Joseph M. Katz Graduate School of Business.
Department of Critical Care Medicine, and.
Ann Am Thorac Soc. 2022 Apr;19(4):633-639. doi: 10.1513/AnnalsATS.202105-594OC.
Little is known about how physicians develop their beliefs about new treatments or update their beliefs in the face of new clinical evidence. These issues are particularly salient in the context of the coronavirus disease (COVID-19) pandemic, which created rapid demand for novel therapies in the absence of robust evidence. To identify psychological traits associated with physicians' willingness to treat with unproven therapies and willingness to update their treatment preferences in the setting of new evidence in the context of COVID-19. We administered a longitudinal e-mail survey to United States physicians board certified in intensive care medicine in April and May 2020 (phase one) and October and November 2020 (phase two). We assessed five psychological traits potentially related to evidence uptake: need for cognition, evidence skepticism, need for closure, risk tolerance, and research engagement. We then examined the relationship between these traits and physician preferences for pharmacological treatment for a hypothetical patient with severe COVID-19 pneumonia. There were 592 responses to the phase one survey, conducted prior to publication of trial data. At this time physicians were most willing to treat with macrolide antibiotics (50.5%), followed by antimalaria agents (36.1%), corticosteroids (24.5%), antiretroviral agents (22.6%), and angiotensin inhibitors (4.4%). Greater evidence skepticism (relative risk [RR], 1.40; 95% confidence interval [CI], 1.30-1.52; < 0.001), greater need for closure (RR, 1.19; 95% CI, 1.06-1.34; = 0.003), and greater risk tolerance (RR, 1.17; 95% CI, 1.08-1.26; < 0.001) were associated with an increased willingness to treat, whereas greater need for cognition (RR, 0.85; 95% CI, 0.75-0.96, = 0.010) and greater research engagement (RR, 0.91; 95% CI, 0.88-0.95; < 0.0001) were associated with decreased willingness to treat. In phase two, most physicians updated their beliefs after publication of trial data about antimalarial agents and corticosteroids. Physicians with greater evidence skepticism were more likely to persist in their beliefs. Psychological traits associated with clinical decisions in the setting of uncertain evidence may provide insight into strategies to better align clinical practice with published evidence.
关于医生如何形成对新疗法的看法或在面对新的临床证据时更新他们的看法，人们知之甚少。在冠状病毒病（COVID-19）大流行的背景下，这些问题尤其突出，因为在缺乏有力证据的情况下，对新型疗法的需求迅速增加。本研究旨在确定与医生对未经证实的疗法的治疗意愿以及在 COVID-19 背景下新证据下更新治疗偏好意愿相关的心理特征。我们在 2020 年 4 月至 5 月（第 1 阶段）和 10 月至 11 月（第 2 阶段）期间向美国重症监护医学委员会认证的医生发送了一份关于心理特征的纵向电子邮件调查。我们评估了与证据获取相关的五个潜在心理特征：认知需求、证据怀疑主义、寻求封闭、风险容忍度和研究参与度。然后，我们研究了这些特征与医生对患有严重 COVID-19 肺炎的假设患者进行药物治疗的偏好之间的关系。第一阶段调查共收到 592 份回复，在试验数据公布之前进行。此时，医生最愿意用大环内酯类抗生素（50.5%）治疗，其次是抗疟药（36.1%）、皮质类固醇（24.5%）、抗逆转录病毒药物（22.6%）和血管紧张素抑制剂（4.4%）。更大的证据怀疑主义（相对风险 [RR]，1.40；95%置信区间 [CI]，1.30-1.52； < 0.001）、更大的寻求封闭（RR，1.19；95% CI，1.06-1.34； = 0.003）和更大的风险容忍度（RR，1.17；95% CI，1.08-1.26； < 0.001）与增加治疗意愿相关，而更大的认知需求（RR，0.85；95% CI，0.75-0.96， = 0.010）和更大的研究参与度（RR，0.91；95% CI，0.88-0.95； < 0.0001）与降低治疗意愿相关。在第二阶段，在公布了关于抗疟药和皮质类固醇的试验数据后，大多数医生更新了他们的信念。证据怀疑主义更强的医生更有可能坚持自己的信念。在不确定证据的情况下与临床决策相关的心理特征可能有助于制定更好地将临床实践与已发表证据相结合的策略。
