影响从业者对替代医学试验证据解读的因素：一项全国性调查中嵌入的因子情境实验。
Factors that influence practitioners' interpretations of evidence from alternative medicine trials: a factorial vignette experiment embedded in a national survey.
机构信息
Department of Bioethics, National Institutes of Health, Bethesda, MD 20892, USA.
出版信息
Med Care. 2010 Apr;48(4):341-8. doi: 10.1097/mlr.0b013e3181ca3ee2.
BACKGROUND
Clinical trial evidence in controversial areas such as complementary and alternative medicine (CAM) must be approached with an open mind.
OBJECTIVE
To determine what factors may influence practitioners' interpretation of evidence from CAM trials.
RESEARCH DESIGN
In a mailed survey of 2400 US CAM and conventional medicine practitioners we included 2 hypothetical factorial vignettes of positive and negative research results for CAM clinical trials. Vignettes contained randomly varied journal (Annals of Internal Medicine vs. Journal of Complementary and Alternative Medicine) and CAM treatment type (acupuncture, massage, glucosamine, meditation, and reiki). Response items also included randomly varied patient circumstances-chronic refractory symptoms and the patient requesting CAM.
MEASURES
All practitioners rated the effectiveness and their willingness to recommend the therapy for a described patient. We used logistic regression to determine the independent influence of the 4 factors on respondents' effectiveness and legitimacy judgments.
RESULTS
A total of 1561 practitioners responded (65%). Relative to Reiki, conventional medicine practitioners were most willing to recommend glucosamine (OR = 3.0; 95% CI [1.6-5.4]), than massage (1.9 [1.1-3.3]), acupuncture (1.3 [0.8-2.2]), and meditation (1.2 [0.7-2.0]). CAM practitioners rated acupuncture as effective more than other CAM therapies (OR = 5.8 [2.6-12.8] compared with Reiki), and were more willing to recommend acupuncture (OR = 12.3 [4.8-31.8]). When presented evidence of inefficacy, CAM practitioners were most willing to recommend acupuncture relative to other CAM therapies (OR = 15.5 [9.0-26.9]).
CONCLUSIONS
Practitioners' judgments about CAM trial evidence depend on the type of treatments reported. Confirmation bias may play a role in the clinical translation of new evidence from clinical trials.
背景
在补充和替代医学（CAM）等有争议领域的临床试验证据必须持开放态度。
目的
确定哪些因素可能影响从业者对 CAM 试验证据的解释。
研究设计
我们在对 2400 名美国 CAM 和常规医学从业者的邮寄调查中，包括了 2 个关于 CAM 临床试验阳性和阴性研究结果的假设情况。病例包含了随机变化的期刊（《内科学年鉴》与《补充和替代医学杂志》）和 CAM 治疗类型（针灸、按摩、氨基葡萄糖、冥想和灵气）。应答项目还包括了随机变化的患者情况——慢性难治性症状和患者要求 CAM。
措施
所有从业者都为描述的患者评定了治疗的有效性及其推荐意愿。我们使用逻辑回归来确定这 4 个因素对应答者有效性和合法性判断的独立影响。
结果
共有 1561 名从业者（65%）做出了回应。与灵气相比，常规医学从业者更愿意推荐氨基葡萄糖（OR=3.0；95%CI[1.6-5.4]），其次是按摩（1.9[1.1-3.3]）、针灸（1.3[0.8-2.2]）和冥想（1.2[0.7-2.0]）。CAM 从业者认为针灸比其他 CAM 疗法更有效（与灵气相比，OR=5.8[2.6-12.8]），并且更愿意推荐针灸（OR=12.3[4.8-31.8]）。当出现无效证据时，CAM 从业者相对于其他 CAM 疗法更愿意推荐针灸（OR=15.5[9.0-26.9]）。
结论
从业者对 CAM 试验证据的判断取决于报告的治疗类型。在从临床试验中转化新证据的临床应用中，可能存在确认偏倚。
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