Patients make health care decisions in a complex and alien environment
with little, if any, insightful aid from health care professionals; s
uch professionals may be well intentioned but naive about how to provi
de decisional support. The search for information is unstructured, and
once information is obtained, it is not easily understood by the layp
erson who may have difficulty understanding ambiguous and uncertain in
formation. This paper addresses issues and concerns pertaining to the
representation of unaided decision making in clinical practice among p
atients in two clinical contexts (breast cancer and cardiovascular dis
ease). An analysis of qualitative clinical interviews provides indicat
ors of naturalistic rule-based approaches patients use when making a m
edical decision. The relative salience of the alternatives plays a key
role in discriminating rapid, intuitive decisions from those that are
more deliberative. Empirical descriptions of real-world decision-maki
ng processes support a theoretical model of unaided decisions in healt
h care.