Article Figures & Data
Figures
- Figure 1a
Trends in components of shared decision making, 2002–2014.
Note: Change between 2002 and 2014 for each question included in the SDM composite. All comparisons P <.01.
Error bars represent 95% CIs (for verbatim questions, see Supplemental Appendix, available at http://www.AnnFamMed.org/content/15/6/552/suppl/DC1/).
- Figure 1b
Trend in shared decision-making composite score, 2002–2014.
SDM=shared decision making.
a Number of points out of 7.
Note: Change from 2002 to 2014 in the SDM composite score. Comparison of 2002 to 2014: P <.01.
Error bars represent 95% CIs (for verbatim questions, see Supplemental Appendix, available at http://www.AnnFamMed.org/content/15/6/552/suppl/DC1/).
Tables
- Table 1
Characteristics of the Medical Expenditure Panel Survey Participants and Independent Predictors of Shared Decision Making, 2002–2014
Characteristic Mean Value (95% CI) or % (95% CI)a Association With SDM Composite Score,b Points 2002 (n=12,138) 2014 (n=9,049) SDM composite score, points 4.4 (4.3–4.4) 5.0 (4.9–5.1) n/a Age, y 49.3 (48.8–49.8) 51.8 (51.1–52.5) 0.01c Femaled 59.6 (58.8–60.4) 59.1 (58–60.1) 0.06c Race/ethnicity Non-Hispanic white 76.3 (74.8–77.8) 71.7 (69.4–74.0) Referent Hispanic 8.5 (7.5–9.5) 10.8 (9.3–12.3) −0.03 Non-Hispanic black 10.2 (9.2–11.2) 10.8 (9.4–12.1) 0.33c Non-Hispanic Asian 3.0 (2.4–3.6) 4.0 (3.1–5.0) −0.29c Non-Hispanic other or multiple 2.0 (1.5–2.5) 2.7 (2.0–3.4) 0.08 Census region Northeast 21.3 (19.6–23.1) 18.3 (16.5–20.0) Referent Midwest 24.1 (22.1–26.0) 23.0 (21.2–24.8) 0 South 34.3 (32.1–36.5) 37.2 (35.0–39.5) −0.01 West 20.3 (18.5–22.0) 21.5 (19.8–23.1) −0.21c Partner status Married/partnered 60.9 (59.5–62.3) 57.6 (55.8–59.4) Referent Widowed 8.8 (8.1–9.4) 8.3 (7.5–9.1) 0.10c Divorced/separated 12.8 (12.0–13.6) 14.0 (12.9–15.0) 0.05c Never married 17.6 (16.7–18.5) 20.2 (18.9–21.4) −0.03 Education <High school 19.4 (18.3–20.4) 11.2 (10.3–12.1) Referent High school/GED/some college 54.1 (52.9–55.2) 57.5 (55.9–59.2) −0.09c Bachelor’s degree 15.8 (14.9–16.8) 18.8 (17.6–20.0) −0.19c >Bachelor’s degree 10.7 (9.9–11.5) 12.5 (11.3–13.6) −0.26c Health insurance coverage Any private 77.7 (76.4–79.0) 71.9 (70.2–73.6) Referent Public only 16.2 (15.1–17.3) 23.6 (22.1–25.1) 0.04 Uninsured 6.1 (5.5–6.8) 4.5 (3.8–5.1) −0.17c Perceived health status Excellent 21.2 (20.2–22.3) 21.2 (19.9–22.5) Referent Very good 32.8 (31.7–34.0) 32.2 (30.7–33.6) −0.32c Good 28.9 (27.9–30.0) 28.9 (27.6–30.3) −0.41c Fair 11.9 (11.2–12.7) 13.3 (12.3–14.2) −0.33c Poor 5.1 (4.6–5.6) 4.4 (3.9–5.0) −0.15c Usual source of care is same race/ethnicityd 41.1 (39.2–43.0) 36.3 (34.0–38.6) 0.24c Employedd 66.5 (65.2–67.8) 63.6 (62.0–65.2) −0.09c Currently smoked 19.3 (18.3–20.2) 13.1 (12.1–14.1) 0.02 Need help with ADLe 3.9 (3.4–4.3) 4.4 (3.8–4.9) 0.20c Need help with iADLe 7.0 (6.4–7.7) 7.5 (6.8–8.3) 0.13c SF-12 PCS scoref 47.0 (46.7–47.3) 47.1 (46.7–47.5) 0.03c SF-12 MCS scoref 50.3 (50.1–50.6) 51.1 (50.8–51.4) 0.04c Body mass index, kg/m2 27.4 (27.3–27.6) 28.6 (28.4–28.8) 0.01c Family income as % of poverty line Poor/negative (<100%) 9.8 (9.0–10.6) 11.5 (10.4–12.6) Referent Near poor (100% to 124%) 3.6 (3.2–4.0) 4.4 (3.9–5.0) 0 Low income (125% to 199%) 12.1 (11.3–12.9) 11.4 (10.5–12.4) 0 Middle income (200% to 399%) 29.5 (28.2–30.8) 27.4 (25.9–29.0) −0.06c High income (≥400%) 45.0 (43.3–46.6) 45.2 (43.2–47.3) −0.01 Chronic diseased Hypertension 25.8 (24.7–26.9) 38.7 (36.9–40.5) 0.03 Hyperlipidemia 14.2 (13.3–15.0) 31.6 (30.1–33.1) −0.04 Depression 11.1 (10.4–11.8) 14.7 (13.7–15.7) 0.13c Diabetes 9.9 (9.2–10.6) 16.4 (15.4–17.5) 0.10c COPD 6.5 (6.0–7.1) 9.0 (8.1–10.0) −0.01 CAD/MI 6.8 (6.2–7.3) 10.1 (9.3–11.0) 0.07c Cancerg 6.5 (5.9–7.1) 9.7 (8.9–10.5) 0.01 Asthma 6.0 (5.5–6.4) 8.9 (8.2–9.7) −0.05 Arthritis 2.4 (2.1–2.7) 13.6 (12.5–14.8) −0.02 Number of chronic diseasesh 0 44.9 (43.7–46.1) 34.0 (32.3–35.6) Referent 1 27.8 (26.9–28.7) 21.4 (20.3–22.5) 0.07c 2 15.2 (14.4–15.9) 17.0 (15.9–18.1) 0.10c ≥3 12.2 (11.3–13.1) 27.7 (26.3–29.1) 0.11 Total annual health care expenditure, $ 4,677.6 (4,502.3–4,852.8) 7,950.2 (7,501.6–8,398.8) 0 Office visits, No. 8.4 (8.1–8.7) 9.6 (9.2–10.0) 0 ADL = activities of daily living; CAD = coronary artery disease; COPD = chronic obstructive pulmonary disease; GED = General Educational Development Test; iADL = instrumental activities of daily living; MCS = mental component summary; MI = myocardial infarction; n/a = not applicable; PCS = physical component summary; SDM = shared decision making; SF-12 = 12-item Short Form Health Survey.
↵a Percentages may not sum to 100 because of rounding.
↵b Multivariate linear regression of SDM_Composite = β0 + β1Year + β2Covariates..., where Year is points per year and Covariates are all of the variables in the Table. The unit for the association is SDM composite score points, out of 7 points. For example, a black participant’s SDM composite score had 0.34 additional points compared with a white participant’s, all else constant. For year, coefficient is 0.04 points per year (P <.01).
↵c P <.05.
↵d Referent is the converse.
↵e Three-part screening question to determine if respondent required assistance with ADLs or iADLs.
↵f Possible scores range from 0 to 100. Higher scores represent better self-reported health.
↵g All except nonmelanoma skin cancer.
↵h Out of the 20 conditions considered chronic by the Health and Human Services Office of the Assistant Secretary of Health.
Supplemental Appendix
Supplemental Appendix
Files in this Data Supplement:
- Supplemental data: Appendix - PDF file
The Article in Brief
Trends in Patient-Perceived Shared Decision Making Among Adults in the United States, 2002-2014
David M. Levine , and colleagues
Background This study explores how shared medical decision-making between patient and clinician has changed over time.
What This Study Found Between 2002 and 2014, reports of shared decision making increased significantly among adult Americans. Analyses of data from a nationally representative survey found that the mean shared decision making composite increased from 4.4 to 5. In multivariable modeling, blacks reported more shared decision making, while Asians, those without insurance, and those in poor health reported less. When a respondent and their clinician were of the same race/ethnicity, the respondent reported improved shared decision making.
Implications
- The authors suggest that efforts to improve shared decision-making target Americans who do not share race/ethnicity with their clinician and those with poor perceived health.
