Department of Hematology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China.
Department of Psychology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China.
J Gen Intern Med. 2021 Oct;36(10):3023-3030. doi: 10.1007/s11606-020-06467-w. Epub 2021 Jan 28.
Elderly patients with acute myeloid leukemia (AML) can be treated with intensive therapy, low-intensity therapy, or best supportive care. Medical decision-making might be affected by physicians' occupational and non-occupational factors.
To explore the impact of physicians' personalities and behavioral traits on treatment-related decision-making for elderly AML patients.
A nationwide cross-sectional survey.
Hematologists in mainland China (N = 529; response rate 64.5%).
The medical decision-making for elderly AML patients was evaluated using 6 clinical vignettes. Hematologists' attitudes toward risk and uncertainty, Big Five personality traits, and decision-making styles were assessed using binary lottery choices and well-recognized self-report inventories.
The resulting binary regression model in predicting treatment intensity contained professional title group (OR = 0.012, 95% CI 0.001 to 0.136, P < 0.001), conscientiousness (OR = 0.336, 95% CI 0.121 to 0.932, P = 0.036), extraversion (OR = 0.403, 95% CI 0.166 to 0.974, P = 0.044), conscientiousness by title group (OR = 2.009, 95% CI 1.100 to 3.667, P = 0.023), and extraversion by title group (OR = 1.627, 95% CI 0.965 to 2.743, P = 0.068) as predictors of therapy intensity preference. Junior physicians with a higher level of extraversion (mean difference = 0.27; 95% CI 0.07 to 0.45; P = 0.009) or conscientiousness (mean difference = 0.19; 95% CI 0.01 to 0.36; P = 0.028) tended to prescribe more intensive therapy. Meanwhile, no significant correlation was found between physicians' personalities or behavioral traits and treatment-related decision-making in senior physicians.
Physicians' personalities contribute to treatment-related decision-making for elderly AML patients, depending on the professional titles. More extravert or conscientious attending physicians tended to prescribe more intensive therapy. Meanwhile, the decisions made by chief and associate chief physicians were not impacted by their personal traits. Junior physicians should be aware of such potential influence when making medical decisions.
老年急性髓系白血病（AML）患者可接受强化治疗、低强度治疗或最佳支持治疗。医生的职业和非职业因素可能会影响医疗决策。
探讨医生的个性和行为特征对老年 AML 患者治疗相关决策的影响。
全国性横断面调查。
中国大陆的血液科医生（N=529；应答率 64.5%）。
使用 6 个临床病例评估老年 AML 患者的医疗决策。使用二项式彩票选择和公认的自我报告量表评估血液科医生对风险和不确定性的态度、大五人格特质和决策风格。
预测治疗强度的二元回归模型包含职称组（OR=0.012，95%CI 0.001 至 0.136，P<0.001）、尽责性（OR=0.336，95%CI 0.121 至 0.932，P=0.036）、外向性（OR=0.403，95%CI 0.166 至 0.974，P=0.044）、尽责性与职称组（OR=2.009，95%CI 1.100 至 3.667，P=0.023）和外向性与职称组（OR=1.627，95%CI 0.965 至 2.743，P=0.068）作为治疗强度偏好的预测因子。具有较高外向性（平均差异=0.27；95%CI 0.07 至 0.45；P=0.009）或尽责性（平均差异=0.19；95%CI 0.01 至 0.36；P=0.028）的初级医师更倾向于开更强化疗。同时，在资深医师中，未发现医师的个性或行为特征与治疗相关决策之间存在显著相关性。
医生的个性特征影响老年 AML 患者的治疗相关决策，这取决于医生的职称。更外向或尽责的主治医生往往会开出更强化疗。同时，主任和副主任医师的决策不受个人特征的影响。初级医师在做出医疗决策时应注意这种潜在影响。
