Table 2.

Factors Related to Lesser or Greater Participation in Healthcare Decisions by Very Old Adults Demonstrated by Contrasting Quotations from Low Participation and High Participation Respondents

Factor	Low Participation Respondents	High Participation Respondents
Awareness that a decision or choice is possible	No Awareness	High Awareness
	We talked about changing your medication. Tell me, when you go see your cardiologist does he ever order any tests for you? “Yes he does I sort of ask him about doing a diabetes test and he ordered that and then he had me to have a bone scan and that’s been within the last year. And of course I’ve had my mammogram.” – age 82	“He [doctor] told me and you better go get a mammogram” Oh the mammogram, he told you to go get one and then what happen? “I am not going to and he said why and I said frankly doctor at my age I could not take the chemo. I know it. And what did he say? “He stood there looked down his nose at me. He knows that sometimes I win and he gets mad and leaves.”-age 83
Patient Activation	Low Patient Activation	High Patient Activation
	“They know more about the subject and they know more about me and my health conditions than I do. I am fairly knowledgeable about things, but I figure the doctor knows more about my body than I do so I go by what they, he, whoever says.”	“People tell me I’m really healthy and I feel healthy. I’m vigilant about it…I try to be a partner.”
Communication	Perceived as obstructed	Perceived as open
	Are you able to tell him everything that you think you need to about your blood pressure? “No, I tried but I think that is one of my problems. I don’t get everything across, or either he doesn’t hear at all, or something.”	“There’s been a huge change in how doctors are willing to receive whatever the thoughts are from their patients…Younger doctors are more open to receiving (whereas) 60 years ago when I was 20, physicians were pretty much God in their field.”
Perceived Clinician Motives	Reported as Financially influenced	Reported as Patient-centered
	“Now every time I have gone to the specialist, that has led to surgery…Whether I have a real problem or not, it seems they all want their money and want the surgery, but I’ve learned at my age I’m not going to play that kind of game.”	“(I want her) to be honest, no hiding of anything, to be open, and I am open with her. And she is pretty good with being what I want of her. She doesn’t push anything on me, she is so good.”
Information Sources	Rely solely on clinician	Access to multiple sources
	“I don’t know why he did it (bone densitometry) but he said I needed it and I just did it.”	“I have a lot of conversations with myself and I talk with the physician, I talk with my husband, everyone has had back pain so there were lots of people to talk to about back pain. I talked with the medical staff here. I talked with people who had had the operation.”
Knowledge of Patient Values	Assumed by Patient	Directly Communicated
	Do you feel like your doctor understands the things that you need and that you want for your health? “Definitely.” And how does he know those things? “I don’t know how he knows, cause he’s a doctor I guess. They had to go to school quite a while to be a doctor….laughs….they should know something…laughs”	Have you been able to communicate that with them?” “oh you bet…it’s plastered all over my charts, DNR all over the place”
Addressing Discord	Avoid Addressing Discord	Actively Address Discord
	“I was complaining about dry mouth, and he said Avapro won’t ruin your mouth and my daughter, he went to see her and he walked out and that was the end of my talk, didn’t tell me a thing.” How did you feel about that? “Then I went and looked for another doctor.”	“(The) surgeon who I went and talked with, he was strongly in favor of operating. But when I said, ‘What are the chances of this really getting better,’ about the best that he could promise me was that it would probably stop any further deterioration. …he was less than happy with my decision [not to have surgery] and it was pretty strong.” How did he express that? “He was aggressive. He could combat my exchange…interesting…yeah but I am sure he succeeded with some people.”

Note: Interviewer comments in italics, Participant comments in quotation marks.