DECISIONS survey study: Americans often make medication decisions without being well-informed

According to the findings of the DECISIONS survey study published in a September/October supplement of Medical Decision Making, Americans frequently find themselves faced with high blood pressure, high cholesterol, and depression medication decisions that they are ill prepared to make. 

“Informed consent isn’t real if patients understand so little about the tests and treatments they are getting,” suggested Michael Barry, MD, a professor of medicine at Harvard Medical School and president of the Foundation for Informed Medical Decision Making, which funded the DECISIONS survey study.

In order to determine the prevalence of high blood pressure, high cholesterol, or depression medication initiation decisions faced by Americans and their knowledge relevant to providing informed consent, researchers conducted a survey of 3,010 English-speaking adults ≥40 years of age identified using a stratified random sample of telephone numbers.

The researchers found that nearly half of the participants surveyed [42.9% (95% CI, 40.8%–45.1%)] were faced with at least one decision regarding the initiation of a medication to treat high blood pressure, high cholesterol, or depression in the 2 years prior to their participation. More specifically, 21.0% (95% CI, 19.2%–22.8%), 26.3% (95% CI, 24.5%–28.3%), and 12.3% (95% CI, 11.0%–13.8%) were asked to make the decision to initiate an antihypertensive, cholesterol-lowering medication, or antidepressant, respectively.

The researchers noted in their paper, “To place these statistics in context, consider that there were approximately 130 million adults aged 40 years and older in the United States in July 2006.” They continued, “By our estimates, about 27 million of these adults discussed initiation of antihypertensive medications in the preceding 2 years.”

The survey also revealed that despite the fact that initiation of cholesterol-lowering medication was discussed with participants more frequently than medications to treat high blood pressure or depression, the discussions regarding high blood pressure medication were significantly more likely to result in medication initiation than those of either high cholesterol or depression medications [76.1% (95% CI, 71.9%–79.9%) vs 54.6% (95% CI, 50.5%–58.8%) vs 47.6% (95% CI, 41.5%–53.7%); P<.001].

When researchers evaluated these same participants knowledge by asking medication-related questions [such as, “What is the number that is usually considered to be normal for (the disease state)?” or “How much do you think medications will reduce your risk?”], they discovered that overall accuracy rates were low (ranging from 17.1% to 78.5%), but typically higher for high blood pressure questions compared to high cholesterol or depression questions (P≤.009). Moreover, high-levels of education [OR=1.11; 95% CI, 1.04–1.18; P=.002)] and African-American race [OR=0.77; (95% CI, 0.60–0.97; P=.03)] were identified as independent predictors of providing correct answers to knowledge questions. Finally, the survey found that individuals who made the decision to take medications were more likely to answer knowledge questions correctly compared with those opting not to take them [OR=1.19; 95% CI, 1.00–1.41; P=.04].

The researchers concluded by stressing the importance of improving patient knowledge about the risks, benefits, and characteristics of medical decisions.