Cognitive Biases and Interpretive Schemas in Antiretroviral Therapy Decision-Maki

描述（由申请人提供）：拟议研究的目的是调查患者决定接受或拒绝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，但许多符合临床条件的患者拒绝接受抗逆转录病毒疗法。其他人在没有通知医疗提供者的情况下停止了抗逆转录病毒治疗。有证据表明，解释图式和认知扭曲可能在ART决策中发挥作用。如果图式和认知偏见扭曲了个人对风险、收益、结果概率和卫生信息来源可信度的认知，则可能影响抗逆转录病毒治疗决策。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应该开始抗逆转录病毒治疗。这项拟议的研究将检查这些过程如何影响150名艾滋病毒感染者对抗逆转录病毒治疗的决定，这些人是市中心一家诊所的病人，主要服务于弱势的非洲裔美国人。受试者将在基线和6个月和12个月的随访中完成结构化访谈和一系列调查问卷，以检查他们对健康、疾病和艾滋病毒的看法。医学变量，如实验室值和机会性感染将从电子临床数据库中记录。问卷调查结果和医学因素将用于预测在随访期间接受抗逆转录病毒治疗或对抗逆转录病毒治疗意图的改变。还将采用问卷调查的方法来检查公开拒绝抗逆转录病毒治疗的患者和暗中拒绝抗逆转录病毒治疗的患者之间的差异，例如，通过自我停止抗逆转录病毒治疗。假设解释偏差将在ART决策中发挥重要作用，并且患者会将症状和其他可观察到的健康指标视为比实验室值更重要的ART决策。还有一种假设是，公开拒绝抗逆转录病毒治疗的患者会比那些暗中拒绝抗逆转录病毒治疗的患者表现出更高水平的社会心理功能和对卫生保健系统的更多信任。

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.