Comparison of physicians' decisions regarding estrogen replacement therapy for menopausal women and decisions derived from a decision analytic model

Elstein, Arthur S.; Holzman, Gerald B.; Ravitch, Michael M.; Metheny, William A.; Holmes, Margaret M.; Hoppe, Ruth B.; Rothert, Marilyn L.; Rovner, David R.

doi:10.1016/0002-9343(86)90016-1

Cited by 99 publications

(32 citation statements)

References 40 publications

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“…Studies have shown that patients [Pauker and Pauker, 19871 and physicians [Elstein et al, 1986;Clancy et al, 19881 often make choices that differ from those of decision models based on their utilities. Reasons for disagreements between actual decision making and expected utility models are probably multifactorial, and include the overweighting of small probabilities [Tversky and Kahneman, 19811, timedependent instability of utilities [Christensen-Szalanski, 19841, perception of short-vs. long-term expectation [Lopes, 19811, consideration of regret [Bell, 1982;Elstein et al, 1986;Feinstein, 19851, and other factors. Secondly, despite her preferences, Patient 3 may have presented to her physician when her pregnancy was too advanced for chorionic villus sampling, and amniocentesis was her only option.…”

Section: Discussionmentioning

confidence: 99%

Use of decision analysis to evaluate patients' choices of diagnostic prenatal test

Verp

Heckerling

1995

Am. J. Med. Genet.

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Women with a family history of a chromosomal or genetic abnormality must weigh several factors in choosing between amniocentesis and chorionic villus sampling. We compared the prenatal test choices of three such women with those of decision analytic models that incorporated their preferences. Patient preferences were assessed using visual linear rating scales. Threshold analysis was used to determine preference ranges, and stochastic sensitivity analysis to provide confidence levels, for each choice of test. The test choices of patients and decision analytic models agreed in one case, and disagreed in two cases. In one of the latter two cases, stochastic and threshold analyses showed the disagreement to be slight; for small shifts in preference differences for first- vs. second-trimester diagnosis, or first- vs. second-trimester therapeutic abortion, patient and decision model would have agreed. In the other, stochastic analysis showed their differences to be large; there were no thresholds for early diagnosis, or for early therapeutic abortion, that would have led to agreement between patient and model. In the two cases in which patient and decision model agreed or slightly disagreed, the patients had made their own choice of prenatal test. In the case in which patient and decision model strongly disagreed, the patient's physician had shared in the choice of test. Decision analysis can be useful in analyzing prenatal test choices based on individual preferences for pregnancy outcomes. When choices of patients and decision models do not agree, examination of the locus of decision making (patient vs. physician) may help resolve apparent differences.

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Section: Discussionmentioning

confidence: 99%

Use of decision analysis to evaluate patients' choices of diagnostic prenatal test

Verp

Heckerling

1995

Am. J. Med. Genet.

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“…Studies of omission bias indicate that physicians underutilize preventive interventions in order to avoid having a direct role in bad outcomes (Elstein, 1999;Elstein et al, 1986). Death by 'natural causes' is viewed by physicians as better than death by prescription independent of the actual risk benefit ratio.…”

Section: Limitations Of the Descriptive Modelmentioning

confidence: 99%

Understanding our mistakes: a primer on errors in clinical reasoning

2003

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Clinical reasoning allows physicians to move from areas of clinical uncertainty to points where the medical literature offers guidance, and is equally important in deducing whether the results of clinical trials are applicable to an individual patient. However, studies in the field of cognitive psychology indicate that the reasoning skills of clinicians are imperfect. Moreover, clinicians may be aware of their mistakes but often do not understand the cognitive processes underlying their errors. Greater understanding of the reasoning process has the potential to improve patient care but independent study of clinical reasoning can be difficult, as the literature is complex and unfamiliar to most physicians. This article provides an introduction to diagnostic reasoning and highlights some of the cognitive factors that lead to errors in clinical problem solving. Clinical scenarios are used to illustrate key points and place the material in a readily accessible framework.

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“…They note that: expected utility theory states that individuals should assign (or act as if they assign) a utility value to each possible outcome, and, when faced with a set of risky alternatives, choose the one that yields the highest mathematical expectation of utility. (p. 203) However, it should be noted that the expected utility model excludes aspects such as risk aversion, that is, the avoidance of making a high risk judgment, or regret, the withholding of a decision for fear of being wrong (Elstein et al, 1986;Hogarth, 1987).…”

Section: The Study Of Clinical Judgmentmentioning

confidence: 99%

Clinical Judgment : an Overview

Records

Weiss

1990

Journal of Childhool Communication Disorders

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The process of clinical judgment and decision making in assessment is a poorly understood phenomenon, perhaps because it has been largely ignored in the speech-language pathology literature. In contrast, the fields of medicine and psychology have provided a substantial body of research investigating clinical judgment and decision making in clinical practice. The authors provide an overview of this literature, emphasizing the need for clinical judgment to be systematically studied and taught within our own field.

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Comparison of physicians' decisions regarding estrogen replacement therapy for menopausal women and decisions derived from a decision analytic model

Cited by 99 publications

References 40 publications

Use of decision analysis to evaluate patients' choices of diagnostic prenatal test

Use of decision analysis to evaluate patients' choices of diagnostic prenatal test

Understanding our mistakes: a primer on errors in clinical reasoning

Clinical Judgment : an Overview

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