Risk as feelings in the effect of patient outcomes on physicians' future treatment decisions: a randomized trial and manipulation validation.

The present study tested predictions derived from the Risk as Feelings hypothesis about the effects of prior patients' negative treatment outcomes on physicians' subsequent treatment decisions. Two experiments at The University of Chicago, U.S.

Thinking about diagnostic thinking: a 30-year perspective.

This paper has five objectives: (a) to review the scientific background of, and major findings reported in, Medical Problem Solving, now widely recognized as a classic in the field; (b) to compare these results with some of the findings in a recent best-selling collection of case studies; (c) to summarize criticisms of the hypothesis-testing model and to show how these led to greater emphasis on the role of clinical experience and prior knowledge in diagnostic reasoning; (d) to review some common errors in diagnostic reasoning; (e) to examine strategies to reduce the rate of diagnostic errors, including evidence-based medicine and systematic reviews to augment personal knowledge, guidelines and clinical algorithms, computer-based diagnostic decision support systems and second opinions to facilitate deliberation, and better feedback.

Radiation from mobile phone systems: Is it perceived as a threat to people's health?

The aim of this study was to explore the prevalence, nature and determinants of concerns about mobile phone radiation. We used data from a 2006 telephone survey of 1004 people aged 15+ years in Denmark. Twenty-eight percent of the respondents were concerned about exposure to mobile phone radiation; radiation from masts was of concern to about 15%.

Patient-physician fit: an exploratory study of a multidimensional instrument.

Background: Patients face difficulty selecting physicians because they have little knowledge of how physicians' behaviors fit with their own preferences.

Objective: To develop scales of patient and physician behavior preferences and determine whether patient-physician fit is associated with patient satisfaction.

Design: Two cross-sectional surveys of patients and providers.

Patients' values and clinical substituted judgments: the case of localized prostate cancer.

The authors examined agreement between patients' utilities and importance rankings and clinicians' judgments of these assessments using a multiattribute model representing 6 aspects of health states potentially associated with localized prostate cancer. Patients were interviewed individually shortly after diagnosis and at a follow-up visit to obtain time-tradeoff utilities for 4 health states, including current health, and importance ranks of the 6 attributes. Their clinicians independently provided views of what utilities and importance ranks would be in the patient's best interest.

Do physicians know when their diagnoses are correct? Implications for decision support and error reduction.

Objective: This study explores the alignment between physicians' confidence in their diagnoses and the "correctness" of these diagnoses, as a function of clinical experience, and whether subjects were prone to over-or underconfidence.

Design: Prospective, counterbalanced experimental design.

Setting: Laboratory study conducted under controlled conditions at three academic medical centers.

Inter-rater agreement in judging errors in diagnostic reasoning.

Context And Objective: Inter-rater agreement is essential in rating clinical performance of doctors and other health professionals. The purpose of this study was to establish inter-rater agreement in categorising errors in the diagnostic process made by clinicians using computerised decision support systems.

Methods: Eight possible error categories were developed for coding errors in diagnostic hypotheses and plans for next steps in the work-up.

Agreement between prostate cancer patients and their clinicians about utilities and attribute importance.

Purpose: To examine the agreement between prostate cancer patients' utilities for selected health states and their rankings of the importance of six attributes of the health states and the clinicians' judgements of what would be in the patients' best interests.

Method: Patients with newly diagnosed localized prostate cancer individually completed a time trade-off utility assessment shortly after being diagnosed. The health states evaluated were constructed from a multi-attribute utility model that incorporated six aspects of living with the disease and outcomes of treatment.

Pilot study of a utilities-based treatment decision intervention for prostate cancer patients.

This pilot study evaluates a shared decision-making approach to individual decision making in localized prostate cancer care. The approach is based on a decision analytic model that incorporates patient utilities, ie, patient preferences among possible health states that might occur with prostate cancer treatments. Data on comorbidities, histologic grade of the biopsy, and age were obtained for 13 patients with newly diagnosed localized prostate cancer who received care in a Veterans Administration medical center.

Critical thinking and clinical decision making in critical care nursing: a pilot study.

Objective: This pilot study examined the relationship of education level, years of critical care nursing experience, and critical thinking (CT) ability (skills and dispositions) to consistency in clinical decision making among critical care nurses. Consistency was defined as the degree to which intuitive and analytical decision processes resulted in similar selection of interventions in tasks of low and high complexity.

Design: The study was nonexperimental and correlational.

Presenting risks and benefits to patients.

Objective: To investigate whether patients are influenced by the order in which they learn the risks and benefits of a treatment and whether this effect is attenuated by a treatment's associated risk and/or benefit.

Design: Subjects were randomized to review 1 of 6 medical treatment information brochures.

Setting: Waiting rooms of primary care physicians at an academic health center.

Physicians' judgments of survival after medical management and mortality risk reduction due to revascularization procedures for patients with coronary artery disease.

Study Objective: s: To assess the accuracy of physicians' judgments of survival probability for medically managed patients with coronary artery disease (CAD), and of the absolute risk reduction of mortality due to coronary artery bypass grafting (CABG) or percutaneous transluminal coronary angioplasty (PTCA) for such patients; and relationships among these judgments and the physicians' propensity to perform revascularization.

Design: Two surveys (for three-vessel or two-vessel CAD) for patients presenting with stable CAD, currently managed medically, and without other life-limiting problems.

Setting: Multiple educational conferences, 1996-1997.