Are patients making cost-effective treatment decisions?

Involving patients in decision-making is thought to reduce costs, but U-M authors argue that might not be the case

The idea of patients and their families being involved in decisions about their medical treatment ensures that patients’ values and preferences are taken into account.

But does it also result in less overtreatment and reduced costs? A new commentary by University of Michigan Comprehensive Cancer Center researchers says that’s an overstatement.

“The assumption that the doctor is pushing harder than the patient for the most aggressive treatment is misguided,” says Steven J. Katz, M.D., M.P.H., co-author on a commentary published today in the Journal of the American Medical Association.

Recent studies have suggested that an informed patient will be less likely to choose a more-extensive treatment than what the doctor recommends. But Katz and co-author Sarah Hawley, Ph.D., say that’s not necessarily the case.

In fact, some studies have suggested that more patient involvement in decisions may result in more extensive treatment.

The authors say that treatment decisions should be a partnership between doctor and patient.

“Patients are looking for the doctor to help them make the right decisions. We have a concern about overtreatment or doing more harm than good, which is something the patient and doctor need to work through. But we’re talking about a partnership here, not a conflict,” says Katz, professor of internal medicine and of health management and policy at the University of Michigan.

“Patients want better communication with their doctor. What they get out of that is they feel more satisfied with the clinical encounter. They have more certainty and confidence in the plan going forward,” he says.

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