May 31, 2006 -- If a deadly flu outbreak occurred in the U.S. would you choose to take a risky experimental vaccine that carried a 5% chance of death or do nothing, knowing that your risk of flu death would be twice as high?
Although the question is academic, fears of a future bird flu pandemic make it seem all too real. And a new study suggests that your answer may depend on whether you are making the decision for yourself or someone else.
Researchers from the University of Michigan Medical School and the VA Ann Arbor Healthcare System conducted the study, designed to shed light on how people make the most difficult health care decisions.
They found that those surveyed were more likely to choose immunization for their children than themselves. They were even more likely to recommend immunization when asked to take on the role of a physician or public health policy maker making decisions for the community at large.
"The main message here for the public is that perspective does matter," decision psychologist and author Brian J. Zikmund-Fisher, PhD, tells WebMD.
"The tendency among people facing complex and emotionally charged medical decisions is to focus only on the decision without necessarily seeing the big picture. If they are able to consider the situation from a different perspective their decision may be different."
Weighing the Options
The nearly 2,400 study participants were asked to consider two hypothetical medical quandaries.
In one instance, some of the participants were asked if they would take a risky flu vaccine during a deadly influenza outbreak. In the other scenario, the same people were asked if they would choose to have chemotherapy or no treatment when faced with a slow-growing cancer.
The same questions were asked of other study participants, who were told to assume the roles of either a parent making the decision for a child, a doctor advising a patient, or a hospital policy maker making decisions to be adopted hospital wide.
In each case, it was also made clear that the active treatment was the statistically better choice, even though it was associated with a 5% risk of death. The risk of death with no treatment was 10%.
Experimental bird flu vaccines are in the works, but no single vaccine has been approved for public use, and there is no suggestion that any of them are anywhere near as risky as the hypothetical vaccine in this study.
While just under half of the participants making the medical decision for themselves chose to get the hypothetical vaccine (48%), 57% of those asked to make the decision for their child said they would choose immunization. Sixty-three percent of the study participants taking on the role of an advising physician and 73% of those responding as medical directors said they would choose the active treatment.
Although more "patient" responders said they would choose chemotherapy over doing nothing for a slow-growing cancer, a larger percentage of the other responders said they would choose active treatment for their children, patients, or the community at large.
The findings are published in the June issue of the Journal of General Internal Medicine.
The findings suggest that people facing tough health care decisions make better choices for others than for themselves, the researchers say.
Physicians may best serve their patients who must make complex medical decisions by adopting the role of a coach, rather than telling them what to do or leaving the decision entirely to them, Zikmund-Fisher says.
He points out that as patients have become more educated about their health, many physicians have become less willing to recommend specific treatments for fear of being perceived as paternalistic.
Peter Ubel, MD, who directs the University of Michigan's Center for Behavioral and Decision Sciences in Medicine, where the study was conducted, agrees that physicians must help patients make medical decisions that are in their best interest.
"For the health situations we studied, [study participants] actually made better decisions for other people than they made for themselves," he noted. "If physicians think this way when talking with patients, they may end up helping patients by talking them into decisions -- good decisions -- that they otherwise would not make."
The researchers are currently completing work on a medical decisions study examining end-of-life treatments.
"The question that many patients and families face is, 'Do you extend life at the expense of quality [with aggressive treatment] or do you preserve quality of life and live for a shorter time?'" Zikmund-Fischer asks. "There is no single right answer. But people deciding for themselves may look at the trade-offs differently than people who adopt the role of a parent or physician."