RI Hospital study looks at patients' decision-making in asymptomatic carotid stenosis

PROVIDENCE, R.I. – A paper from Rhode Island Hospital and Henry Ford Hospital in Detroit examines whether different presentation formats, presenter characteristics, and patient characteristics affect decision-making for patients requiring treatment for asymptomatic carotid stenosis. Based on the study, the researchers concluded that how the treatment options are presented to a patient strongly impacts patients' decision-making, while the patient's age, gender, and education level may also influence the decision. The study was recently published in the journal Neurology.

Lead author and principal investigator, Brian Silver, M.D., is a neurologist and the director of the Stroke Center at Rhode Island Hospital. Silver and his colleagues looked at asymptomatic carotid stenosis, a condition in which there is an abnormal narrowing of the carotid artery without any symptoms. The goal of treatment is to reduce the risk of stroke and can include medications with or without surgery.

Silver and his colleagues devised a study to present treatment options in different formats to the patient. To evaluate decision-making outcomes, 409 subjects watched a randomly selected video of 20 possible options, and completed a survey on the decision to have surgery.

In each video, there was one of four possible physicians (black or white middle-aged woman, and black or white middle-aged man) in the video, and one of five different presentation formats. Presentation formats varied in terms of how the risk of having a stroke was described.

Overall, 198 subjects, nearly 50 percent, chose surgery as a treatment option. The findings indicate that how the stroke risk was presented strongly predicted that choice of surgery. When the subjects were shown a qualitative format with no numbers or statistics on stroke risk, patients were three times more likely to choose surgery (67 percent of all subjects watching that video) than when information was presented in other formats (33 percent of all subjects watching that video).

Silver comments, "A key finding in our study is that how the information is presented strongly influences a person's decision making. This suggests that a person's choice can be dramatically altered depending on what they are told, and physicians must be aware of this when discussing options with patients."

"Our study demonstrates a clear difference in patients' decision making when information is presented in a descriptive manner versus using statistical variables," says co-author Iram Zaman, D.O., a neurologist at Henry Ford Hospital. "It is important that physicians are aware of this impact so that we can better serve our patients. It is our responsibility to deliver information in a clear and concise manner allowing individuals to make informed medical decisions."

The researchers also found a trend for younger age, male gender, and advanced education to predict surgery choice. Differences in choice of surgery based on presentation format were also significant for both younger and older subjects; whereas differences in positive surgery response rates for the presentation formats were significant for both men and women. Further findings indicate significant differences in the decision-making in terms of education, however, there were no differences detected in terms of gender or race of the presenter or subject.

This study was performed without funding. Silver's principal affiliation is Rhode Island Hospital, a member hospital of the Lifespan health system in Rhode Island. He also holds an academic appointment as associate professor of neurology at The Warren Alpert Medical School of Brown University. Other researchers involved in this study with Silver include Iram Zaman, D.O., Komal Ashraf, D.O., Youssef Majed, M.D., Richard E. Smith, M.D., Lonni R. Schultz, Ph.D., Earlexia M. Norwood, M.D., and Lori A. Schuh, M.D., of the Henry Ford Hospital, Detroit, Mich.; and Brien J. Smith, M.D. of Spectrum Health, Grand Rapids, Mich.

Founded in 1863, Rhode Island Hospital in Providence, R.I., is a private, not-for-profit hospital and is the principal teaching hospital of The Warren Alpert Medical School of Brown University. A major trauma center for southeastern New England, the hospital is dedicated to being on the cutting edge of medicine and research. Last year, Rhode Island Hospital received more than $55 million in external research funding. It is also home to Hasbro Children's Hospital, the state's only facility dedicated to pediatric care. For more information on Rhode Island Hospital, visit www.rhodeislandhospital.org, follow us on Twitter @RIHospital or like us on Facebook www.facebook.com/rhodeislandhospitalpage.