Redelmeier D A, Shafir E, Aujla P S
Department of Medicine, University of Toronto, Ontario, Canada.
Med Decis Making. 2001 Sep-Oct;21(5):376-81. doi: 10.1177/0272989X0102100504.
The authors tested whether clinicians make different decisions if they pursue information than if they receive the same information from the start.
Three groups of clinicians participated (N=1206): dialysis nurses (n=171), practicing urologists (n=461), and academic physicians (n=574). Surveys were sent to each group containing medical scenarios formulated in 1 of 2 versions. The simple version of each scenario presented a choice between 2 options. The search version presented the same choice but only after some information had been missing and subsequently obtained. The 2 versions otherwise contained identical data and were randomly assigned.
In one scenario involving a personal choice about kidney donation, more dialysis nurses were willing to donate when they first decided to be tested for compatibility and were found suitable than when theyknew they were suitable from the start (65% vs. 44%, P= 0.007). Similar discrepancies were found in decisions made by practicing urologists concerning surgery for a patient with prostate cancer and in decisions of academic physicians considering emergency management for a patient with acute chest pain.
The pursuit of information can increase its salience and cause clinicians to assign more importance to the information than if the same information was immediately available. An awareness of this cognitive bias may lead to improved decision making in difficult medical situations.
作者测试了临床医生主动寻求信息时做出的决策是否与一开始就收到相同信息时做出的决策不同。
三组临床医生参与了研究(N = 1206):透析护士(n = 171)、执业泌尿科医生(n = 461)和学术医生(n = 574)。向每组发送了包含两种版本之一的医疗场景的调查问卷。每个场景的简单版本提供了两个选项之间的选择。搜索版本呈现相同的选择,但只有在一些信息缺失并随后获得之后才呈现。这两个版本在其他方面包含相同的数据,并被随机分配。
在一个涉及个人肾脏捐赠选择的场景中,更多的透析护士在首次决定进行相容性检测并被发现合适时愿意捐赠,而不是从一开始就知道自己合适时(65%对44%,P = 0.007)。在执业泌尿科医生关于前列腺癌患者手术的决策以及学术医生考虑急性胸痛患者的紧急处理的决策中也发现了类似的差异。
寻求信息会增加其显著性,并导致临床医生比在相同信息立即可用时更重视该信息。意识到这种认知偏差可能会在困难的医疗情况下改善决策。