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是否接受或拒绝其医疗提供者开始抗逆转录病毒治疗(ART)的建议的过程。抗逆转录病毒疗法极大地延长了艾滋病毒携带者的生命，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ART。有证据表明，解释图式和认知扭曲可能在关于艺术的决策中发挥作用。图式和认知偏差如果扭曲了个体对风险、收益、结果概率和健康信息来源的可信度的看法，可能会影响抗逆转录病毒治疗的决策。此外，患者和医疗提供者可以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。这项拟议的研究将研究这些过程如何影响150名艾滋病毒携带者的决定，这些人是市中心一家诊所的患者，服务于主要处于不利地位的非裔美国人。受试者将在基线和6个月和12个月的随访中完成一次结构化的访谈和一系列调查问卷，检查他们对健康、疾病和艾滋病毒的看法。实验室数值和机会性感染等医疗变量将从电子临床数据库中记录下来。问卷回答和医学因素将被用来预测在后续期间对ART的接受程度或对ART的意图的变化。问卷调查也将被用来检查那些公开拒绝抗逆转录病毒治疗的患者和那些秘密拒绝抗逆转录病毒治疗的患者之间的差异，例如，通过自我终止抗逆转录病毒疗法。据假设，解释偏差将在抗逆转录病毒治疗决策中发挥重要作用，患者将权衡症状和其他可观察到的健康指数，认为其对抗逆转录病毒治疗决策比实验室价值更重要。它还假设，公开拒绝抗逆转录病毒疗法的患者将比那些暗中拒绝抗逆转录病毒疗法的患者表现出更高的心理社会功能水平和对医疗体系的更多信任。 如果解释模式和认知扭曲导致艾滋病毒携带者以没有经验支持或基于误解的理由拒绝抗逆转录病毒疗法，这是与艾滋病毒有关的可预防发病率和死亡率的一个重要来源。不适当的医疗会导致更高的病毒载量，因此传染性更大。如果与预防行为的减少相结合，这也被发现与对艾滋病毒的不信任模式有关，结果可能会极大地增强艾滋病毒对未感染个人的传播。

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.