ArticleBMC medical informatics and decision making2016
Understanding clinical and non-clinical decisions under uncertainty: a scenario-based survey.
Article in BMC medical informatics and decision making, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers, 1 of them a synthesis that pooled it.
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Who cites it
7 citing papers in PubMed, 1 synthesis or guideline pooled it.
- How defensive medicine is defined in European medical literature: a systematic review.BMJ open · 2022Pooled it
- A combined behavioural economics- and simulation-based medical education to promote effectiveness among medical residents in coping with workplace violence in Northern China: a quasi-experimental study.BMC public health · 2022Trial
- Policy Options for Reducing Defensive Medicine Behaviors: A Multi-Method Study.Medical journal of the Islamic Republic of Iran · 2024Article
- A cumulative prospect theory-based method for group medical emergency decision-making with interval uncertainty.BMC medical informatics and decision making · 2022Article
- At the end: A vignette-based investigation of strategies for managing end-of-life decisions in the intensive care unit.Journal of the Intensive Care Society · 2021Article
- Barriers and facilitators to reduce low-value care: a qualitative evidence synthesis.BMJ open · 2020Article
- Clinical Genome Data Model (cGDM) provides Interactive Clinical Decision Support for Precision Medicine.Scientific reports · 2020Article
Corrections and comments
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Authors and funding
10 authors.
Funding
Abstract
backgroundProspect theory suggests that when faced with an uncertain outcome, people display loss aversion by preferring to risk a greater loss rather than incurring certain, lesser cost. Providing probability information improves decision making towards the economically optimal choice in these situations. Clinicians frequently make decisions when the outcome is uncertain, and loss aversion may influence choices. This study explores the extent to which prospect theory, loss aversion, and probability information in a non-clinical domain explains clinical decision making under uncertainty.
methodsFour hundred sixty two participants (n = 117 non-medical undergraduates, n = 113 medical students, n = 117 resident trainees, and n = 115 medical/surgical faculty) completed a three-part online task. First, participants completed an iced-road salting task using temperature forecasts with or without explicit probability information. Second, participants chose between less or more risk-averse ("defensive medicine") decisions in standardized scenarios. Last, participants chose between recommending therapy with certain outcomes or risking additional years gained or lost.
resultsIn the road salting task, the mean expected value for decisions made by clinicians was better than for non-clinicians(-$1,022 vs -$1,061; <0.001). Probability information improved decision making for all participants, but non-clinicians improved more (mean improvement of $64 versus $33; p = 0.027). Mean defensive decisions decreased across training level (medical students 2.1 ± 0.9, residents 1.6 ± 0.8, faculty1.6 ± 1.1; p-trend < 0.001) and prospect-theory-concordant decisions increased (25.4%, 33.9%, and 40.7%;p-trend = 0.016). There was no relationship identified between road salting choices with defensive medicine and prospect-theory-concordant decisions.
conclusionsAll participants made more economically-rational decisions when provided explicit probability information in a non-clinical domain. However, choices in the non-clinical domain were not related to prospect-theory concordant decision making and risk aversion tendencies in the clinical domain. Recognizing this discordance may be important when applying prospect theory to interventions aimed at improving clinical care.
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