Dataset Information

A matter of perspective: choosing for others differs from choosing for yourself in making treatment decisions.

ABSTRACT:

Background

Many people display omission bias in medical decision making, accepting the risk of passive nonintervention rather than actively choosing interventions (such as vaccinations) that result in lower levels of risk.

Objective

Testing whether people's preferences for active interventions would increase when deciding for others versus for themselves.

Research design

Survey participants imagined themselves in 1 of 4 roles: patient, physician treating a single patient, medical director creating treatment guidelines, or parent deciding for a child. All read 2 short scenarios about vaccinations for a deadly flu and treatments for a slow-growing cancer.

Participants

Two thousand three hundred and ninety-nine people drawn from a demographically stratified internet sample.

Measures

Chosen or recommended treatments. We also measured participants' emotional response to our task.

Results

Preferences for risk-reducing active treatments were significantly stronger for participants imagining themselves as medical professionals than for those imagining themselves as patients (vaccination: 73% [physician] & 63% [medical director] vs 48% [patient], Ps<.001; chemotherapy: 68% & 68% vs 60%, Ps<.012). Similar results were observed for the parental role (vaccination: 57% vs 48%, P=.003; chemotherapy: 72% vs 60%, P<.001). Reported emotional reactions were stronger in the responsible medical professional and parental roles yet were also independently associated with treatment choice, with higher scores associated with reduced omission tendencies (OR=1.15 for both regressions, Ps<.01).

Conclusions

Treatment preferences may be substantially influenced by a decision-making role. As certain roles appear to reinforce "big picture" thinking about difficult risk tradeoffs, physicians and patients should consider re-framing treatment decisions to gain new, and hopefully beneficial, perspectives.

SUBMITTER: Zikmund-Fisher BJ

PROVIDER: S-EPMC1924622 | biostudies-literature | 2006 Jun

REPOSITORIES: biostudies-literature

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Publications

A matter of perspective: choosing for others differs from choosing for yourself in making treatment decisions.

Zikmund-Fisher Brian J BJ Sarr Brianna B Fagerlin Angela A Ubel Peter A PA

Journal of general internal medicine 20060601 6

<h4>Background</h4>Many people display omission bias in medical decision making, accepting the risk of passive nonintervention rather than actively choosing interventions (such as vaccinations) that result in lower levels of risk.<h4>Objective</h4>Testing whether people's preferences for active interventions would increase when deciding for others versus for themselves.<h4>Research design</h4>Survey participants imagined themselves in 1 of 4 roles: patient, physician treating a single patient, m ...[more]

PMID: 16808746

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Project description:Challenges arise when treatment to improve maternal health brings the possibility of risk to fetal health. The coronavirus disease 2019 (COVID-19) vaccine is the most recent, but hardly the only, example. Because pregnant patients are often specifically excluded from trials of new therapies, this is often the dilemma that patients and providers face when considering new treatments. In this study, we used the COVID-19 vaccine as an exemplar to question the broader issue of how society, in general, and obstetricians, in particular, should balance obligations to pregnant women's right of access to new therapeutic agents with the physician's desire to protect the fetus from potential risks. We will argue that in almost all circumstances (with few exceptions, as will also be discussed), maternal benefit and respect for autonomy create the uncertainty that absent safety data bring. Consequently, if pregnant women choose to try new interventions and treatments, such as the COVID-19 vaccination, they should be offered those new regimens and their decision supported. In addition, we will argue that the right solution to avoid the dilemma of absent data is to include pregnant individuals in clinical trials studying new treatments, drugs, and other therapies. We will also discuss the basis for our opinion, which are mainstream obstetrical ethics, precedents in law (supreme court ruling that forbids companies to exclude women from jobs that might pose a risk to the fetus), and historic events (thalidomide). The ethical framework includes the supposition that sacrifice to improve fetal outcome is a virtue and not a mandate. Denying a pregnant patient treatment because of threats to their life can create absurd and paradoxical consequences. Either requiring abortion or premature delivery before proceeding with treatments to optimize maternal health, or risking a patient's own life and ability to parent a child by delaying treatment brings clear and significant risks to fetal and/or neonatal outcomes. With rare exceptions, properly and ethically balancing such consequential actions cannot be undertaken without considering the values and goals of the pregnant patient. Therefore, active participation of both the pregnant patient and their physician in shared decision making is needed.

Dataset Information

A matter of perspective: choosing for others differs from choosing for yourself in making treatment decisions.

Background

Objective

Research design

Participants

Measures

Results

Conclusions

Publications

A matter of perspective: choosing for others differs from choosing for yourself in making treatment decisions.

Similar Datasets

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