is made, and by family involvement in the decision. This hypothesis is also confirmed.

Conclusion:

We conclude that specifically for pregnancy and childbirth decisions domain, emotional outcome of a decision is influenced by the level of doctor’s involvement in the decision. The emotion outcome is better for patient-made and shared decisions, and is worse for doctor-made decisions. Additionally, we conclude that there is a negative link between family involvement in the decision and PDR: patients who reported high family and/or friends’ involvement in the decision also reported higher levels of PDR.