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

When a care decision feels rushed, one question can create room to understand the options: “What happens if I do nothing right now?” That pause may help patients talk through a recommendation and consider what matters to them. It can’t replace a clinician’s judgment or delay care when time matters, but it can support a more active conversation when there is time to have one.

The question comes from B.R.A.I.N., a framework used by birth doulas and others to help patients discuss medical choices. The letters stand for benefits, risks, alternatives, intuition and nothing. The questions are straightforward: What might this option help with? What are its risks? What else could be considered? How do I feel about the choices? And what could happen if I wait or take no action for now?

Gina Conley, a doula in North Carolina, began supporting shared decision-making after a difficult experience during the birth of her first child. She had hoped for fewer interventions, but when her labor progressed slowly, her midwife recommended Pitocin to speed it up. Later, the midwife asked to break her amniotic sac. Conley agreed to that step, though she says she felt uneasy about several decisions and did not feel fully heard.

Her experience shaped how she now supports other people. The goal, she says, isn’t to avoid medical interventions. It’s to help patients and clinicians discuss the choices together, so the care plan reflects both medical information and the patient’s preferences.

Questions that open a conversation

Margaret Buxton, a certified nurse midwife and vice president of clinical operations at Diana Health, describes B.R.A.I.N. as a framework for moments when a patient is weighing a decision or considering a change in plan. It can help organize questions without requiring patients to know medical terminology or decide on the spot.

• Benefits: What is the expected benefit of this option?
• Risks: What possible downsides or complications should I understand?
• Alternatives: Are there other options, including waiting?
• Intuition: How do I feel about what’s being proposed?
• Nothing: What may happen if I don’t act right now?

The answers depend on the specific medical situation. Asking about benefits and risks can clarify what a treatment is meant to do and what trade-offs may come with it. Asking about alternatives can show whether there are different approaches, while a question about waiting can help establish whether a decision needs to be made immediately.

Intuition is part of the framework because patients may notice emotional or physical reactions as they hear about their options. Buxton says checking in with those feelings can help someone assess whether they understand the choice and feel comfortable with it. Feelings don’t establish which option is medically best, but they can point to questions that still need answers.

For patients who have little time or energy to use all five prompts, the question about doing nothing may be a useful starting point. Buxton says a pause can give someone an opportunity to talk with trusted people and feel more involved in the decision. Whether waiting is safe, though, depends on the circumstances; patients can ask their care team to explain what might change during that time.

Time and trust shape the choice

Some decisions arise in emergencies, when a care team may need to act quickly. Conley notes that there are situations when there isn’t time for a long discussion. In other circumstances, patients can ask for an explanation, request a moment to think, or check that they understand the recommendation. A clinician can help explain whether there is time to consider options and what signs would make the situation more urgent.

Patients may also find it hard to question a clinician, particularly when they’re worried about being dismissed or feel that the clinician has more authority in the room. Buxton describes medical care as having traditionally placed the clinician in the expert role and the patient in the receiving role. Shared decision-making asks both people to bring something to the discussion: the clinician’s medical knowledge and the patient’s values, priorities and experience.

Research has found differences in care that make respectful listening especially relevant. A study reported that clinicians were less likely to prescribe pain medication to women than to men reporting the same symptoms. Data from the Centers for Disease Control and Prevention show that Black women are three times as likely as white women to die in childbirth. These findings describe broader disparities; they don’t predict what will happen to any individual patient. They do underline why patients’ concerns and questions need to be taken seriously.

For planned care, Conley suggests paying attention to how a provider responds to questions during appointments. Patients can consider whether the clinician listens, explains options and takes their preferences seriously. Finding a provider with whom it feels possible to have an open conversation can make shared decisions easier.

A prompt, not a substitute for care

B.R.A.I.N. can help patients prepare for a conversation, but it doesn’t supply medical answers on its own. The clinician can explain which outcomes are likely, what uncertainties remain and whether a recommendation is time-sensitive. Patients who still feel unsure can ask for a simpler explanation or check with another trusted health professional, such as a pharmacist when medication questions are involved.

The wider idea of shared decision-making has been recommended in obstetrics and gynecology guidance for years. That guidance calls for discussing the benefits and risks of available options in light of a patient’s values and priorities. The framework gives patients a practical way to begin that discussion, though it doesn’t ensure every visit will leave them feeling heard.

When a medical choice comes up, a patient can start with the question that feels most useful. A clear explanation of the options, the possible consequences of waiting and the reasons behind a recommendation can help make the next step easier to understand.

Katherine Ruppelt at Nashville Public Radio contributed to this report.

HealthQ is a health series from reporters Cara Anthony and Blake Farmer, produced with Nashville Public Radio and KFF Health News.

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