Variability of the impact of adverse events on physicians’ decision making

BMC Medical Informatics and Decision Making

Research Article

Peter A Merkel¹  Elizabeth Wahl²  Raluca Cozmuta³  Liana Fraenkel⁴ 

[1] Division of Rheumatology, University of Pennsylvania, 19104, Philadelphia, PA, USA;University of San Francisco, San Francisco, USA;Yale University School of Medicine, PO Box 208031, 06520-8031, New Haven, CT, USA;Yale University School of Medicine, PO Box 208031, 06520-8031, New Haven, CT, USA;Clinical Epidemiology Research Center, VA Connecticut Healthcare System, 06516, West Haven, CT, USA;

关键词: Vasculitis;    Decision-making;    Drug toxicity;    Cyclophosphamide;    Rituximab;    Best-worst scaling;   

DOI  :  10.1186/1472-6947-14-86

 received in 2013-09-17, accepted in 2014-05-28,  发布年份 2014

来源: Springer

【 摘 要 】

BackgroundPhysicians frequently differ in their treatment recommendations. However, few studies have examined the reasons underlying these differences. The objective of this study was to examine whether physicians vary in the importance they attach to specific adverse events for two treatment options found in recent randomized controlled trials to have equivalent efficacy and overall toxicity.MethodsA Max-Diff survey was administered to physicians attending a national scientific conference to quantify the influence of 23 specific adverse events on decision making related to two treatment options for vasculitis. This approach was chosen because it results in greater item discrimination compared to rating scales. We used Hierarchical Bayes modeling to generate the relative importance score for each adverse event and examined the association between physicians’ characteristics and the five most influential factors.Results118 physicians completed the survey. The mean age (SD) was 48 years (10); 68% were male and 81% reported spending the majority of time in clinical practice. There was significant variability in the ratings of the relative importance of all adverse events, except those that were mild and easily reversible. We found a positive correlation between increasing physician age with ratings of sepsis (r = 0.29, p = 0.002) and opportunistic infection (r = 0.23, p = 0.016), and an inverse association between age with progressive multifocal leukoencephalopathy (r = - 0.28, p = 0.003). Physician sex, work setting, location, and number of patients with vasculitis seen per year were not associated with the influence of specific adverse events on decision making.ConclusionOur findings demonstrate that physicians differ substantially in how they perceive the importance of specific adverse events which may help explain observed unwarranted variability in physicians’ recommendations in clinical practice. Further efforts are needed to ensure that the reasons underlying variability in physicians’ recommendations are transparent.

【 授权许可】

Unknown   
© Cozmuta et al.; licensee BioMed Central Ltd. 2014. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.