Medical maximizing-minimizing preferences and health beliefs associated with emergency department patients' intentions to take a cardiac stress test after receiving information about testing

Abstract

Purpose: The Medical Maximizer-Minimizer Scale (MMS) has been validated to predict preferences for health-care service use on hypothetical vignettes in nonclinical cohorts. Using mixed methods, we sought to determine whether it would predict preferences for cardiac stress testing in a cohort of emergency department (ED) patients with low-risk chest pain within the context of the Health Belief Model (HBM). Design: Patients who met the definition for low-risk chest pain and who were eligible to take a cardiac stress test before being discharged from the hospital were recruited to participate. Each participant provided demographic information and completed the MMS-10 paper-and-pencil scale. They then watched a 7-min informational video on an iPad tablet that provided information about the condition of “low-risk chest pain” and the probabilities of results and outcomes following a cardiac stress test. After the video, participants answered a one-question survey on their intention-to-take (ITT) a cardiac stress test or not and were then interviewed about factors that influenced their decision-making. Interviews were interpreted using a HBM lens. Results: Sixty participants were enrolled in the study who were between the ages of 29 and 80 years with a mean age of 53 (± 10.8); 58% were women and 90% were white. The mean MMS score was 4.6 (± 0.8) and ranged from 2.6 to 6.8. Minimizers accounted for 25% (n = 15) of the cohort while maximizers accounted for 75% (n = 45). MMS scores followed a normal distribution and were found to be mildly correlated with ITT scores (r = 0.25; P = 0.051). The mean ITT scores for individuals with MMS scores in the 1st and 4th quartiles were 3.9 ± 2.2 and 5.9 ± 1.7, respectively. After watching the informational video, individuals' perceptions related to the: (1) low threat posed by the condition, (2) low utility (low benefits + significant barriers) of taking a cardiac stress test, and (3) high benefits of taking a cardiac stress test were all strongly associated with ITT scores in a directional manner. No direct connection was found between minimizer-maximizer preferences and health beliefs after watching the informational video. This may have been due to sample size and underrepresentation of minimizers in the cohort. Conclusions: MMS and health beliefs predicted preferences for cardiac stress testing in ED patients with low-risk chest pain after viewing an informational video on the topic. However, we did not find direct evidence that the relationship between MMS and decision-making is mediated through the formation of perceptions of threat and utility consistent with the HBM. More research is needed to establish this connection and understand how framing of information in the health-care space may interact with stable personality traits to influence decision-making.

Keywords

• chest pain
• health belief model
• medical decision-making
• risk communication
• stress testing