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临床实践中直觉决策的个人及工作特定因素:匈牙利医生和护士样本调查结果

Person- and job-specific factors of intuitive decision-making in clinical practice: results of a sample survey among Hungarian physicians and nurses.

作者信息

Ruzsa Gabor, Szeverenyi Csenge, Varga Katalin

机构信息

Doctoral School of Psychology, Institute of Psychology, Eötvös Loránd University, Budapest, Hungary.

Department of Statistics, School of Economics, Corvinus University of Budapest, Budapest, Hungary.

出版信息

Health Psychol Behav Med. 2020 Mar 23;8(1):152-184. doi: 10.1080/21642850.2020.1741372.

Abstract

To assess the prevalence of intuitive decision-making (IDM) among health care practitioners (HCPs) and explore its person- and job-specific factors. We used on-line survey data from a cross-sectional sample of Hungarian physicians and nurses ( = 460) to assess their reliance on IDM. In a second survey we asked physicians ( = 104) to rate medical specialties on dimensions of 'emergency' (necessity of making instantaneous decisions in unforeseeable situations) and 'complexity' (necessity of considering multiple perceptual and diagnostic aspects of patients' health condition along with diverse treatment options). Altogether 40% of participants reported ever relying on IDM. Using logistic regression analysis, we found the estimated probability of IDM was 0.24 greater for physicians than for nurses, 0.10 greater for females than for males, and 0.11 greater for advanced level HCPs than for novices. Reaching expert level further increased (by 0.31) the probability of IDM for physicians, but not for nurses. Concerning physicians, practicing in a medical specialty of 'high likelihood of emergency' or 'high complexity' increased the probability of IDM by 0.25 and 0.23; the same effects for nurses were 0.20 and 0.07. We found some (inconclusive) evidence for education positively influencing HCPs' propensity for IDM. Additionally, we performed content analysis of participants' free-text answers to explore the psychological background of IDM instances. HCPs educated in the subject of IDM were found more disposed to perform or request further medical investigation, less prone to deviate from medical protocols, apter to reflect on their mental processes, and more inclined to rely on a large scope of information for their decisions. The associations between job- and person-specific factors and HCPs' propensity for IDM may have implications for their training and allocation in the health care system. Education has great potential for enhancing the quality of IDM in clinical practice.

摘要

评估医疗从业者(HCPs)中直觉决策(IDM)的普遍性,并探究其个人和工作特定因素。我们使用了来自匈牙利医生和护士横断面样本(n = 460)的在线调查数据来评估他们对IDM的依赖程度。在第二项调查中,我们要求医生(n = 104)根据“紧急情况”(在不可预见的情况下做出即时决策的必要性)和“复杂性”(考虑患者健康状况的多个感知和诊断方面以及多种治疗选择的必要性)维度对医学专业进行评分。共有40%的参与者报告曾依赖IDM。通过逻辑回归分析,我们发现医生依赖IDM的估计概率比护士高0.24,女性比男性高0.10,高级水平的HCPs比新手高0.11。达到专家水平进一步增加了(0.31)医生依赖IDM的概率,但护士没有。对于医生来说,在“紧急情况可能性高”或“复杂性高”的医学专业中执业会使IDM的概率分别增加0.25和0.23;护士的相应影响分别为0.20和0.07。我们发现一些(不确定的)证据表明教育对HCPs的IDM倾向有积极影响。此外,我们对参与者的自由文本回答进行了内容分析,以探究IDM实例的心理背景。发现接受过IDM主题教育的HCPs更倾向于进行或要求进一步的医学调查,不太容易偏离医疗规程,更倾向于反思自己的思维过程,并且更倾向于在决策时依赖广泛的信息。工作和个人特定因素与HCPs的IDM倾向之间的关联可能对他们在医疗系统中的培训和分配有影响。教育在提高临床实践中IDM质量方面具有巨大潜力。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1d5d/8114373/b551814a8d3b/RHPB_A_1741372_F0001_OB.jpg

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