Cognitive Biases and Interpretive Schemas in Antiretroviral Therapy Decision-Maki

抗逆转录病毒治疗决策中的认知偏差和解释模式

• 批准号: 7495435
• 负责人: REBECCA WALD
• 金额: $ 18.75万
• 依托单位: UNIVERSITY OF MARYLAND BALTIMORE
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-04-09 至 2010-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7495435
• 关键词: Adult; Adverse effects; Affect; African American; Anti-Retroviral Agents; Attitude; Behavior; Belief; Benefits and Risks; CD4 Lymphocyte Count; Clinic; Clinical; Cognitive; Cognitive Dissonance; Computerized Medical Records Systems; Condition; Control Locus; Databases; Decision Making; Depressed mood; Disadvantaged; Drops; Goals; Guidelines; HIV; HIV Seropositivity; Health; Health Personnel; Health Status; Health behavior; Healthcare; Healthcare Systems; Hospitalization; Individual; Interview; Label; Lead; Life; Link; Measures; Mediating; Medical; Medical Research; Mental Depression; Modeling; Morbidity - disease rate; Numbers; Opportunistic Infections; Outcome; Patients; Pattern; Perception; Personal Satisfaction; Persons; Play; Population; Prevention; Probability; Process; Provider; Public Health; Purpose; Questionnaires; Reaction; Recommendation; Recording of previous events; Recovery; Research; Role; Sampling; Source; Structure; Symptoms; Time; Toxic effect; Treatment Protocols; Trust; Viral Load result; Well in self; abstracting; antiretroviral therapy; base; experience; follow-up; health belief; indexing; inner city; interest; mortality; prescription document; prescription procedure; psychosocial; response; stressor; theories; transmission process; willingness

DESCRIPTION (provided by applicant): The purpose of the proposed study is to investigate the processes by which patients decide whether to accept or reject their medical provider's recommendation to begin anti-retroviral therapy (ART). ART has dramatically extended the lives and reduced the suffering of people with HIV, but many clinically eligible patients refuse ART. Others stop ART without notifying their medical providers. There is some evidence that interpretive schemas and cognitive distortions may play a role in decision-making about ART. Schemas and cognitive biases may affect ART decision-making if they distort individuals' perceptions of risks, benefits, outcome probabilities, and the credibility of health information sources. Additionally, patients and medical providers may use different health criteria for deciding when ART should be initiated. The proposed study will examine how these processes affect decisions about ART in a sample of 150 persons with HIV who are patients in an inner-city clinic serving a largely disadvantaged, African-American population. Subjects will complete a structured interview and a battery of questionnaires examining their beliefs about health, illness, and HIV at baseline and at 6- and 12-month follow-up. Medical variables such as lab values and opportunistic infections will be recorded from electronic clinical databases. Questionnaire responses and medical factors will be used to predict acceptance of ART or change in intentions towards ART during the follow-up period. Questionnaire measures will also be used to examine differences between patients who overtly refuse ART and those who refuse ART covertly, e.g., by self-discontinuing ART. It is hypothesized that interpretive biases will play a significant role in ART decision-making, and that patients will weigh symptoms and other observable indices of health as more important to ART decision-making than lab values. It is also hypothesized that patients who overtly refuse ART will display a higher level of psychosocial functioning and more trust in the health care system than those who covertly reject ART. PUBLIC HEALTH RELEVANCE To the extent that interpretive schemas and cognitive distortions lead persons with HIV to reject ART for reasons which are not empirically supported or are based on misconceptions, this represents a significant source of preventable morbidity and mortality related to HIV. Inadequate medical treatment results in higher viral loads, and therefore greater infectivity. If combined with decreased prevention behavior, which has also been found to be linked to mistrustful schemas about HIV, the result is likely to be greatly enhanced transmission of HIV to uninfected individuals.

描述（由申请人提供）：拟议研究的目的是调查患者决定是否接受或拒绝其医疗提供者建议开始抗逆转录病毒治疗（ART）的过程。抗逆转录病毒疗法极大地延长了艾滋病毒感染者的生命，减少了他们的痛苦，但许多临床合格的患者拒绝接受抗逆转录病毒疗法。有一些证据表明，解释性图式和认知扭曲可能会在ART决策中发挥作用。图式和认知偏差可能会影响ART决策，如果它们扭曲了个人对风险、益处、结果概率和健康信息来源的可信度的看法。此外，患者和医疗提供者可能使用不同的健康标准来决定何时开始ART。拟议的研究将研究这些过程如何影响对ART的150名艾滋病毒感染者的样本中的决定，他们是在一个内城诊所服务的主要是弱势群体，非洲裔美国人的患者。受试者将完成一个结构化的访谈和一组调查问卷，检查他们在基线和6个月和12个月随访时对健康，疾病和HIV的信念。将从电子临床数据库中记录医学变量，如实验室检查值和机会性感染。将使用问卷回答和医学因素来预测随访期间ART的接受程度或ART意向的变化。还将使用问卷测量来检查公开拒绝ART的患者与秘密拒绝ART的患者之间的差异，例如，据推测，解释性偏差将在ART决策中发挥重要作用，并且患者将权衡症状和其他可观察到的健康指标，认为其对ART决策比实验室值更重要。也有人假设，公开拒绝抗逆转录病毒疗法的患者将显示出更高水平的心理社会功能，并在卫生保健系统比那些谁偷偷拒绝抗逆转录病毒疗法的信任。 解释模式和认知扭曲导致艾滋病毒感染者拒绝抗逆转录病毒疗法，其原因没有经验支持或基于误解，这是与艾滋病毒相关的可预防发病率和死亡率的重要来源。不适当的医疗导致更高的病毒载量，因此更大的传染性。如果再加上预防行为的减少，这也被发现与对艾滋病毒的不信任模式有关，结果可能会大大增加艾滋病毒向未感染个体的传播。