Lin Senlin, Ma Yingyan, Zou Haidong
Department of Eye Disease Prevention, Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai 200010, People's Republic of China.
Shanghai General Hospital, National Clinical Research Center for Eye Diseases, Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai 200000, People's Republic of China.
Patient Prefer Adherence. 2020 Feb 25;14:371-381. doi: 10.2147/PPA.S227829. eCollection 2020.
This study tried to establish a metric framework of patient adherence to doctor's advice based on the expected utility and prospect theories, and it explained why the key to patient adherence to doctor's advice is patients' perceptions.
Our framework is primarily based on two mature theories: expected utility theory and prospect theory. We started with a basic assumption: the doctor is rational and cares for patient's health utility. We analyzed the expected utility of therapy with a definite diagnosis. Then, we considered the impacts of the accuracy of diagnostic techniques. After that, we explored the patient's response to the doctors' advices based on behavioral economics. In addition, we launched a discrete choice experiment to test our main point: perception is the key to patients' adherence. A total of 200 undergraduate students participated in the discrete choice experiment.
Three main factors might impact a rational clinical decision: the therapeutic and side effects of the treatment, patient's true disease risk, and diagnostic accuracy. However, another factor, patient's individual percepion, was crucial for patient's adherence since it may bias the patient's estimations regarding the above three factors. As a result, doctors and patients would have a cognitive gap in the estimation of the disease and the treatment.
The results indicate that without the necessary information, better clinical techniques may not help to improve patient adherence, which support our theoretical reasoning forcefully. Therefore, improving patient adherence should be more of a process of empathy and communication rather than a promotion of medical technology.
本研究试图基于期望效用理论和前景理论建立一个衡量患者遵医嘱程度的度量框架，并解释患者遵医嘱的关键在于患者的认知。
我们的框架主要基于两个成熟的理论：期望效用理论和前景理论。我们从一个基本假设出发：医生是理性的，并且关心患者的健康效用。我们分析了明确诊断后治疗的期望效用。然后，我们考虑了诊断技术准确性的影响。之后，我们基于行为经济学探讨了患者对医生建议的反应。此外，我们开展了一项离散选择实验来检验我们的主要观点：认知是患者遵医嘱的关键。共有200名本科生参与了该离散选择实验。
三个主要因素可能影响合理的临床决策：治疗的疗效和副作用、患者真正的疾病风险以及诊断准确性。然而，另一个因素，即患者的个体认知，对患者的遵医嘱程度至关重要，因为它可能会使患者对上述三个因素的估计产生偏差。结果，医生和患者在对疾病和治疗的估计上会存在认知差距。
结果表明，在没有必要信息的情况下，更好的临床技术可能无助于提高患者的遵医嘱程度，这有力地支持了我们的理论推理。因此，提高患者的遵医嘱程度应该更多地是一个共情和沟通的过程，而不是推广医疗技术。
