"For the many medical decisions now deemed preference-sensitive, the interplay of volition and willingness to assume risk could profoundly affect public health."

N Engl J Med. 2015 Aug 13;373(7):589-92. doi: 10.1056/NEJMp1508418.

The Paternalism Preference--Choosing Unshared Decision Making.

Rosenbaum L1.

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• 1Dr. Rosenbaum is a national correspondent for the Journal.

"In more routine circumstances, such as medication prescribing, shifting the burden of responsibility could influence risk perception and subsequent behavior. In one study, participants were presented with two hypothetical drugs — one preventing heart disease, one treating chronic pain, both conferring a low probability of an adverse event. Some were told that doctors recommended the medication; the others, that “The doctor tells you that it is completely up to you whether or not you take this medication and then asks you to make a decision.” Participants in the increased-volition group were significantly more worried about risks and concomitantly less willing to take the medication.4

For the many medical decisions now deemed preference-sensitive, the interplay of volition and willingness to assume risk could profoundly affect public health. For treatments ranging from antihypertensives to joint replacements, we need to study how various approaches to providing information shape choice, behavior, and outcomes. But science cannot answer a question at the core of our professional identities: As information-empowered patients assume greater responsibility for choices, do we assume less?"