Patient decision making in the face of conflicting medication information

Figures & data

Table I. Table I. Study vignettes.

Vignette number	Source(s) of conflicting information	Vignette
Vignette 1	N/A (Doctor presents risk of side effects)	“Your doctor just gave you a prescription for a new arthritis medicine. He tells you that the medicine is safe and works well for people with arthritis like yours. However, he warns you that the medicine may cause side effects like upset stomach. What would you do after you got this information?”
Vignette 2	Cousin and pharmacist	“Imagine that your cousin, who also has arthritis, calls you. His doctor gave him the same new medicine that your doctor gave you, and he loves it. He did have an upset stomach at first, but it went away when he took the pills with food. You've been feeling sick to your stomach since you started taking these new arthritis pills, but your pharmacist said that you should not take the pills with food. What would you do after talking to your cousin?”
Vignette 3	Doctor and medication package insert	“Imagine you just told your spouse that you were taking a new arthritis medicine. They ask to look at the information sheet (also called an insert) that comes in the medication package. After reading the information sheet they tell you that they are worried that this medicine may cause liver problems. You look at the information sheet and you see that a very small number of patients get liver problems with this medicine, but you don't remember your doctor saying anything about liver problems. What would you do next?”
Vignette 4	Doctor and pharmacist	“Imagine a couple of months go by, and your arthritis isn't bothering you as much as it did. You take the pills with food, and you don't have an upset stomach now. When you talk to your doctor though, she thinks the medicine isn't working as well as it could because you're taking it with food. She decides to raise the dose from one pill to two pills per day. When you go to pick up the pills at the pharmacy, the pharmacist tells you that two pills is higher than usual. He says you should stop taking the medicine with food and that you should only take one pill instead of the two pills your doctor recommended. What would you do now?”

Table II. Patient use of decision strategies by vignette (n=20)*.

Vignette	Source of conflicting information	Representativeness heuristic	Proximal trust	Trial and error	Weigh benefits and risks	Seek more information
Vignette 1	N/A (Doctor presents risk of side effects)	0	0	15	3	7
Vignette 2	Cousin and pharmacist	5	4	8	1	12
Vignette 3	Doctor and medication package insert	0	2	2	4	18
Vignette 4	Doctor and pharmacist	0	10	0	1	9
Total		5	16	25	7	46

*Row values refer to the number of patients who used a particular decisional strategy for each vignette. Totals reflect the number of times a particular decisional strategy was used across all four vignettes and may add to greater than 20. Responses were not totaled across vignettes as patients could use more than one decisional strategy per vignette.