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Medicare Patients Given Fewer Treatment Options

Cheryl Clark, for HealthLeaders Media, March 5, 2012

Rather, the project attempted to learn how much these patients were told by their physicians about these options in advance, and whether they were engaged in a discussion about the pros and cons.

One possible weakness in the study was in the length of time between the intervention and the time the patient returned the survey, which averaged 14 months with a range from 12 to 16 months. Memory problems in older patients, especially during a time of health status stress, could mean that more doctors had engaged their patients than the study says.

But Fowler says he doesn't think so, because the responses varied so much between prostate cancer patients and stent patients. That indicates that they largely remembered their experience.

"Clearly those two populations have really different reports" (about being given information on options), he says. "So that makes the argument, that people make this stuff up or they forget what really happened and it all gets homogenized or forgotten, harder to make."

There is some evidence that for those patients who didn't have information about more conservative approaches, about 20% to 25% would have foregone the more aggressive intervention, Fowler says.

That might indicate physicians are thinking more about their financial benefit from performing the surgery or stent procedure than involving the patient in that decision that might prompt them to delay or seek another type of treatment.

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