Purpose: Physicians are reluctant to use decision aids despite the aids' ability to improve patient care. One potential reason is that physicians lend more credence to human than decision aid advice. Do internal medicine residents lend more credence to a human specialist or a validated decision aid when the advice contradicts their own decision?
Method: A randomized controlled trial. Internal medicine residents from two programs 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. The residents were randomized to receive contrary advice from either an unspecified pulmonologist or a validated decision aid. They were then asked, in light of this new information, to which location they would admit the patient. The primary endpoint was the number of subjects who switched their admission decision depending on whether they received human or decision aid advice, adjusting for their initial admission location. The secondary endpoint was the change in confidence in the decision.
Result: 108 internal medicine residents responded. 28 of 52 residents (53.8%, 95% CI: 39.5-67.8%) who received contradictory advice from the decision aid and 20 of 56 residents (35.7%, 95% CI: 23.3-49.6%) who received contradictory advice from the pulmonologist changed their decision. The odds ratio for a location change, adjusting for the initial admission location, was 2.27 (95% CI: 1.04 – 5.08, P = 0.04) favoring the decision aid. Respondents changed their confidence more after hearing the decision aid’s recommendation (mean -36.0%) than the pulmonologist’s recommendation (mean -23.0%) adjusting for their initial admission decision (adjusted difference -12.9%, 95% CI -3.0% to -22.8%, P = 0.011). Residents also lowered their confidence more if their initial admission location was to the floor (mean -32.8%) than to the ICU (mean -22.2%) adjusting for the source of advice (adjusted difference -12.0%, 95% CI -1.5% to -22.4%, P = 0.025).
Conclusion: Physicians in training treating a scenario depicting community acquired pneumonia were more influenced by the recommendation of a validated decision aid than the recommendation of an unnamed specialist, each of which provided advice that conflicted with the initial admission decision. This suggests that greater willingness to adhere to human over decision aid advice is not a cause of decision aid non-use.
Candidate for the Lee B. Lusted Student Prize Competition