Aversion to ambiguity and willingness to take risks affect therapeutic decisions in managing atrial fibrillation for stroke prevention: results of a pilot study in family physicians.
Aversion to ambiguity and willingness to take risks affect therapeutic decisions in managing atrial fibrillation for stroke prevention: results of a pilot study in family physicians.
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DOI：
10.2147/ppa.s143958
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发表时间：
2017
影响因子：
2.2
通讯作者：
Saposnik G
中科院分区：
文献类型：
--
作者：
Raptis S;Chen JN;Saposnik F;Pelyavskyy R;Liuni A;Saposnik G
抗凝是预防房颤（AF）患者卒中的治疗范例。目前尚不清楚医生如何在AF患者的一级卒中预防中做出治疗决策。通过应用行为经济学的概念，评估家庭医生的风险偏好（规避风险和模糊性）与AF一级卒中预防管理中的治疗建议（抗凝治疗）之间的相关性。共有73名家庭医生参与并完成了这项研究。我们的研究包括七个模拟案例，三个行为实验，和两个验证的调查。行为实验和调查纳入了一个经济框架，以确定风险偏好和偏见（例如，（1）愿意承担风险（willing to take risks）。主要结局是做出正确的抗凝治疗决定。次要结局包括为预防卒中而管理AF时的医疗错误。总体而言，23.3%（17/73）的家庭医生选择不按照最佳实践指南的建议将抗血小板治疗升级为抗凝治疗。共有67.1%的医生在三个模拟病例中的两个或两个以上选择了正确的治疗方案。多因素分析显示，避免模棱两可与房颤治疗中适当改变抗凝治疗相关（OR 5.48，95%CI 1.08-27.85）。医生愿意在多个领域承担个人风险与较低的错误相关（OR 0.16，95%CI 0.03-0.86）。医生对模糊性的厌恶和愿意承担风险与房颤管理中卒中一级预防的适当治疗决策相关。需要进一步的大规模研究。
Anticoagulation is the therapeutic paradigm for stroke prevention in patients with atrial fibrillation (AF). It is unknown how physicians make treatment decisions in primary stroke prevention for patients with AF. To evaluate the association between family physicians’ risk preferences (aversion risk and ambiguity) and therapeutic recommendations (anticoagulation) in the management of AF for primary stroke prevention by applying concepts from behavioral economics. Overall, 73 family physicians participated and completed the study. Our study comprised seven simulated case vignettes, three behavioral experiments, and two validated surveys. Behavioral experiments and surveys incorporated an economic framework to determine risk preferences and biases (e.g., ambiguity aversion, willingness to take risks). The primary outcome was making the correct decision of anticoagulation therapy. Secondary outcomes included medical errors in the management of AF for stroke prevention. Overall, 23.3% (17/73) of the family physicians elected not to escalate the therapy from antiplatelets to anticoagulation when recommended by best practice guidelines. A total of 67.1% of physicians selected the correct therapeutic options in two or more of the three simulated case vignettes. Multivariate analysis showed that aversion to ambiguity was associated with appropriate change to anticoagulation therapy in the management of AF (OR 5.48, 95% CI 1.08–27.85). Physicians’ willingness to take individual risk in multiple domains was associated with lower errors (OR 0.16, 95% CI 0.03–0.86). Physicians’ aversion to ambiguity and willingness to take risks are associated with appropriate therapeutic decisions in the management of AF for primary stroke prevention. Further large scale studies are needed.