Sorum Paul C, Mullet Etienne, Shim Junseop, Bonnin-Scaon Sylvie, Chasseigne Gérard, Cogneau Joël
Med Decis Making. 2004 Mar-Apr;24(2):149-59. doi: 10.1177/0272989X04263163.
When making decisions, people are known to try to minimize the regret that would be provoked by unwanted consequences of these decisions. The authors explored the strength and determinants of such anticipated regret in a study of physicians' decisions to order prostate-specific antigen (PSA) tests.
32 US and 33 French primary care physicians indicated the likelihood they would order a PSA for 32 hypothetical men presenting for routine physical exams. They then indicated how much regret they would feel if they found advanced prostate cancer in 12 other patients for whom they had chosen not to order PSAs several years before. The latter patients differed according to age (55, 65, or 75 years), a prior request or not for PSA testing, and no or some irregularity of the prostate on the earlier rectal exam.
ANOVA found that regret was higher when the patient had requested a PSA, the prostate was irregular, and the patient was younger. Shape had less effect when the patient had requested a PSA. US physicians had more regret than the French, patient request had a greater impact on the Americans, and increasing patient age reduced regret more among the French. In a 1-way correlation, the regret score was associated with the likelihood of ordering PSAs for both the French (r = 0.64, P < 0.005) and the Americans (r = 0.42, P< 0.02). In a regression analysis too, the regret score was the most important predictor of the likelihood of ordering a PSA (beta = 0.37, P < 0.0001).
Regret over failing to diagnose aggressive prostate cancer is associated with a policy of ordering PSAs. This regret appears to be culturally sensitive.
众所周知，人们在做决策时会试图将这些决策产生的不良后果所引发的遗憾降至最低。作者在一项关于医生决定进行前列腺特异性抗原（PSA）检测的研究中，探讨了这种预期遗憾的强度及其决定因素。
32名美国和33名法国初级保健医生表示了他们为32名前来进行常规体检的假设男性开具PSA检测的可能性。然后，他们指出，如果几年前他们选择不为另外12名患者开具PSA检测，而后来这些患者被发现患有晚期前列腺癌，他们会感到多大的遗憾。后一组患者在年龄（55岁、65岁或75岁）、之前是否要求进行PSA检测以及早期直肠指检时前列腺是否有异常方面存在差异。
方差分析发现，当患者要求进行PSA检测、前列腺有异常且患者较年轻时，遗憾感更强。当患者要求进行PSA检测时，前列腺形状的影响较小。美国医生比法国医生有更多的遗憾感，患者的要求对美国人的影响更大，而患者年龄的增加在法国医生中减少遗憾感的作用更明显。在单因素相关性分析中，遗憾得分与法国医生（r = 0.64，P < 0.005）和美国医生（r = 0.42，P < 0.02）开具PSA检测的可能性相关。在回归分析中，遗憾得分也是开具PSA检测可能性的最重要预测因素（β = 0.37，P < 0.0001）。
对未能诊断出侵袭性前列腺癌的遗憾与开具PSA检测的政策相关。这种遗憾似乎具有文化敏感性。
