The University of Texas at Austin, USA.
Hand (N Y). 2022 Sep;17(5):988-992. doi: 10.1177/1558944720974123. Epub 2020 Dec 24.
Patients who help choose their health strategies are more adherent and achieve better health. An important role of the clinician is to verify that a patient's expressed preferences are consistent with what matters most to the patient and not muddled by common misconceptions about symptoms or conditions. Patient choices are influenced by estimation of the potential benefits and potential harms of a given intervention. One method for quantifying these estimations is the concept of maximum acceptable risk (MAR), or the maximum risk that subjects are willing to accept in exchange for a given therapeutic benefit. This study addressed the hypothesis that misconceptions due to unhelpful cognitive bias regarding pain are associated with risk acceptance among people seeking care for an upper extremity condition.
We invited 140 new adult patients visiting an upper extremity specialist to complete a survey including demographics, pain intensity, depression and anxiety symptoms, catastrophic thinking, activity limitations, and MAR. Trauma or nontrauma diagnosis was obtained from the treating clinician and recorded by the research assistant. We used bivariate and linear regression analyses to identify factors associated with MAR among this population.
Accounting for potential confounding in multivariable analysis, higher MAR was associated with older age and greater catastrophic thinking.
Specialists can be aware that people with more unhelpful cognitive biases may be willing to take more risk. Vigilance for common misconceptions and gentle, incremental reorientation of those misconceptions can increase the probability that people will choose options consistent with what matters most to them.
选择自己健康策略的患者更具依从性，且能获得更好的健康状况。临床医生的一个重要作用是核实患者表达的偏好与其自身的首要需求是否一致，而非受到对症状或疾病的常见误解的影响。患者的选择会受到对特定干预措施潜在益处和潜在危害的估计的影响。量化这些估计的一种方法是最大可接受风险 (MAR) 的概念，即患者愿意接受的最大风险，以换取给定的治疗益处。本研究检验了这样一个假设，即与疼痛相关的无益认知偏差导致的误解与寻求上肢疾病治疗的人群的风险接受意愿相关。
我们邀请了 140 名新的成年上肢专科就诊患者完成一项调查，内容包括人口统计学资料、疼痛强度、抑郁和焦虑症状、灾难性思维、活动受限和 MAR。创伤或非创伤性诊断由主治临床医生提供，并由研究助理记录。我们使用双变量和线性回归分析来确定该人群中与 MAR 相关的因素。
在多变量分析中考虑到潜在的混杂因素后，更高的 MAR 与年龄较大和灾难性思维更严重相关。
专科医生可以意识到，具有更多无益认知偏见的人可能愿意承担更多风险。警惕常见的误解，并对这些误解进行温和、渐进式的重新引导，可以增加人们选择符合自身首要需求的可能性。
