Factors impacting physicians’ decisions to prevent variceal hemorrhage

Abstract

BackgroundReasons underlying the variability of physicians’ preferences for non-selective beta-blockers (BBs) and endoscopic variceal ligation (EVL) to prevent a first variceal bleed have not been empirically studied. Our aims were to examine whether 1) gastroenterologists can be classified into distinct subgroups based on how they prioritize specific treatment attributes and 2) physician characteristics are associated with treatment preference.MethodsWe surveyed physicians to determine their preferred treatment for a standardized patient with large varices and examined the influence of treatment characteristics on physicians’ decision making using best-worst scaling. Latent class analysis was used to examine whether physicians could be classified into groups with similar decision-making styles.Results110 physicians were interviewed (participation rate 39%). The majority spent two or more days a week performing endoscopies and had practices comprising less than 25% of patients with liver disease. Latent class analysis demonstrated that physicians could be classified into at least two distinct groups. Most (n = 80, Group 1) were influenced solely by the ability to visually confirm eradication of varices. In contrast, members of Group 2 (n = 30) were influenced by the side effects and mechanism of action of BBs. Group 1 members were more likely to have practices that included fewer patients with liver disease and more likely to choose options including EVL (p = 0.01 for both).ConclusionsAmong physicians, where the majority performs endoscopy on two or more days per week, most prefer prevention strategies which include EVL. This may be due to the strong appeal of being able to visualize eradication of varices.

Portal hypertensive bleeding in cirrhosis

“…Subjective factors influence the physician's choice in selecting NSBBs versus EVL, as illustrated in a recent study in which gastroenterologists who spent at least half their time performing endoscopy were more likely to choose EVL, whereas physicians who had a less procedural‐based practice were more likely to choose NSBBs …”

Using Best–Worst Scaling to Investigate Preferences in Health Care

“…[52]USA20153011115101NANA2 Yan et al. [53]USA201511010115101114 Yu et al. [54]USA20151826103101002 Median175121353BWS profile case Szeinbach et al.…”

Varices and Variceal Hemorrhage in Cirrhosis: A New View of an Old Problem

“…Interestingly, in a recent survey using best-worst scaling, physicians that spent at least half their time performing endoscopy were more likely to choose EVL and were influenced mostly by the ability to visually confirm disappearance of varices while physicians that had a large Hepatology practice were more likely to choose NSBB and were influenced by the side effects and mechanism of action of NSBB 32 .…”