B.R.A.I.N. Questions Help Patients Take Part in Medical Decisions

When a medical decision arrives under pressure, five questions can help patients understand their options and say what matters to them. The B.R.A.I.N. framework, used by birth doulas and midwives, prompts people to ask about benefits, risks, alternatives, intuition and what happens if they wait or do nothing.

Its value is not in steering patients toward or away from a procedure. It creates a structure for a conversation at a point when treatment plans may change quickly, and helps patients take part in deciding what happens next.

A birth plan meets hospital care

Gina Conley, an Army veteran from Aberdeen, North Carolina, wanted a low-intervention birth with her first child. At the hospital, she said, her labor progressed differently from what she had hoped. Her midwife urged her to take Pitocin because her cervix was dilating slowly, then later asked to break her amniotic sac to help move labor along. Conley agreed to the latter, though reluctantly.

Looking back, Conley felt that she had been uncomfortable with several decisions and that her providers hadn’t fully heard her. The experience helped lead her to become a birth doula, supporting other women through labor and delivery.

For Conley, that support isn’t about avoiding medical interventions. It’s about helping patients and clinicians discuss the choices together. Patients who are involved in decisions report greater satisfaction with care, and studies have found better outcomes in some settings. Conley’s measure is personal: “How were you treated? And how many decisions did you feel like you got to truly make?”

Five prompts for a decision point

The acronym gives patients a concise set of questions to bring to a provider:

• What are the benefits of this intervention?
• What are the risks?
• What are the alternative options?
• What does my intuition tell me?
• What happens if I do nothing right now?

Margaret Buxton, a certified nurse midwife and vice president of clinical operations at Diana Health, a network of women’s healthcare practices in the South, describes B.R.A.I.N. as a way to talk with a healthcare provider when a decision or change in direction comes up.

One part of the framework turns attention inward. Buxton says emotions register physically as well as mentally, and checking in with intuition may help someone feel more settled about a choice. Patients who feel heard can also experience less anxiety and stress, she said, making it easier to process information, think and listen.

Start with the question about waiting

Patients who can’t remember all five prompts can ask just one: “What happens if I do nothing right now?” Buxton says that question can create room to pause, discuss options with trusted people and feel more involved in the decision.

There are emergencies when immediate action takes priority. Conley says that’s apparent when staff are rushing a patient to the operating room. In other circumstances, she says, there’s often time to reach a decision that feels comfortable and well understood.

Questions work best in a trusting relationship

Even when people have questions, the power dynamic in a medical setting can make them hard to ask. Buxton says medicine has often operated as a top-down relationship, with an expert on one side and a patient receiving care on the other.

Some patients also worry they won’t be taken seriously. Research has found that medical professionals are less likely to prescribe pain medication to women than to men reporting the same symptoms. Black women are three times as likely to die in childbirth as white women.

For planned care such as childbirth, Conley recommends paying attention to how a provider handles questions during appointments. Does the provider listen and explain their expertise in a way that respects the patient’s preferences? If not, Conley says, patients may want to find someone else to oversee their care. It’s harder to have a productive conversation with a provider who dismisses questions, she said.

From informed consent to shared decisions

Before most procedures, medical professionals are legally and ethically required to obtain informed consent and provide accurate, complete information about the recommended treatment, typically in writing. Shared decision-making goes further by making a patient’s values and priorities part of the discussion.

Nearly two decades ago, the American College of Obstetricians & Gynecologists’ ethics committee recommended that doctors discuss the benefits and risks of available options in that context. The Centers for Medicare & Medicaid Services has also made shared decision-making a condition of payment for a limited number of treatments.

B.R.A.I.N. can help patients start that exchange, but the quality of the conversation still depends on whether a provider is willing to listen. For patients facing a decision, asking what happens next—and whether a pause is possible—can be a practical first step.

Katherine Ruppelt at Nashville Public Radio contributed to this report.

HealthQ is a health series from reporters Cara Anthony and Blake Farmer, approachable guides to an unapproachable healthcare system. It’s a collaboration between Nashville Public Radio and KFF Health News.

This article first appeared on KFF Health News and is republished here under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.