Decision making by patients: An application of naturalistic decision making theory to cervical screening and chronic renal failure, Working Paper 2006/5

Over their lifetime, individuals typically make many decisions about health and health care. Theoretical approaches to decision making have been dominated by a rational, analytic approach which assumes that problems are relatively fixed and well-defined and which have foreseeable and measurable endpoints. Naturalistic decision making (NDM) approaches attempt to mimic ?real world? situations where problems vary, may be defined differently by individuals with diverse perspectives and where endpoints are uncertain and complicated. In-depth interviews were conducted with 40 individuals living in the community: twenty participants had chronic renal failure and twenty were women in the target age range for cervical cancer screening. Decision making processes used by these two groups of health care consumers correspond well with the concepts of NDM. In particular, Image Theory provides a framework within which the process of decision making by health care consumers can be described, including the issues which influence what decisions are made. The findings also demonstrate the usefulness of studying decision making in ?real world? situations and in using less analytic techniques than traditional normative approaches in evaluating health care decision making. The results suggest that NDM is deserving of a wider audience in health care. Health care providers who use NDM models to understand their patients? decision making processes may improve their capacity to involve patients in decision making.