Abstract - Rakow, T., Bull, C. (2003). Same patient, different advice: A study into why doctors vary. Archives of Disease in Childhood, 88, 497-502.
Objective: To understand why doctors differ in their recommendations in situations where there is little certainty about the long-term outcomes of the possible treatment options.
Design: A correlational design was used to examine the relationship between preference for different treatment options and beliefs about likely outcomes for these options.
Setting: Conference: serious congenital heart disease.
Subjects: 80 doctors, with a mean of 9 years in paediatric cardiology/surgery.
Main outcome measures: Ratings of the extent to which each of four treatment options were favoured. Subjective probabilities for three outcomes: death, survival with 'good heart function' (New York Heart Association functional class ('NYHA') I or II), and survival with 'poor heart function' (NYHA III or IV) for different treatment options over a twenty-year time frame.
Results: Preference for one treatment option over another was most closely associated with the subjective estimate of the additional years in with 'good heart function' that it offered 10-20 years after surgery, Pearson r = 0.66, p < 0.001. In influencing a preference, the possibility of early death was subordinate to optimising the late outcome.
Conclusions: Doctors' treatment preferences are consistent with selecting the option that maximises the chance of the best outcome (long-term survival with good heart function). Doctors' recommendations imply that they place more value on years of life in the child's far future than on life-years in the immediate future.
Tim Rakow - Publications
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