College of Social and Behavioral Sciences, University of Massachusetts, Amherst, MA, USA.
Science. 2021 Oct 15;374(6565):324-329. doi: 10.1126/science.abc9818. Epub 2021 Oct 14.
Clinical decisions made in the delivery setting are often made under high pressure and great uncertainty, and have serious consequences for mother and baby. Theories of decision-making suggest that individuals in such settings may resort to using heuristics, or simplified decision rules, to aid complex decision-making. This study investigates whether physicians’ delivery mode decisions (i.e., when to perform a vaginal versus a cesarean delivery) are influenced by such a heuristic. Electronic health records spanning 86,000 deliveries suggest that if the prior patient had complications in one delivery mode, the physician will be more likely to switch to the other—and likely inappropriate—delivery mode for the subsequent patient, regardless of patient indications. There is evidence that this heuristic has small, suboptimal effects on patient health.
在分娩环境中做出的临床决策通常是在高压和高度不确定的情况下做出的，并且会对母婴产生严重后果。决策理论表明，处于这种环境中的个体可能会诉诸于使用启发式或简化的决策规则来辅助复杂的决策。本研究调查了医生的分娩方式决策（即何时进行阴道分娩与剖宫产）是否受到这种启发式的影响。跨越 86000 次分娩的电子健康记录表明，如果前一个患者在一种分娩方式中出现并发症，那么医生更有可能为随后的患者切换到另一种——且可能不合适的——分娩方式，而不管患者的指征如何。有证据表明，这种启发式对患者健康有较小的、次优的影响。
