McNeil B J, Pauker S G, Sox H C, Tversky A
N Engl J Med. 1982 May 27;306(21):1259-62. doi: 10.1056/NEJM198205273062103.
We investigated how variations in the way information is presented to patients influence their choices between alternative therapies. Data were presented summarizing the results of surgery and radiation therapy for lung cancer to 238 ambulatory patients with different chronic medical conditions and to 491 graduate students and 424 physicians. We asked the subjects to imagine that they had lung cancer and to choose between the two therapies on the basis of both cumulative probabilities and life-expectancy data. Different groups of respondents received input data that differed only in whether or not the treatments were identified and whether the outcomes were framed in terms of the probability of living or the probability of dying. In all three populations, the attractiveness of surgery, relative to radiation therapy, was substantially greater when the treatments were identified rather than unidentified, when the information consisted of life expectancy rather than cumulative probability, and when the problem was framed in terms of the probability of living rather than in terms of the probability of dying. We suggest that an awareness of these effects among physicians and patients could help reduce bias and improve the quality of medical decision making.
我们研究了向患者呈现信息的方式差异如何影响他们在替代疗法之间的选择。向238名患有不同慢性疾病的门诊患者、491名研究生和424名医生呈现了总结肺癌手术和放射治疗结果的数据。我们要求受试者想象自己患有肺癌，并根据累积概率和预期寿命数据在两种疗法之间做出选择。不同组的受访者收到的输入数据仅在治疗是否被明确标识以及结果是以生存概率还是死亡概率来表述方面有所不同。在所有这三类人群中，当治疗被明确标识而非未被标识时，当信息是预期寿命而非累积概率时，以及当问题是以生存概率而非死亡概率来表述时，相对于放射治疗，手术的吸引力显著更大。我们建议医生和患者了解这些影响有助于减少偏差并提高医疗决策质量。
