Are residents' decisions influenced more by a decision aid or a specialist's opinion? A randomized controlled trial

Abstract

Background: Physicians are reluctant to use decision aids despite their ability to improve care. A potential reason may be that physicians do not believe decision aid advice.

Objective: To determine whether internal medicine residents lend more credence to contradictory decision aid or human advice.

Design: Randomized controlled trial. Residents read a scenario of a patient with community-acquired pneumonia and were asked whether they would admit the patient to the intensive care unit or the floor. Residents were randomized to receive contrary advice from either a referenced decision aid or an anonymous pulmonologist. They were then asked, in light of this new information, where they would admit the patient.

Participants: One hundred eight internal medicine residents.

Measurements: The percentage of residents who changed their admission location and the change in confidence in the decision.

Main results: Residents were more likely to change their original admission location (OR 2.3, 95% CI 1.04 to 5.1, P = 0.04) and to reduce their confidence in the decision (adjusted difference between means -12.9%, 95% CI -3.0% to -22.8%, P = 0.011) in response to the referenced decision aid than to the anonymous pulmonologist. Confidence in their decision was more likely to change if they initially chose to admit the patient to the floor.

Conclusions: In a hypothetical case of community-acquired pneumonia, physicians were influenced more by contrary advice from a referenced decision aid than an anonymous specialist. Whether this holds for advice from a respected specialist or in actual practice remains to be studied.