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The objective of this study, undertaken in the USA, was to investigate the consequences of autonomy-related companion behaviors on patient decision-making activity during geriatric primary care visits. Videotapes were analyzed to characterize patient and companion decision-making activity and related companion behaviors. These behaviors were coded throughout the visit using an autonomy-based framework that included both autonomy enhancing (i.e. facilitating patient understanding, patient involvement, and doctor understanding) and detracting behaviors, (i.e. controlling the patient and building alliances with the physician). Patients (N=93) in this cross-sectional sample range in age from 65 to 95 years and are mostly white (n=73, 79%) and female (n=67, 72%). Companions are spouses (n=42, 46%), adult children (n=33, 36%), or other relatives and friends (n=15, 16%) of patients. Companions are active …