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. 2008 Jul 30:8:50.
doi: 10.1186/1471-2288-8-50.

Vignette studies of medical choice and judgement to study caregivers' medical decision behaviour: systematic review

Lucas M Bachmann  1 , Andrea Mühleisen, Annekatrin Bock, Gerben ter Riet, Ulrike Held, Alfons G H Kessels
Affiliations

Vignette studies of medical choice and judgement to study caregivers' medical decision behaviour: systematic review

Lucas M Bachmann et al. BMC Med Res Methodol. .

Abstract

Background: Vignette studies of medical choice and judgement have gained popularity in the medical literature. Originally developed in mathematical psychology they can be used to evaluate physicians' behaviour in the setting of diagnostic testing or treatment decisions. We provide an overview of the use, objectives and methodology of these studies in the medical field.

Methods: Systematic review. We searched in electronic databases; reference lists of included studies. We included studies that examined medical decisions of physicians, nurses or medical students using cue weightings from answers to structured vignettes. Two reviewers scrutinized abstracts and examined full text copies of potentially eligible studies. The aim of the included studies, the type of clinical decision, the number of participants, some technical aspects, and the type of statistical analysis were extracted in duplicate and discrepancies were resolved by consensus.

Results: 30 reports published between 1983 and 2005 fulfilled the inclusion criteria. 22 studies (73%) reported on treatment decisions and 27 (90%) explored the variation of decisions among experts. Nine studies (30%) described differences in decisions between groups of caregivers and ten studies (33%) described the decision behaviour of only one group. Only six studies (20%) compared decision behaviour against an empirical reference of a correct decision. The median number of considered attributes was 6.5 (IQR 4-9), the median number of vignettes was 27 (IQR 16-40). In 17 studies, decision makers had to rate the relative importance of a given vignette; in six studies they had to assign a probability to each vignette. Only ten studies (33%) applied a statistical procedure to account for correlated data.

Conclusion: Various studies of medical choice and judgement have been performed to depict weightings of the value of clinical information from answers to structured vignettes of care givers. We found that the design and analysis methods used in current applications vary considerably and could be improved in a large number of cases.

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Figures

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Figure 1
Study flow.
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References

    1. Green PE. On the Design of Choice Experiments Involving Multifactor Alternatives. Journal of Consumer Research: An Interdisciplinary Quarterly. 1974;1:61–68.
    1. Cooksey RW. Judgment Analysis: Theory, Methods, and Applications. Academic Press; 1 edition (January 16, 1996) 2007. p. ISBN 012187575X.
    1. Hammond KR, Hursch CJ, Todd FJ. Analyzing the Components of Clinical Inference. Psychol Rev. 1964;71:438–456. doi: 10.1037/h0040736. - DOI - PubMed
    1. Poses RM, Cebul RD, Wigton RS. You can lead a horse to water--improving physicians' knowledge of probabilities may not affect their decisions. Med Decis Making. 1995;15:65–75. doi: 10.1177/0272989X9501500110. - DOI - PubMed
    1. Puhan MA, Steurer J, Bachmann LM, ter RG. Variability in diagnostic probability estimates. Ann Intern Med. 2004;141:578–579. - PubMed

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