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The Israel Medical Association Journal... Mar 2014
Topics: Ethics, Professional; Humans; Israel; Physician's Role; Physicians; Politics
PubMed: 24761707
DOI: No ID Found -
PloS One 2020Interventions informed by behavioral economics have the potential to change behaviors governed by underlying cognitive biases. This has been explored extensively for...
OBJECTIVE
Interventions informed by behavioral economics have the potential to change behaviors governed by underlying cognitive biases. This has been explored extensively for various use in healthcare including changing patient behavior and, more recently, physician behavior. We aimed to systematically review the literature on the use and effectiveness of behavioral economics-informed interventions in changing physician behavior.
METHOD
We searched Medline, Cochrane Library, EBM Reviews, PsychINFO, EconLit, Business Source Complete and Web of Science for peer-reviewed studies published in English that examined the effectiveness of behavioral economics-informed interventions on physician behavioral change. We included studies of physicians in all care settings and specialties and all types of objectively measured behavioral outcomes. The reporting quality of included studies was appraised using the Effective Public Health Practice Project tool.
RESULTS
We screened 6,439 studies and included 17 studies that met our criteria, involving at least 9,834 physicians. The majority of studies were conducted in the United States, published between 2014 and 2018, and were in the patient safety and quality domain. Reporting quality of included studies included strong (n = 7), moderate (n = 6) and weak (n = 4). Changing default settings and providing social reference points were the most widely studied interventions, with these studies consistently demonstrating their effectiveness in changing physician behavior despite differences in implementation methods among studies. Prescribing behavior was most frequently targeted in included studies, with consistent effectiveness of studied interventions.
CONCLUSION
Changing default settings and providing social reference points were the most frequently studied and consistently effective interventions in changing physician behavior towards guideline-concordant practices. Additional theory-informed research is needed to better understand the mechanisms underlying the effectiveness of these interventions to guide implementation.
Topics: Economics, Behavioral; Humans; Physicians
PubMed: 32497082
DOI: 10.1371/journal.pone.0234149 -
JAMA Internal Medicine Mar 2021This cohort study investigates physician voter participation, voter registration, and voter turnout from 2006 through 2018 in 3 states with the largest number of...
This cohort study investigates physician voter participation, voter registration, and voter turnout from 2006 through 2018 in 3 states with the largest number of physicians.
Topics: Adult; Aged; California; Female; Humans; Male; Middle Aged; New York; Physicians; Politics; Texas
PubMed: 33090177
DOI: 10.1001/jamainternmed.2020.6887 -
The Oncologist Mar 2018In a previous randomized crossover study, patients perceived a physician delivering a more optimistic message (MO) as more compassionate and professional. However, the...
BACKGROUND
In a previous randomized crossover study, patients perceived a physician delivering a more optimistic message (MO) as more compassionate and professional. However, the impact of the clinical outcome of the patient on patient's perception of physician's level of compassion and professionalism has not been previously studied. Our aim was to determine if the reported clinical outcome modified the patient's perception of physician compassion, professionalism, impression, and preference for physician.
MATERIALS AND METHODS
One hundred twenty-eight advanced cancer patients in an outpatient Supportive Care Center were randomized to complete validated questionnaires about patients' perception of physician's level of compassion, professionalism, impression, and preference of physician for themselves and their family after watching scripted videos depicting a physician delivering an MO versus a less optimistic (LO) message followed by a clinical vignette depicting a worse outcome.
RESULTS
Median age was 61 years and 55% were female. There was no difference in compassion score after the vignette in the MO and LO groups. However, there were significantly worse overall impression and professionalism scores in both the MO and LO groups after the vignette. In the MO group, preference for the physician for themselves and their family significantly decreased after the vignette.
CONCLUSION
Seeing a worse clinical outcome did not change the patients' appraisal of an inappropriately optimistic physician. However, it reduced the overall impression of both physicians that conveyed an MO or an LO message and it also resulted in less likelihood of choosing the MO physician for themselves and their family.
IMPLICATIONS FOR PRACTICE
The study found that a patient's perception of a physician's compassion did not change after reading a vignette describing a negative clinical outcome, regardless of whether the physician had given a more or a less optimistic message to the patient. However, the results suggested that patients perceived worse professionalism and overall physician impression scores for both more and less optimistic physicians and lower likelihood to choose the more optimistic physician for themselves and their family.
Topics: Ambulatory Care; Attitude of Health Personnel; Communication; Cross-Over Studies; Empathy; Female; Humans; Male; Middle Aged; Neoplasms; Optimism; Patient Preference; Physician-Patient Relations; Physicians; Surveys and Questionnaires; Video Recording
PubMed: 29118266
DOI: 10.1634/theoncologist.2017-0326 -
Methodist DeBakey Cardiovascular Journal 2015
Topics: Boston; Career Choice; Clinical Medicine; Hospitals, General; Humans; Interprofessional Relations; Job Satisfaction; Male; Physician's Role; Physician-Patient Relations; Physicians; Practice Patterns, Physicians'; Time Factors
PubMed: 25793034
DOI: 10.14797/mdcj-11-1-60 -
Journal of Medical Internet Research Jun 2020Although online physician rating information is popular among Chinese health consumers, the limited number of reviews greatly hampers the effective usage of this...
BACKGROUND
Although online physician rating information is popular among Chinese health consumers, the limited number of reviews greatly hampers the effective usage of this information. To date, little has been discussed on the variables that influence online physician rating from the users' perspective.
OBJECTIVE
This study aims to investigate the factors associated with the actual behavior and intention of generating online physician rating information in urban China.
METHODS
A web-based cross-sectional survey was conducted, and the valid responses of 1371 Chinese health consumers were recorded. Using a pilot interview, we analyzed the effects of demographics, health variables, cognitive variables, and technology-related variables on online physician rating information generation. Binary multivariate logistic regression, multiple linear regression, one-way analysis of variance analyses, and independent samples t test were performed to analyze the rating behavior and the intentions of the health consumers. The survey instrument was designed based on the existing literature and the pilot interview.
RESULTS
In this survey, 56.7% (778/1371) of the responders used online physician rating information, and 20.9% (287/1371) of the responders rated the physicians on the physician rating website at least once (posters). The actual physician rating behavior was mainly predicted by health-related factors and was significantly associated with seeking web-based physician information (odds ratio [OR] 5.548, 95% CI 3.072-10.017; P<.001), usage of web-based physician service (OR 2.771, 95% CI 1.979-3.879; P<.001), health information-seeking ability (OR 1.138, 95% CI 0.993-1.304; P=.04), serious disease development (OR 2.699, 95% CI 1.889-3.856; P<.001), good medical experience (OR 2.149, 95% CI 1.473-3.135; P<.001), altruism (OR 0.612, 95% CI 0.483-0.774; P<.001), self-efficacy (OR 1.453, 95% CI 1.182-1.787; P<.001), and trust in online physician rating information (OR 1.315, 95% CI 1.089-1.586; P=.004). Some factors influencing the intentions of the posters and nonposters rating the physicians were different, and the rating intention was mainly determined by cognitive and health-related factors. For posters, seeking web-based physician information (β=.486; P=.007), using web-based medical service (β=.420; P=.002), ability to seek health information (β=.193; P=.002), rating habits (β=.105; P=.02), altruism (β=.414; P<.001), self-efficacy (β=.102; P=.06), trust (β=.351; P<.001), and perceived ease of use (β=.275; P<.001) served as significant predictors of the rating intention. For nonposters, ability to seek health information (β=.077; P=.003), chronic disease development (β=.092; P=.06), bad medical experience (β=.047; P=.02), rating habits (β=.085; P<.001), altruism (β=.411; P<.001), self-efficacy (β=.171; P<.001), trust (β=.252; P<.001), and perceived usefulness of rating physicians (β=.109; P<.001) were significantly associated with the rating intention.
CONCLUSIONS
We showed that different factors affected the physician rating behavior and rating intention. Health-related variables influenced the physician rating behavior, while cognitive variables were critical in the rating intentions. We have proposed some practical implications for physician rating websites and physicians to promote online physician rating information generation.
Topics: Adult; Cross-Sectional Studies; Female; Humans; Intention; Internet; Male; Physicians; Surveys and Questionnaires
PubMed: 32496198
DOI: 10.2196/14417 -
BMC Medical Ethics Nov 2012Following passage of the Patient Self Determination Act in 1990, health care institutions that receive Medicare and Medicaid funding are required to inform patients of...
BACKGROUND
Following passage of the Patient Self Determination Act in 1990, health care institutions that receive Medicare and Medicaid funding are required to inform patients of their right to make their health care preferences known through execution of a living will and/or to appoint a surrogate-decision maker. We evaluated the impact of external factors and perceived patient preferences on physicians' decisions to honor or forgo previously established advance directives (ADs). In addition, physician views regarding legal risk, patients' ability to comprehend complexities involved with their care, and impact of medical costs related to end-of-life care decisions were explored.
METHODS
Attendees of two Mayo Clinic continuing medical education courses were surveyed. Three scenarios based in part on previously court-litigated matters assessed impact of external factors and perceived patient preferences on physician compliance with patient-articulated wishes regarding resuscitation. General questions measured respondents' perception of legal risk, concerns over patient knowledge of idiosyncrasies involved with their care, and impact medical costs may have on compliance with patient preferences. Responses indicating strength of agreement or disagreement with statements were treated as ordinal data and analyzed using the Cochran Armitage trend test.
RESULTS
Three hundred eighty-eight of 951 surveys were completed (41% response rate). Eighty percent reported they were likely to honor a patient's AD despite its 5 year age. Fewer than half (41%) would honor the AD of a patient in ventricular fibrillation who had expressed a desire to "pass away in peace." Few (17%) would forgo an AD following a family's request for continued resuscitative treatment. A majority (52%) considered risk of liability to be lower when maintaining someone alive against their wishes than mistakenly failing to provide resuscitative efforts. A large percentage (74%) disagreed that patients could not appreciate complexities surrounding their care while 69% agreed that costs should never impact a physician's decision as to whether to comply with a patient's AD.
CONCLUSIONS
Our findings highlight the impact, albeit small, external factors have on physician AD compliance. Most respondents based their decision on the clinical situation at hand and interpretation of the patient's initial wishes and preferences expressed by the AD.
Topics: Adult; Advance Directives; Attitude of Health Personnel; Decision Making; Family; Female; Humans; Liability, Legal; Male; Middle Aged; Physician-Patient Relations; Physicians; Resuscitation Orders; Surveys and Questionnaires; United States
PubMed: 23171364
DOI: 10.1186/1472-6939-13-31 -
BMC Medical Ethics Mar 2023Despite consensus about the importance of implementing shared decision-making (SDM) in clinical practice, this ideal is inconsistently enacted today. Evidence shows that...
Physician-reported characteristics, representations, and ethical justifications of shared decision-making practices in the care of paediatric patients with prolonged disorders of consciousness.
BACKGROUND
Despite consensus about the importance of implementing shared decision-making (SDM) in clinical practice, this ideal is inconsistently enacted today. Evidence shows that SDM practices differ in the degree of involvement of patients or family members, or in the amount of medical information disclosed to patients in order to "share" meaningfully in treatment decisions. Little is known on which representations and moral justifications physicians hold when realizing SDM. This study explored physicians' experiences of SDM in the management of paediatric patients with prolonged disorders of consciousness (PDOC). Specifically, we focused on physicians' SDM approaches, representations, and ethical justifications for engaging in SDM.
METHODS
We used a qualitative approach to explore the SDM experiences of 13 ICU physicians, paediatricians, and neurologists based in Switzerland who have been or were involved in the care of paediatric patients living with PDOC. A semi-structured interview format was used and interviews were audio-recorded and transcribed. Data were analysed through thematic analysis.
RESULTS
We found that participants followed three main decision-making approaches: the "brakes" approach, characterized by maximized family's decisional freedom, though conditional to physician's judgment regarding the medical appropriateness of a treatment; the "orchestra director" approach, characterized by a multi-step decision-making process led by the main physician aimed at eliciting the voices of the care team members and of the family; and the "sunbeams" approach, characterized by a process oriented to reach consensus with family members through dialogue, where the virtues of the physician are key to guide the process. We also found that participants differed in the moral justifications sustaining each approach, citing the duty to respect parental autonomy, to invest in an ethics of care, and to employ physicians' virtues to guide the decision-making process.
CONCLUSION
Our results show that physicians come to perform SDM in different ways, with several representations, and distinct ethical justifications. SDM training among health care providers should clarify the ductility of SDM and the several ethical motivations underpinning it, rather than insisting on the principle of respect for patient's autonomy as its only moral foundation.
Topics: Child; Humans; Consciousness Disorders; Physicians; Family; Health Personnel; Pediatricians
PubMed: 36882830
DOI: 10.1186/s12910-023-00896-y -
Implementation Science : IS Nov 2020Compliance with clinical practice guidelines (CPGs) remains insufficient around the world, despite frequent updates and continuing efforts to disseminate and implement...
BACKGROUND
Compliance with clinical practice guidelines (CPGs) remains insufficient around the world, despite frequent updates and continuing efforts to disseminate and implement these guidelines through a variety of strategies. We describe the current status of young resident physician practices towards CPGs and investigate the multiple factors associated with the active use of CPGs, including the physician's knowledge, attitudes, behaviours, CPG-related education received, and the hospital's IT infrastructures. The aim is to identify a more effective point for intervention to promote CPG implementation.
METHODS
We conducted a questionnaire survey among resident physicians working at 111 hospitals across Japan in 2015 and used results with hospital IT score data collected from a prior survey. Multivariable logistic regression analysis was performed to examine the determinants of frequent use of CPGs (defined at least once per week). The independent variables were selected based on physician demographics, clinical speciality and careers, daily knowledge and behaviour items, CPG-related education received, digital preference, and hospital IT score (high/medium/low), with and without interaction terms.
RESULTS
Responses from 535 resident physicians, at 61 hospitals, were analysed. The median hospital IT score was 6 out of a possible 10 points. Physicians who had learned about CPGs tended to work at hospitals with medium to high IT scores, had easier access to paywalled medical databases, and had better knowledge of the guideline network 'Minds'. In addition, these physicians tended to use CPGs electronically. A physician's behaviour towards using CPGs for therapeutic decision-making was strongly associated with frequent use of CPGs (odds ratio [95% CI] 6.1 [3.6-10.4]), which indicated that a physician's habit strongly promotes CPG use. Moreover, CPG-related education was associated with active use of CPGs (OR1.7 [1.1-2.5]). The interaction effects between individual digital preferences and higher hospital IT score were also observed for frequent CPG use (OR2.9 [0.9-8.8]).
CONCLUSIONS
A physician's habitual behaviours, CPG-related education, and a combination of individual digital preference and superior hospital IT infrastructure are key to bridging the gap between the use and implementation of CPGs.
Topics: Attitude of Health Personnel; Hospitals; Humans; Japan; Physicians; Practice Patterns, Physicians'; Surveys and Questionnaires
PubMed: 33239076
DOI: 10.1186/s13012-020-01056-1 -
CJEM Sep 2023Physician documentation plays a central role in the delivery of safe patient care. It describes a physician's clinical decision-making and supports essential...
OBJECTIVES
Physician documentation plays a central role in the delivery of safe patient care. It describes a physician's clinical decision-making and supports essential communication between healthcare providers within the patient's circle of care. Good documentation can potentially also decrease a physician's medico-legal risk. This study provides examples of documentation issues attributed to physicians practicing emergency medicine as identified by peer experts in civil legal actions, regulatory authority complaints (College) and hospital complaints (collectively, medico-legal cases) in Canada.
METHODS
We conducted a descriptive study and content analysis of medico-legal cases involving emergency department physicians from a national repository at the Canadian Medical Protective Association. Cases with peer expert criticism of an emergency physician's documentation, which were closed between 2016 and 2020, and occurred in an emergency department were included in our analysis.
RESULTS
Of the 1628 cases involving emergency medicine, our inclusion criteria identified that absent or insufficiently detailed documentation was present in 24% of cases (391/1,628). A detailed review of 20% of the cases (79/391), selected randomly, found that documentation issues were most often associated with the assessment and investigation stage of care. This pertained to documenting details of the clinical examination, relevant medical history, diagnosis, and differential diagnosis.
CONCLUSIONS
For physicians practicing emergency medicine, criticism of documentation was frequently observed in medico-legal cases. Based on the findings of this study and the expert criticism related to documentation, emergency medicine physicians may consider reflecting upon their documentation of the care provided to determine if their documentation provides a clear and accurate chronicle of the care and the rationale for their clinical decisions.
Topics: Humans; Canada; Health Personnel; Physicians; Documentation; Emergency Service, Hospital
PubMed: 37646956
DOI: 10.1007/s43678-023-00576-1