Elstein A S, Holzman G B, Belzer L J, Ellis R D
Department of Medical Education, University of Illinois College of Medicine, Chicago 60680.
Med Decis Making. 1992 Oct-Dec;12(4):265-73. doi: 10.1177/0272989X9201200404.
The authors investigated strategies employed by resident physicians to decide whether to prescribe hormonal replacement therapy (HRT) for menopausal women, a matter of continuing clinical controversy. Verbal protocols were obtained from 21 residents in three specialties as they responded to 12 brief case descriptions. The cases incorporated three levels of cancer risk and two levels of osteoporosis risk in a 3 x 2 factorial design with two replications in each cell. Substantial variation in willingness to prescribe HRT was observed. By clustering subjects with relatively similar approaches to the problem, three treatment strategies were formulated that accounted for the decisions of 20 subjects. Each strategy is a simplified representation of the conflicting considerations in this clinical dilemma that facilitates rapid decision making. The differences between these representations and formal decision-analytic models help to explain why observed clinical decisions were inconsistent with expected utility maximization.
作者们研究了住院医师在决定是否为更年期女性开激素替代疗法（HRT）时所采用的策略，这是一个仍存在临床争议的问题。通过让来自三个专业的21名住院医师对12个简短病例描述做出回应，获取了他们的口头记录。这些病例采用3×2析因设计，包含三个癌症风险水平和两个骨质疏松风险水平，每个单元格有两个重复。研究观察到在开HRT意愿方面存在很大差异。通过将对该问题处理方式相对相似的受试者归为一组，制定了三种治疗策略，这三种策略解释了20名受试者的决策情况。每种策略都是对这一临床困境中相互冲突的考虑因素的简化呈现，有助于快速做出决策。这些呈现方式与正式决策分析模型之间的差异有助于解释为何观察到的临床决策与预期效用最大化不一致。
