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Open Access Research article

Patient involvement in medical decision-making and pain among elders: physician or patient-driven?

Tyrone F Borders1*, Ke Tom Xu2, James Heavner3 and Gina Kruse4

Author Affiliations

1 Department of Health Management and Policy, University of North Texas School of Public Health, 3500 Camp Bowie Blvd., Fort Worth, TX 76107, USA

2 Division of Health Services Research, Texas Tech University School of Medicine, Lubbock, Texas, USA

3 Department of Anesthesiology, Texas Tech University School of Medicine, Lubbock, Texas, USA

4 Baylor Medical School, Houston, Texas, USA

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BMC Health Services Research 2005, 5:4  doi:10.1186/1472-6963-5-4

Published: 14 January 2005



Pain is highly prevalent among older adults, but little is known about how patient involvement in medical decision-making may play a role in limiting its occurrence or severity. The purpose of this study was to evaluate whether physician-driven and patient-driven participation in decision-making were associated with the odds of frequent and severe pain.


A cross-sectional population-based survey of 3,135 persons age 65 and older was conducted in the 108-county region comprising West Texas. The survey included self-reports of frequent pain and, among those with frequent pain, the severity of pain.


Findings from multivariate logistic regression analyses showed that higher patient-driven participation in decision-making was associated with lower odds (OR, 0.82; 95% CI, 0.75–0.89) of frequent pain, but was not significantly associated with severe pain. Physician-driven participation was not significantly associated with frequent or severe pain.


The findings suggest that patients may need to initiate involvement in medical decision-making to reduce their chances of experiencing frequent pain. Changes to other modifiable health care characteristics, including access to a personal doctor and health insurance coverage, may be more conducive to limiting the risk of severe pain.