Kthupi Altea, Rochon Paula A, Santini Sara, Paoletti Luca, Mason Robin, McCarthy Lisa M, Carrieri Barbara, Dalton Kieran, Li Joyce, Sivayoganathan Kawsika, Borhani Parya, Sternberg Shelley A, Zwas Donna R, Savage Rachel D
Women's Age Lab, Women's College Hospital, Toronto, ON, Canada.
Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
Drugs Aging. 2024 Dec;41(12):977-988. doi: 10.1007/s40266-024-01158-1. Epub 2024 Nov 27.
Despite growing awareness of sex differences in inappropriate prescribing among older adults, including the initiation of problematic prescribing cascades, the impact of gender bias remains largely unexplored.
We explored how a patient's sex and gender-related sociocultural factors influence physicians' prescribing decisions, potentially leading to prescribing cascades in older adults. A secondary objective was to explore whether and how physician sex affected prescribing decisions for female and male patients.
Physicians in Canada and Italy were presented with a clinical vignette describing an older male or female patient on amlodipine presenting with peripheral edema. Physicians were interviewed using the 'think-aloud' method to describe their treatment considerations. Thematic multi-site analysis was used to analyze the data.
Of 30 physicians, only two considered prescribing a diuretic for an older female patient. Most physicians identified amlodipine as the cause of the edema and adjusted or substituted the medication, often making these treatment decisions without considering sex- and gender-related sociocultural factors. When prompted, physicians acknowledged the relevance of these factors, but their responses varied. Some adapted their treatment plans, noting the challenges of managing edema, particularly for female patients, whereas others did not incorporate these considerations. Interestingly, some physicians adjusted their plans based on gender-related factors yet still stated that gender did not influence their treatment decisions. No variations in treatment decisions based on physician sex were observed.
The study reveals a gap between physicians' recognition of gender-related sociocultural factors and their consistent integration into clinical decision-making, highlighting the need for more nuanced approaches in prescribing practices.
尽管人们越来越意识到老年人不适当处方中的性别差异，包括引发有问题的处方级联反应，但性别偏见的影响在很大程度上仍未得到探索。
我们探讨了患者的性别及与性别相关的社会文化因素如何影响医生的处方决策，这可能导致老年人出现处方级联反应。第二个目的是探讨医生的性别是否以及如何影响对男性和女性患者的处方决策。
向加拿大和意大利的医生展示了一个临床案例，描述了一名正在服用氨氯地平且出现外周水肿的老年男性或女性患者。采用“出声思考”方法对医生进行访谈，以描述他们的治疗考量。使用多地点主题分析法对数据进行分析。
在30名医生中，只有两名医生考虑为老年女性患者开利尿剂。大多数医生将氨氯地平确定为水肿的原因，并调整或更换了药物，通常在做出这些治疗决策时未考虑与性别和社会文化相关的因素。当被提示时，医生们承认这些因素的相关性，但他们的回答各不相同。一些人调整了治疗方案，指出了管理水肿的挑战，特别是对女性患者而言，而另一些人则没有纳入这些考量。有趣的是，一些医生根据与性别相关的因素调整了他们的方案，但仍表示性别没有影响他们的治疗决策。未观察到基于医生性别的治疗决策差异。
该研究揭示了医生对与性别相关的社会文化因素的认识与将其持续纳入临床决策之间的差距，凸显了在处方实践中需要采用更细致入微的方法。
