Attitudes toward risk among emergency physicians and advanced practice clinicians in Massachusetts.
Attitudes toward risk among emergency physicians and advanced practice clinicians in Massachusetts.
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DOI：
10.1002/emp2.12573
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发表时间：
2021-10
影响因子：
2.3
通讯作者：
Landon BE
中科院分区：
文献类型：
--
作者：
Smulowitz PB;Burke RC;Ostrovsky D;Novack V;Isbell L;Landon BE
风险厌恶是一种影响医学决策的人格特质。很少有人知道如何急诊科（艾德）临床医生在他们的态度不同的风险承担。我们对马萨诸塞州的执业艾德临床医生（医生和高级执业临床医生[APC]）进行了一项横断面调查，使用了以下4个现有的经验证的量表：风险承担量表（RTS）、不确定性压力量表（SUS）、对医疗事故的恐惧量表（FMS）和（认知）闭合需求量表（NCC）。我们使用Cronbach α评估每个量表的可靠性，并进行多变量线性回归分析每个量表的评分与临床特征之间的关联。在招募参与研究的1458名艾德临床医生中，1116名（76.5%）来自马萨诸塞州93%的急诊医院。4个量表均表现出较高的内部一致性信度，Cronbach’s α在0.76 ~ 0.92之间。4个量表之间也存在中度相关（0.08 ~ 0.54;均P < 0.05）。多变量结果显示了医生和APC之间的差异，医生对风险或不确定性的容忍度更高（NCC差异，−3.58 [95%置信区间，CI，−5.26至−1.90]; SUS差异，−3.14 [95% CI：−4.99至−1.29]）和对医疗事故的更高关注（FMS差异，1.14 [95% CI，0.11-2.17]）。根据临床医生年龄也观察到差异（代表多年的经验），年龄越大，对风险或不确定性的容忍度越高（年龄大于50岁与年龄小于35岁相比; NCC差异为-2.84 [95%CI，-4.69至-1.00]; SUS差异，−4.71 [95%CI，− 6.74至−2.68]），对医疗事故的关注较少（FMS差异，−3.19 [95%CI，−4.31至−2.06]）。基于性别没有明显的差异，也没有一致的量表分数和实践和支付特性之间的关联评估。我们发现，艾德临床医生的风险态度与培训类型（医生vs APC）和年龄（经验）相关。这些差异为观察到的决策差异提供了一种可能的解释。
Risk aversion is a personality trait influential to decision making in medicine. Little is known about how emergency department (ED) clinicians differ in their attitudes toward risk taking. We conducted a cross‐sectional survey of practicing ED clinicians (physicians and advanced practice clinicians [APCs]) in Massachusetts using the following 4 existing validated scales: the Risk‐Taking Scale (RTS), Stress from Uncertainty Scale (SUS), the Fear of Malpractice Scale (FMS), and the Need for (Cognitive) Closure Scale (NCC). We used Cronbach's α to assess the reliability of each scale and performed multivariable linear regressions to analyze the association between the score for each scale and clinician characteristics. Of 1458 ED clinicians recruited for participation, 1116 (76.5%) responded from 93% of acute care hospitals in Massachusetts. Each of the 4 scales demonstrated high internal consistency reliability with Cronbach's αs ranging from 0.76 to 0.92. The 4 scales also were moderately correlated with one another (0.08 to 0.54; all P < 0.05). The multivariable results demonstrated differences between physicians and APCs, with physicians showing a greater tolerance for risk or uncertainty (NCC difference, −3.58 [95% confidence interval, CI, −5.26 to −1.90]; SUS difference, −3.14 [95% CI: −4.99 to −1.29]) and a higher concern about malpractice (FMS difference, 1.14 [95% CI, 0.11–2.17]). Differences were also observed based on clinician age (a proxy for years of experience), with greater age associated with greater tolerance of risk or uncertainty (age older than 50 years compared with age 35 years and younger; NCC difference, −2.84 [95% CI, −4.69 to −1.00]; SUS difference, −4.71 [95% CI, −6,74 to −2.68]) and less concern about malpractice (FMS difference, −3.19 [95% CI, −4.31 to −2.06]). There were no appreciable differences based on sex, and there were no consistent associations between scale scores and the practice and payment characteristics assessed. We found that risk attitudes of ED clinicians were associated with type of training (physician vs APC) and age (experience). These differences suggest one possible explanation for the observed differences in decision making.