Study Looks at Health Decisions

If a deadly bird flu reaches America, which would you choose: To get a risky experimental vaccine now, or to forego that risk but face an even greater risk of dying in the epidemic? What would you choose for your child? What if you were in charge of public health for your community?

A new study probes how we make such tricky decisions, and how our decisions might change dramatically if we step back and put ourselves in the shoes of others.

The findings may help individuals who face tough health choices, and decision-makers who make choices for larger groups. It may also help illuminate situations where individuals make medical decisions that go against the advice from experts and authorities, and help guide doctors in advising patients.

In the June issue of the Journal of General Internal Medicine, a team from the University of Michigan Medical School and the VA Ann Arbor Healthcare System report the results of a medical decision-making study involving nearly 2,400 people of all ages and backgrounds who completed extensive online questionnaires.

Study participants were first randomly divided into four groups. People in one group of participants were asked to imagine themselves as patients in two different medical scenarios - an experimental vaccine against a deadly flu and chemotherapy for a slow-growing cancer - and asked to choose either to get the medical option or to take their chances without it. Each of the options carried risks and benefits, though the statistically better choice in each scenario was to get the vaccine or chemotherapy.

The remaining three groups of participants also read the same medical scenarios, but they were asked to think about the problem from different perspectives. One group put themselves in the shoes of a doctor advising a patient, another took the role of a parent deciding for a child, and a third group imagined being a medical director of a hospital making a guideline for treating many patients. All four groups made treatment choices and also reported what emotions each of those decisions provoked.

The results were striking. Only 48 percent of individuals who imagined being the patient said they would choose the flu vaccine for themselves, but 57 percent of those imagining being parents would decide to vaccinate a child, 63 percent of respondents taking on a physician role would advise a patient to get it, and 73 percent of those acting as medical directors would choose to vaccinate large numbers of patients.

The same pattern repeated for the chemotherapy scenario, with 60 percent choosing it for themselves, 72 percent choosing it for their children and 68 percent opting to advise individual patients and groups to get it.

"It's very hard to see the big picture when faced with a tough medical decision," says lead author Brian Zikmund-Fisher, Ph.D. "We get wrapped up in our own situation, and that perspective makes us focus on certain aspects of problem and ignore others." It's also human nature to avoid an option that might bring immediate harm upon yourself - even when a "wait and see" approach may carry even greater risks than taking action. It's a reaction that researchers call the "omission tendency."