Patient decision-making modes and causes: A preliminary investigation

A recent study of patient decision making regarding acceptance of an implantable cardiac defibrillator (ICD) provides a substantial but nonrandom sample (N = 191) of telephone interviews with persons who have made an affirmative decision regarding an ICD. Using a coding scheme developed through qualitative analysis of transcribed interviews, these data can be subjected to exploratory statistical analysis. The reasons given by respondents for getting the ICD differed by both region and gender, and show some correlations with whether the device has or has not delivered any stimulation (shocks) since implantation. Cluster analysis reveals association among certain important themes in the discussion of the decision process, particularly linking rather opposite concepts into clusters related to specific dimensions. The results suggest the importance, to patients, of maintaining the integrity of the self by asserting control and independence. The majority of the respondents (61%) have not received the primary intended benefit of the device (stimulation). Thus, the findings suggest that psychological benefits alone of having the device (such as anxiety reduction) serve to justify acceptance of a computerized device. Implications for other lines of computerized health support and for further study of these issues are discussed.