To the Editor: The article by Dr Braddock and
colleagues1 has been useful in our new course
on health communication, especially the table listing the 7 elements of informed
decision making. From a statistical standpoint, however, we are concerned
that the unit of analysis was the individual clinical decision. The analysis
used t tests, χ2 tests, and Fisher
exact tests, all of which require independent observations. Individual physicians
and patients all have past experiences, personalities, and dispositions that
result in preferences for certain styles of communication. For example, a
physician who has developed a heightened awareness of the importance of good
communication may practice more complete, informed decision making with all
patients. The physician may therefore be a more appropriate unit of analysis
than the individual clinical decision.2
On the other hand, patients who take a more active role in the encounter probably
elicit more complete information from the physician. When studying the complex
process of communication3 within this type
of sample, it is important to control for the individual patient and physician
when testing for differences in various communication elements in the clinical
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