Promoting Reflection on Medical Maximizing-Minimizing Preferences May Create Undesired Effects on Decisions About Low-Benefit and High-Benefit Care.

IF 1.7
MDM policy & practice Pub Date : 2021-01-29 eCollection Date: 2021-01-01 DOI:10.1177/2381468320987498
Brian J Zikmund-Fisher, Victoria A Shaffer, Laura D Scherer
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引用次数: 2

Abstract

Background: Medical maximizing-minimizing (MM) preferences predict a variety of medical decisions. We tested whether informing people about their MM preferences and asking them to reflect on the pros and cons of that preference would improve medical decisions when clear clinical recommendations exist.

Methods: We surveyed 1219 US adults age 40+ that were sampled to ensure a 50%/50% distribution of medical maximizers versus minimizers. Participants either received no MM feedback (Control) or received feedback about their MM type and instructions to reflect on how that MM type can be helpful in some circumstances and problematic in others (Reflection). All participants then completed five hypothetical decision scenarios regarding low-value care services (e.g., head computed tomography scan for mild concussion) and three about high-value care (e.g., flu vaccination).

Results: There were no significant differences between the Control and Reflection groups in five of eight scenarios. In three scenarios (two low-benefit and one high-benefit), we observed small effects in the nonhypothesized direction for the MM subgroup least likely to follow the recommendation (e.g., maximizers in the Reflection group were more likely to request low-benefit care).

Conclusions: Asking people to reflect on their MM preferences may be a counterproductive strategy for optimizing patient decision making around quality of care.

Abstract Image

Abstract Image

促进对医疗最大化-最小化偏好的反思可能会对低效益和高效益护理的决策产生不良影响。
背景:医疗最大化-最小化(MM)偏好预测各种医疗决策。我们测试了当有明确的临床建议时,告知人们他们的MM偏好并要求他们反思这种偏好的利弊是否会改善医疗决策。方法:我们对1219名40岁以上的美国成年人进行了抽样调查,以确保医疗最大化者和最小化者的比例为50%/50%。参与者要么没有收到MM反馈(对照组),要么收到关于他们的MM类型的反馈,并指示他们反思MM类型在某些情况下是如何有用的,而在其他情况下是如何有问题的(反思)。然后,所有参与者完成了五个关于低价值护理服务(例如,轻度脑震荡的头部计算机断层扫描)和三个关于高价值护理(例如,流感疫苗接种)的假设决策场景。结果:对照组和反思组在8种情况中的5种情况下无显著差异。在三种情况下(两种低效益和一种高效益),我们观察到最不可能遵循建议的MM亚组在非假设方向上的小影响(例如,反思组的最大化者更有可能要求低效益护理)。结论:要求人们反思他们的MM偏好可能是一种适得其反的策略,无法优化患者在护理质量方面的决策。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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