Peng Jiaxi, He Fei, Zhang Yan, Liu Quanhui, Miao Danmin, Xiao Wei
Department of Psychology, Fourth Military Medical University, Xi'an, China.
PLoS One. 2013 Nov 14;8(11):e79181. doi: 10.1371/journal.pone.0079181. eCollection 2013.
Patients are often confronted with diverse medical decisions. Often lacking relevant medical knowledge, patients fail to independently make medical decisions and instead generally rely on the advice of doctors.
This study investigated the characteristics of and differences in doctor-patient medical decision making on the basis of construal level theory.
A total of 420 undergraduates majoring in clinical medicine were randomly assigned to six groups. Their decisions to opt for radiotherapy and surgery were investigated, with the choices described in a positive/neutral/negative frame × decision making for self/others.
Compared with participants giving medical advice to patients, participants deciding for themselves were more likely to select radiotherapy (F1, 404 = 13.92, p = 011). Participants from positive or neutral frames exhibited a higher tendency to choose surgery than did those from negative frames (F2, 404 = 22.53, p<.001). The effect of framing on independent decision making was nonsignificant (F2, 404 = 1.07, p = 35); however the effect of framing on the provision of advice to patients was significant (F2, 404 = 12.95, p<.001). The effect of construal level was significant in the positive frame (F1, 404 = 8.06, p = 005) and marginally significant in the neutral frame (F2, 404 = 3.31, p = 07) but nonsignificant in the negative frame (F2, 404 = .29, p = 59).
Both social distance and framing depiction significantly affected medical decision making and exhibited a significant interaction. Differences in medical decision making between doctors and patients need further investigation.
患者常常面临各种不同的医疗决策。由于通常缺乏相关医学知识,患者无法独立做出医疗决策,而是普遍依赖医生的建议。
本研究基于解释水平理论调查医患医疗决策的特点及差异。
将420名临床医学专业本科生随机分为六组。研究他们对放疗和手术的选择决策,选择描述采用积极/中性/消极框架×为自己/他人做决策。
与为患者提供医疗建议的参与者相比,为自己做决策的参与者更倾向于选择放疗(F1, 404 = 13.92, p = 0.011)。积极或中性框架的参与者比消极框架的参与者表现出更高的选择手术的倾向(F2, 404 = 22.53, p <.001)。框架对独立决策的影响不显著(F2, 404 = 1.07, p = 0.35);然而,框架对为患者提供建议的影响显著(F2, 404 = 12.95, p <.001)。解释水平效应在积极框架中显著(F1, 404 = 8.06, p = 0.005),在中性框架中接近显著(F2, 404 = 3.31, p = 0.07),但在消极框架中不显著(F2, 404 = 0.29, p = 0.59)。
社会距离和框架描述均显著影响医疗决策,并呈现出显著的交互作用。医患之间医疗决策的差异有待进一步研究。