Are Residents' Decisions Influenced More by a Decision Aid or a Specialist's Opinion? A Randomized Controlled Trial

Overview

Journal J Gen Intern Med

Publisher Springer

Specialty General Medicine

Date 2010 Feb 2

PMID 20119873

Citations 5

Authors

Mitchell A Medow

Hal R Arkes

Victoria A Shaffer

Affiliations

Soon will be listed here.

Abstract

Background: Physicians are reluctant to use decision aids despite their ability to improve care. A potential reason may be that physicians do not believe decision aid advice.

Objective: To determine whether internal medicine residents lend more credence to contradictory decision aid or human advice.

Design: Randomized controlled trial. Residents read a scenario of a patient with community-acquired pneumonia and were asked whether they would admit the patient to the intensive care unit or the floor. Residents were randomized to receive contrary advice from either a referenced decision aid or an anonymous pulmonologist. They were then asked, in light of this new information, where they would admit the patient.

Participants: One hundred eight internal medicine residents.

Measurements: The percentage of residents who changed their admission location and the change in confidence in the decision.

Main Results: Residents were more likely to change their original admission location (OR 2.3, 95% CI 1.04 to 5.1, P = 0.04) and to reduce their confidence in the decision (adjusted difference between means -12.9%, 95% CI -3.0% to -22.8%, P = 0.011) in response to the referenced decision aid than to the anonymous pulmonologist. Confidence in their decision was more likely to change if they initially chose to admit the patient to the floor.

Conclusions: In a hypothetical case of community-acquired pneumonia, physicians were influenced more by contrary advice from a referenced decision aid than an anonymous specialist. Whether this holds for advice from a respected specialist or in actual practice remains to be studied.

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References

Ridderikhoff J, van Herk E . A diagnostic support system in general practice: is it feasible?. Int J Med Inform. 1997; 45(3):133-43. DOI: 10.1016/s1386-5056(97)00022-1. View

DesRoches C, Campbell E, Rao S, Donelan K, Ferris T, Jha A . Electronic health records in ambulatory care--a national survey of physicians. N Engl J Med. 2008; 359(1):50-60. DOI: 10.1056/NEJMsa0802005. View

Fine M, Auble T, Yealy D, Hanusa B, Weissfeld L, Singer D . A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med. 1997; 336(4):243-50. DOI: 10.1056/NEJM199701233360402. View

Chase C, Vacek P, Shinozaki T, Giard A, Ashikaga T . Medical information management: improving the transfer of research results to presurgical evaluation. Med Care. 1983; 21(4):410-24. DOI: 10.1097/00005650-198304000-00004. View

Corey G, Merenstein J . Applying the acute ischemic heart disease predictive instrument. J Fam Pract. 1987; 25(2):127-33. View

Garg A, Adhikari N, McDonald H, Rosas-Arellano M, Devereaux P, Beyene J . Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: a systematic review. JAMA. 2005; 293(10):1223-38. DOI: 10.1001/jama.293.10.1223. View

Dreiseitl S, Binder M . Do physicians value decision support? A look at the effect of decision support systems on physician opinion. Artif Intell Med. 2004; 33(1):25-30. DOI: 10.1016/j.artmed.2004.07.007. View

Lim W, van der Eerden M, Laing R, Boersma W, Karalus N, Town G . Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax. 2003; 58(5):377-82. PMC: 1746657. DOI: 10.1136/thorax.58.5.377. View

Sittig D, Krall M, Dykstra R, Russell A, Chin H . A survey of factors affecting clinician acceptance of clinical decision support. BMC Med Inform Decis Mak. 2006; 6:6. PMC: 1403751. DOI: 10.1186/1472-6947-6-6. View

10.

Berner E, Maisiak R, Heuderbert G, Young Jr K . Clinician performance and prominence of diagnoses displayed by a clinical diagnostic decision support system. AMIA Annu Symp Proc. 2004; :76-80. PMC: 1480080. View

11.

Landefeld C, Chren M, Myers A, Geller R, Robbins S, Goldman L . Diagnostic yield of the autopsy in a university hospital and a community hospital. N Engl J Med. 1988; 318(19):1249-54. DOI: 10.1056/NEJM198805123181906. View

12.

Friedman C, Elstein A, Wolf F, Murphy G, Franz T, Heckerling P . Enhancement of clinicians' diagnostic reasoning by computer-based consultation: a multisite study of 2 systems. JAMA. 1999; 282(19):1851-6. DOI: 10.1001/jama.282.19.1851. View

13.

Arkes H, Shaffer V, Medow M . Patients derogate physicians who use a computer-assisted diagnostic aid. Med Decis Making. 2007; 27(2):189-202. DOI: 10.1177/0272989X06297391. View

14.

de Dombal F, DALLOS V, McAdam W . Can computer aided teaching packages improve clinical care in patients with acute abdominal pain?. BMJ. 1991; 302(6791):1495-7. PMC: 1670180. DOI: 10.1136/bmj.302.6791.1495. View

15.

Dawson N, Connors Jr A, Speroff T, Kemka A, Shaw P, Arkes H . Hemodynamic assessment in managing the critically ill: is physician confidence warranted?. Med Decis Making. 1993; 13(3):258-66. DOI: 10.1177/0272989X9301300314. View

16.

Lomas J, ENKIN M, Anderson G, Hannah W, Vayda E, Singer J . Opinion leaders vs audit and feedback to implement practice guidelines. Delivery after previous cesarean section. JAMA. 1991; 265(17):2202-7. View

17.

Kaplan B . Evaluating informatics applications--clinical decision support systems literature review. Int J Med Inform. 2001; 64(1):15-37. DOI: 10.1016/s1386-5056(01)00183-6. View

18.

Getty D, PICKETT R, DOrsi C, Swets J . Enhanced interpretation of diagnostic images. Invest Radiol. 1988; 23(4):240-52. DOI: 10.1097/00004424-198804000-00002. View

19.

Arkes H, Shaffer V, Medow M . The influence of a physician's use of a diagnostic decision aid on the malpractice verdicts of mock jurors. Med Decis Making. 2008; 28(2):201-8. DOI: 10.1177/0272989X07313280. View