What Influences Physicians' Decisions - Statistics or Stories?

Not Applicable

Withdrawn

• Conditions: Prescribing Tendencies
• Interventions: Behavioral: Guideline; Behavioral: Victim; Behavioral: Cost

• Registration Number: NCT02048982
• Lead Sponsor: Weill Medical College of Cornell University

Brief Summary

The purpose of this study is to test whether physicians change their use of non-recommended tests, procedures, or medications more in response to evidence based-guidelines, price information, or an individual patient's story.

Detailed Description

We will perform a randomized controlled trial (RCT) of information presented to physicians to test the hypothesis that an identifiable victim affects physician practice behavior more than a statistical victim.

Specifically, we will answer the following research questions: 1) do physicians order fewer non-recommended tests, procedures, or medications if they are told about a patient or a physician who had a bad outcome from that test, procedure, or medication than if they are simply told the guideline or the cost of the test, procedure or medication, 2) does the effect of learning about the identifiable victim last longer than the effect of learning about the guideline or the cost of a test, procedure, or medication, and 3) does the identifiable victim effect differ if the victim is a patient or a physician? We hypothesize that because of the propensity to respond more to the identifiable victim rather than the statistical victim that physicians will order fewer unnecessary tests when they are told about an individual patient case than if they are simply told about the guideline, that the effect of the identifiable victim will last longer than the effect of the statistical victim, and that a patient as the identifiable victim will have more effect than a physician as the identifiable victim.

The identifiable victim effect refers to the tendency to offer more aid to a specific, identifiable victim rather than a vaguely defined group of people with the same need. In the this study, the identifiable victim is a fictional patient who experience a negative consequence as a result of an unnecessary test. The identifiable victim effect is described and studied in the following articles:

Small D. Sympathy and callousness: The impact of deliberative thought on donations to identifiable and statistical victims. Organizational Behavior and Human Decision Processes 2007;102:143-53.

George Loewenstein, Deborah A. Small, and Jeff Strand. "Statistical, identifiable, and iconic victims" in Edward J. McCaffery, Joel Slemrod (2006). Behavioral public finance. Russell Sage Foundation; pp. 32-35.

Basic Information
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Recruitment & Eligibility
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Study & Design
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Trial Locations

Study Timeline

• Study First Submitted: 2014-01-27
• Study First Submitted QC: 2014-01-28
• Study First Posted: 2014-01-29
• Study Start: 2014-02
• Primary Completion: 2015-09
• Study Completion: 2015-12
• Status Verified: 2018-09
• Last Update Submitted: 2018-09-10
• Last Update Posted: 2018-09-12

Recruitment & Eligibility

• Status: WITHDRAWN
• Sex: All
• Target Recruitment: Not specified

Inclusion Criteria

• Primary care physicians in the Weill Cornell Physicians Organization

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Exclusion Criteria

• None

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Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Guideline and Cost	Guideline	The Choosing Wisely guideline and the cost of the test at our institution: $60.35 for a basic metabolic panel.
Guideline	Guideline	The Choosing Wisely guideline: "Don't perform blood chemistry panels in asymptomatic, healthy adults."
Guideline and Victim	Guideline	The Choosing Wisely Guideline and a clinical scenario with a patient as an identifiable victim who suffered harm from having an unnecessary test done
Guideline and Victim	Victim	The Choosing Wisely Guideline and a clinical scenario with a patient as an identifiable victim who suffered harm from having an unnecessary test done
Guideline and Cost	Cost	The Choosing Wisely guideline and the cost of the test at our institution: $60.35 for a basic metabolic panel.
Guideline, Cost, and Victim	Cost	The Choosing Wisely guideline and a clinical scenario with a physician as an identifiable victim who suffered harm when he ordered an unnecessary test.
Guideline, Cost, and Victim	Guideline	The Choosing Wisely guideline and a clinical scenario with a physician as an identifiable victim who suffered harm when he ordered an unnecessary test.
Guideline, Cost, and Victim	Victim	The Choosing Wisely guideline and a clinical scenario with a physician as an identifiable victim who suffered harm when he ordered an unnecessary test.

Primary Outcome Measures

Name	Time	Method
Percentage of blood chemistry tests among visits by adult patients under 65	Within 1 month of receiving the scenario

Secondary Outcome Measures

Name	Time	Method
Physicians' attitudes and perceived practice immediately after reading the scenario	Immediate (up to 5 min)

Trial Locations

Locations (1)

Weill Cornell Medical College; 🇺🇸 New York, New York, United States