How Clinical and Personal Information Shape Physicians' Risk Judgments
Trial Snapshot
- Phase
- Not Applicable
- Status
- Completed
- Enrollment
- 300
- Locations
- 1
- Primary Endpoint
- Absolute Error in Perceived Risk of MACE
Study Overview
Brief Summary
Physicians often form quick judgments about the risk for serious disease when interacting with patients. Underestimating risk can lead to underuse of diagnostic testing and untreated illness, which can worsen patient outcomes. On the other hand, overestimating risk can lead to overuse of diagnostic testing, which is costly for health systems.
To form judgments of risk, physicians should attend to a host of validated factors that are predictive of disease. However, research suggests that physicians may rely on demographic factors-such as race and gender. Physicians' judgments could also be influenced by non-health-related, personal information about their patients (e.g., hobbies, nicknames), which may moderate the impact of demographics on those judgments.
The investigators examine these dynamics in the context of heart disease. The History, Electrocardiogram, Age, Risk factors and Troponin (HEART) Score is a validated model that specifies a correspondence between certain risk factors and the likelihood of Major Adverse Cardiac Event (MACE). Importantly, there are substantially different diagnostic tests (e.g., noninvasive stress test versus coronary angiogram) that should be used depending on a patient's MACE likelihood.
Specifically, the investigators have three research questions:
- Research Question 1 (RQ1): How accurate are physicians relative to the benchmarks from the HEART score model?
- Research Question 2 (RQ2): How do clinically-relevant risk factors (e.g., smoking history), race, gender, and personal information disclosure influence risk judgments?
- Research Question 3 (RQ3): Does personal information disclosure moderate the effects of race and gender on risk judgments?
Note that when the investigators discuss accuracy and error, they are referring to the comparison of physician judgments to the HEART score model benchmarks.
Detailed Description
The investigators designed a survey to assess physicians' perception of MACE likelihood. Each physician rates a panel of patient profiles. The profiles randomly vary in risk factors, race, gender, and personal information disclosure (e.g., non-health related information about their hobbies). Using the HEART Score model as a benchmark, the investigators will assess how accurately physicians perceive MACE Likelihood based on the risk factors in a given profile. The investigators will further estimate how race, gender, and personal information disclosure causally affect physician judgments.
To do this, the investigators designed a mixed-design experiment. Each participant will respond to eight patient profiles that vary along three fully-crossed within-subject factors: (i) race: black vs. white, (ii) gender: man vs. woman, and (iii) risk factors: low vs. medium risk (based on risk levels from the HEART score model). Each participant will also be randomly assigned (between-subjects) to (iv) either see non-health-related personal information (e.g., hobbies) for all eight of their patients, or not see this information for any of their patients. The investigators refer to each factor as a profile attribute.
For each profile, participants indicate the perceived risk of a major adverse cardiac event in the six weeks following the visit. Our primary outcome is a measure of absolute error in perceived risk of MACE (described under the Primary Outcome section). They also indicate the diagnostic test they believe is most appropriate (Secondary Outcome #4).
Analysis plan
For all analyses, the investigators will format the data such that there are eight observations per participant, each corresponding to a patient profile the participant responded to.
Study Design
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Parallel
- Primary Purpose
- Health Services Research
- Masking
- Single (Participant)
Eligibility Criteria
- Ages
- 18 Years to — (Adult, Older Adult)
- Sex
- All
- Accepts Healthy Volunteers
- Yes
Inclusion Criteria
- •Emergency medicine physicians
- •Cardiologists
- •Hospitalists (i.e., internists whose practice is primarily in the hospital)
- •If there are duplicate participant IDs in the data, only the first response will be included in the analysis
Exclusion Criteria
- •Participants who indicate they are retired
- •Participants who write gibberish in the open-ended items
- •Incomplete responses
Arms & Interventions
No Personal Information Disclosure
Participants rate 8 patient profiles of patients with chest pain. The profiles each contain info about the patient's race, gender, and risk factors associated with MACE.
Personal Information Disclosure
Participants rate 8 patient profiles of patients with chest pain. The profiles each contain info about the patient's race, gender, and risk factors associated with MACE. Each profile also contains non-health related personal information that the patient has disclosed (e.g., nickname, hobbies).
Intervention: Personal Information Disclosure (Behavioral)
Outcomes
Primary Outcomes
Absolute Error in Perceived Risk of MACE
Time Frame: At the time of survey completion, within approximately 2 weeks
For each patient profile, all participants will be asked about their perceived risk of MACE: What is the likelihood that this patient experiences a major adverse cardiac event in the six weeks following the visit? \[0-100\]. The paradigm uses two levels of risk factors, each associated with a specific risk of MACE range as defined by the HEART score model: low risk factors = 0.9-1.7% (midpoint = 1.3%); and medium risk factors = 12-16.6% (midpoint = 14.3%). To calculate each participant's directional error, the investigators will take the difference between participants' perceived risk of MACE and the midpoint of the risk of MACE range from the HEART score model at each patient's corresponding risk level. The absolute error is calculated by taking the absolute value of the directional error.
Secondary Outcomes
- Perceived Risk of MACE(At the time of survey completion, within approximately 2 weeks)
- Directional Error(At the time of survey completion, within approximately 2 weeks)
- Categorical Error(At the time of survey completion, within approximately 2 weeks)
- Diagnostic Test Decision(At the time of survey completion, within approximately 2 weeks)
- Overconfidence(At the time of survey completion, within approximately 2 weeks)
Investigators
Joseph Reiff
Assistant Professor of Marketing
University of Maryland, College Park