What Influences Physicians' Decisions - Statistics or Stories?

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.

Study Overview

• Status: Withdrawn
• Conditions: Prescribing Tendencies
• Intervention / Treatment: Behavioral: Guideline; Behavioral: Cost; Behavioral: Victim

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.

• Study Type: Interventional
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • New York
    • New York, New York, United States, 10065
      • Weill Cornell Medical College

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Primary care physicians in the Weill Cornell Physicians Organization

Exclusion Criteria:

• None

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

4

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Guideline and Cost; The Choosing Wisely guideline and the cost of the test at our institution: $60.35 for a basic metabolic panel.	Behavioral: Guideline; Physicians will receive information on the Choosing Wisely Guideline; Behavioral: Cost; Physicians will receive cost information.
Placebo Comparator: Guideline; The Choosing Wisely guideline: "Don't perform blood chemistry panels in asymptomatic, healthy adults."	Behavioral: Guideline; Physicians will receive information on the Choosing Wisely Guideline
Active Comparator: Guideline and 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	Behavioral: Guideline; Physicians will receive information on the Choosing Wisely Guideline; Behavioral: Victim; Physicians will receive information on an identifiable victim.
Experimental: Guideline, Cost, and 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.	Behavioral: Guideline; Physicians will receive information on the Choosing Wisely Guideline; Behavioral: Cost; Physicians will receive cost information.; Behavioral: Victim; Physicians will receive information on an identifiable victim.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Percentage of blood chemistry tests among visits by adult patients under 65	Within 1 week of receiving the intervention
Percentage of blood chemistry tests among visits by adult patients under 65	Within 1 month of receiving the scenario

Secondary Outcome Measures

Outcome Measure	Time Frame
Physicians' attitudes and perceived practice immediately after reading the scenario	Immediate (up to 5 min)

Collaborators and Investigators

• Sponsor: Weill Medical College of Cornell University
• Collaborators: Duke University

Study record dates

Study Major Dates

• Study Start: February 1, 2014
• Primary Completion (Actual): September 1, 2015
• Study Completion (Actual): December 1, 2015

Study Registration Dates

• First Submitted: January 27, 2014
• First Submitted That Met QC Criteria: January 28, 2014
• First Posted (Estimate): January 29, 2014

Study Record Updates

• Last Update Posted (Actual): September 12, 2018
• Last Update Submitted That Met QC Criteria: September 10, 2018
• Last Verified: September 1, 2018

More Information

Terms related to this study

• Keywords: behavioral economics; physician prescribing; primary care practice
• Other Study ID Numbers: Bishop_stats_stories