BMC Med Inform Decis Mak - Variability of the impact of adverse events on physicians' decision making.

Tópicos

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Resumo

CKGROUND: Physicians 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.METHODS: A 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.RESULTS: 118 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.CONCLUSION: Our 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.

Resumo Limpo

ckground physician frequent differ treatment recommend howev studi examin reason under differ object studi examin whether physician vari import attach specif advers event two treatment option found recent random control trial equival efficaci overal toxicitymethod maxdiff survey administ physician attend nation scientif confer quantifi influenc specif advers event decis make relat two treatment option vascul approach chosen result greater item discrimin compar rate scale use hierarch bay model generat relat import score advers event examin associ physician characterist five influenti factorsresult physician complet survey mean age sd year male report spend major time clinic practic signific variabl rate relat import advers event except mild easili revers found posit correl increas physician age rate sepsi r p opportunist infect r p invers associ age progress multifoc leukoencephalopathi r p physician sex work set locat number patient vascul seen per year associ influenc specif advers event decis makingconclus find demonstr physician differ substanti perceiv import specif advers event may help explain observ unwarr variabl physician recommend clinic practic effort need ensur reason under variabl physician recommend transpar

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