Haward Marlyse F, Murphy Ryan O, Lorenz John M
Department of Pediatrics, Division of Neonatology, Columbia University, New York, New York, USA.
Pediatrics. 2008 Jul;122(1):109-18. doi: 10.1542/peds.2007-0620.
The purpose of this study was to explore the effect of information framing on parental decisions about resuscitation of extremely premature infants. Secondary outcomes focused on elucidating the impact of other variables on treatment choices and determining whether those effects would take precedence over any framing effects.
This confidential survey study was administered to adult volunteers via the Internet. The surveys depicted a hypothetical vignette of a threatened delivery at gestational age of 23 weeks, with prognostic outcome information framed as either survival with lack of disability (positive frame) or chance of dying and likelihood of disability among survivors (negative frame). Participants were randomly assigned to receive either the positively or negatively framed vignette. They were then asked to choose whether they would prefer resuscitation or comfort care. After completing the survey vignette, participants were directed to a questionnaire designed to test the secondary hypothesis and to explore possible factors associated with treatment decisions.
A total of 146 subjects received prognostic information framed as survival data and 146 subjects received prognostic information framed as mortality data. Overall, 24% of the sample population chose comfort care and 76% chose resuscitation. A strong trend was detected toward a framing effect on treatment preference; respondents for whom prognosis was framed as survival data were more likely to elect resuscitation. This framing effect was significant in a multivariate analysis controlling for religiousness, parental status, and beliefs regarding the sanctity of life. Of these covariates, only religiousness modified susceptibility to framing; participants who were not highly religious were significantly more likely to be influenced to opt for resuscitation by the positive frame than were participants who were highly religious.
Framing bias may compromise efforts to approach prenatal counseling in a nondirective manner. This is especially true for subsets of participants who are not highly religious.
本研究旨在探讨信息框架对父母关于极早产儿复苏决策的影响。次要结果集中于阐明其他变量对治疗选择的影响，并确定这些影响是否会优先于任何框架效应。
这项保密的调查研究通过互联网对成年志愿者进行。调查描绘了一个孕23周时面临分娩风险的假设情景，预后结果信息被构建为无残疾存活（积极框架）或死亡几率及幸存者中残疾可能性（消极框架）。参与者被随机分配接受积极或消极框架的情景描述。然后他们被要求选择倾向于复苏还是舒适护理。完成调查情景描述后，参与者被引导至一份旨在检验次要假设并探索与治疗决策相关可能因素的问卷。
共有146名受试者收到构建为生存数据的预后信息，146名受试者收到构建为死亡数据的预后信息。总体而言，24%的样本选择了舒适护理，76%选择了复苏。在治疗偏好上检测到了强烈的框架效应趋势；预后被构建为生存数据的受访者更有可能选择复苏。在控制宗教信仰、父母状况和关于生命神圣性的信念的多变量分析中，这种框架效应显著。在这些协变量中，只有宗教信仰改变了对框架的易感性；与高度虔诚的参与者相比，不太虔诚的参与者受积极框架影响而选择复苏的可能性显著更高。
框架偏差可能会损害以非指导性方式进行产前咨询的努力。对于不太虔诚的参与者子集尤其如此。
