Influence of Patients' Gender on Informed Decision Making Regarding Total Knee Arthroplasty
Influence of Patients' Gender on Informed Decision Making Regarding Total Knee Arthroplasty
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DOI：
10.1002/acr.21970
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发表时间：
2013-08-01
影响因子：
4.7
通讯作者：
Wright, James G.
中科院分区：
文献类型：
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作者：
Borkhoff, Cornelia M.;Hawker, Gillian A.;Wright, James G.
Objective.目的探讨患者性别对全膝关节置换术（TKA）推荐过程中医患沟通的影响。安大略的71名医生（38名家庭医生和33名骨科医生）对2名中度膝关节骨关节炎标准化患者（1男1女）进行了盲态评估，其他情况相同。4名外科医生不同意纳入他们的数据。标准化的患者和陪同的模拟家庭成员记录知情决策（IDM）的元素，作为存在/不存在的病人-医生的讨论，并评价医生的人际交往能力。总体而言，IDM的完整性较低，但女性的完整性更低。只有57%（67人中的38人）和15%（67人中的10人）的医生讨论了决定的性质，并在与男性和女性协商时引起了患者的偏好。即使在调整了医生关于TKA的建议后，当与女性互动时，医生包括较少的IDM元素（IDM评分的校正平均差异为1.2 [95%置信区间（95% CI）0.6，1.8]; P < 0.001），人际交往能力较差（调整后的平均差异为14.1 [95%CI 9.0，19.2]; P < 0.001）。与男性相比，医生向女性提供的医疗信息较少，参与决定接受TKA的鼓励较少，无论他们对TKA的建议如何。我们的研究结果表明，除了直接影响医生的临床决策外，性别偏见还可能影响医生的人际行为。
Objective. To investigate the effect of patient gender on patient-physician communication in the process of recommendation for total knee arthroplasty (TKA).Methods. Seventy-one physicians (38 family physicians and 33 orthopedic surgeons) in Ontario performed blinded assessments of 2 standardized patients (1 man and 1 woman) with moderate knee osteoarthritis and otherwise identical scenarios. Four surgeons did not consent to including their data. Standardized patients and accompanying mock family members recorded elements of informed decision making (IDM) as present/absent in the patient-physician discussion and rated the physicians' interpersonal skills.Results. Overall, the completeness of IDM was low, but was lower still for the woman. Only 57% (38 of 67) and 15% (10 of 67) of physicians discussed the nature of the decision and elicited the patient's preference while consulting with the man and woman, respectively. Even after adjusting for physicians' recommendations regarding TKA, when interacting with the woman, physicians included fewer IDM elements (adjusted mean difference in IDM score 1.2 [95% confidence interval (95% CI) 0.6, 1.8]; P < 0.001) and had poorer interpersonal skills (adjusted mean difference 14.1 [95% CI 9.0, 19.2]; P < 0.001) compared with their consultation with the man.Conclusion. Physicians provided less medical information and less encouragement to participate in the decision to undergo TKA to a woman compared with a man, irrespective of their recommendation regarding TKA. Our findings suggest that in addition to directly influencing physicians' clinical decision making, gender bias may also influence physicians' interpersonal behavior.