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The influence of patient's age on clinical decision-making about coronary heart disease in the USA and the UK

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Adams, Ann, Buckingham, Christopher D., Arber, Sara, McKinlay, John, Marceau, Lisa and Link, Carol. (2006) The influence of patient's age on clinical decision-making about coronary heart disease in the USA and the UK. Ageing and Society, Vol.26 (No.2). pp. 303-321. ISSN 0144-686X

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Official URL: http://dx.doi.org/10.1017/S0144686X05004265

Abstract

This paper examines UK and US primary care doctors' decision-making about older (aged 75 years) and midlife (aged 55 years) patients presenting with coronary heart disease (CHD). Using an analytic approach based on conceptualising clinical decision-making as a classification process, it explores the ways in which doctors' cognitive processes contribute to ageism in health-care at three key decision points during consultations. In each country, 56 randomly selected doctors were shown videotaped vignettes of actors portraying patients with CHD. The patients' ages (55 or 75 years), gender, ethnicity and social class were varied systematically. During the interviews, doctors gave free-recall accounts of their decision-making. The results do not establish that there was substantial ageism in the doctors' decisions, but rather suggest that diagnostic processes pay insufficient attention to the significance of older patients' age and its association with the likelihood of co-morbidity and atypical disease presentations. The doctors also demonstrated more limited use of ‘knowledge structures’ when diagnosing older than midlife patients. With respect to interventions, differences in the national health-care systems rather than patients' age accounted for the differences in doctors' decisions. US doctors were significantly more concerned about the potential for adverse outcomes if important diagnoses were untreated, while UK general practitioners cited greater difficulty in accessing diagnostic tests.

Item Type:

Journal Article

Subjects:

R Medicine > RC Internal medicine

Divisions:

Faculty of Medicine > Warwick Medical School

Library of Congress Subject Headings (LCSH):

Coronary heart disease -- Treatment, Coronary heart disease -- Diagnosis, Age factors in disease, Primary care (Medicine) -- Great Britain -- Decision making, Primary care (Medicine) -- United States -- Decision making

Journal or Publication Title:

Ageing and Society

Publisher:

Cambridge University Press

ISSN:

0144-686X

Official Date:

March 2006

Dates:

Date	Event
March 2006	Published

Volume:

Vol.26

Number:

No.2

Page Range:

pp. 303-321

Identification Number:

10.1017/S0144686X05004265

Status:

Peer Reviewed

Access rights to Published version:

Open Access

Funder:

National Institute on Aging (NIA), National Institute for Health Research (Great Britain) (NIHR)

Grant number:

AG-16747 (NIA-US)

References:

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