Sharing Difficult Choices: Effective Consumer Decision Support

My dissertation investigates highly consequential and emotionally difficult decisions made by consumers of medical services, expanding on Botti et al.’s work (2009). Two studies examine the effect of patient involvement in preference-based medical decisions and the healthcare provider’s control over the decision on emotional outcomes for the consumer. To what extent do medical consumers consult with family and friends when making difficult medical decisions, and how does this involvement affect emotional outcomes for the patient? I adopt a mixed-methods approach to study shared decision making (SDM) in the context of childbirth medical decisions. The first study tests the effect of decision difficulty on post-decision regret, and whether this effect is mediated by family involvement and the role of patient-doctor interaction. A survey questionnaire was administered to an online panel of U.S. women who recently gave birth (N=757). Contrary to expectations, more difficult decisions were associated with less shared and more doctor-controlled interactions, which led to higher post-decision regret. More difficult decisions also led to greater involvement of family and friends in making the decision, which also increased post-decision regret. The second study employed longitudinal dyadic interviews of women and their doctors (N=40) during and after pregnancy. Findings suggest that provider and patient views of factors driving patient choice are mismatched in important ways. While providers attribute consumer choice to approach-type motives such as desire to experience natural birth or to schedule delivery, patients often choose through a prism of coping with negative emotions such as fear of complications or fear of surgery. In the consumer decision journey, the role of pre-existing preference, formed in a patient’s mind prior to a physician’s consultation, emerged as an important driver. Consequently, some patients did not equally consider the risks and benefits of all available alternatives. When making medical decisions, patients reported pressure from their extended families, and felt the need to defend their preferred choice to gain support from family members. Together, these studies extend Pescosolido’s (1992) social organization strategy framework, and suggest a new conceptual framework of the patient-centered medical decision journey for preference-based decisions.