Evaluation of Selected Aspects of the National Medicare Education Program: Final Design Report. 3.1 Informed Decision Making


Fortunately, the IDM literature offers some useful guidance for campaign design, evaluation, and measurement despite its focus on clinical decision making instead of insurance choices. According to Briss and colleagues (2004), IDM occurs

When an individual understands the nature of the disease or condition being addressed; understands the clinical service and its likely consequences, including risks, limitations, benefits, alternatives, and uncertainties; has considered his or her preferences as appropriate; has participated in decision making at a personally desirable level; and either makes a decision consistent with his or her preferences and values or elects to defer a decision to a later time . (Briss et al., 2004p. 68)

Thus, IDM implies that a person understands the choices he or she faces and the relative advantages and disadvantages of these choices. However, neither a standard definition of an “informed person” nor a widely accepted metric for how knowledgeable a person must be to facilitate IDM exists (Rimer et al., 2004 Rimer et al., 2004).

Mullen and colleagues (2006) characterize IDM as occurring using a multiconstruct approach, which is consistent with the Briss et al. definition. In Table 3-1 , we categorize the constructs offered in Mullen etal. as more and less relevant to health insurance decision making. We propose that many of the more clinically rooted IDM constructs are also relevant and should be considered when applying IDM to health insurance choice, yet we recognize that some are not as relevant. For example, assessing whether a Medicare-related decision was informed could involve assessing the intervention’s impact on knowledge, whether the beneficiaries were involved in the decision-making process to the extent that they wanted to be, whether they considered their values and preferences in making their decision, and to what extent the beneficiaries were certain about the decision they made (e.g., felt that this was definitely the right decision for them versus not sure at all that what they have chosen is right for them).

Table 3-1. Informed Decision-Making Constructs: Applicability of More Clinical-Based Constructs to Insurance-Related Decision Making

Common Construct from Informed
Decision Making Literature

More Applicable

Less Applicable or Not Applicable

Demonstrated knowledge



Perceived threat



Decisional balance (i.e., was decision consistent with values)



General attitude toward testing



Role preference (i.e., the extent to which an individual wants to make the decision him/herself or defer to others)



Utilities/values (i.e., the importance placed on potential benefits or risks of a given course of action)



Treatment preference



Decisional self-efficacy (i.e., self-confidence in one’s decision and decision-making ability)



Discussion with a clinician



Test (insurance) preference

X (more applicable if relevant to insurance as opposed to treatment decision)


Screening intention



Satisfaction with the decision and decision-making process



Decision conflict (i.e., the state of uncertainty about the course of action taken)


Source: RTI International based on measures suggested in Mullen et al. (2006)Mullen et al. (2006).


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