CLINICAL DECISION-MAKING: OVERVIEW OF CONCEPTS, STUDIES AND METHODS

© 2019 Evgenia ZAITSEVA

2019  — № 2 (18)


Author info:

Evgenia Aleksandrovna Zaitseva, Sociology MA, is an independent researcher working in Moscow.


Keywords: clinical decision-making, factors of decision-making, physician’s choice, methodology for physician’s choice research

Abstract. The article reviews the studies of clinical decision-making by biomedical physicians. The review covers normative and descriptive concepts of clinical decision-making from the 1970s up to the present time. Major tension points between various theoretical approaches are elicited, and the results of empirical studies in this field are systematized.


Summary

Decision-making process is the essence of clinical life – countless times a day the physician must make a choice regarding diagnostics or treatment of a patient. The purpose of this article is to present theoretical conceptualizations and empirical studies of medical choice and to reveal the main lines of tension in the observed field of research.

One of the basic tensions is between normative and descriptive decision theories. The first influential paradigm of decision-making studies was the expected utility hypothesis. Since the ethical imperative of the medical profession is the maximization of patient’s good, and doctors often act in a situation of diagnostic or therapeutic uncertainty, a look at clinical decisions through the prism of the expected utility hypothesis seems justified. This article examines threshold models that suggest predictions of clinical decisions in some simplified situations of choice. Early threshold models considered only clinical information regarding the probabilities of certain outcomes. The physician was conceptualized as an ideal patient’s agent that makes a choice based on a rational calculation of medical gains and losses.

The threshold approach and the expected utility hypothesis were heavily criticized. The main critical impulse came from the side of cognitive psychologists and decision-making researchers who found out that the behavior of a doctor, as well as any other person, often differs from the normative model prescriptions. An attempt to explain this gap spawned new theories – prospect theory developed by Daniel Kahneman and Amos Tversky, regret theory, dual process theory – that directly influenced the study of clinical choice. Authors of these theories tried to examine the nature of systematic irrationalities in human cognition from all possible sides and to incorporate them into a decision-making model. This article contains the main theses of listed theories and selected empirical researches of the clinical choice, most of which was based on vignettes – the method of hypothetical choices proposed in the earlier works of Kahneman and Tversky. We also briefly considered alternative research strategies that haven’t been widely used yet – Brunswick’s lens model and distributed decision-making model.

Empirical researches found, sometimes accidentally, multiple non-clinical factors that affect the provision of medical care and often impose restrictions on the medically ideal medical choice. A doctor and a patient themselves can become a source of non-medical influence since they are individuals with their personalities and preferences, cultural, psychological and cognitive characteristics. There can also be various “external” factors: situational, that is related to components of a specific meeting, as well as systematic, related to the medical institution or health system as a whole.

The second part of the article thus highlights and systemizes studies of non-clinical factors of influence a lot of which also used vignettes: textual, visual, or mixed. Qualitative research methods, such as interviews and focus groups with physicians, and quantitative analysis of national sociological surveys or statistics of selected health facilities. This article attempts to present the main conclusions from the above researches, elicit conflict lines of different influence factors and describe revealed strategies of their resolution in medical practice.

References

Adair, R.F., Holmgren, L.R. (2005) Do drug samples influence resident prescribing behavior? A randomized trial, The American Journal of Medicine, Vol. 118 No. 8, p. 881–884.

Basinga, P., Moreira, J., Bisoffi, Z., Bisig, B., Van den Ende, J. (2007) Why Are Clinicians Reluctant to Treat Smear-Negative Tuberculosis? An Inquiry about Treatment Thresholds in Rwanda, Medical Decision Making, Vol. 27 No. 1, p. 53–60.

Bell, D.E. (1981) Regret in decision-making under uncertainty, Harvard Business School Working Paper, p. 82–115.

Berner, E.S., Graber, M.L. (2008) Overconfidence as a Cause of Diagnostic Error in Medicine, The American Journal of Medicine, Vol. 121 No 5, p. S2–S23.

Bernheim, S.M., Ross, J.S., Krumholz, H.M., Bradley, E.H. (2008) Influence of Patients’ Socioeconomic Status on Clinical Management Decisions: A Qualitative Study, The Annals of Family Medicine, Vol. 6 No. 1, p. 53–59.

Bertakis, K.D., Franks, P., Azari, R. (2003) Effects of physician gender on patient satisfaction, Journal of the American Medical Women’s Association, Vol. 58 No. 2, p. 69–75.

Bond, M., Bowling, A., McKee, D., Kennelly, M., Banning, A. P., Dudley, N., Martin, A. (2003) Does Ageism Affect the Management of Ischaemic Heart Disease? Journal of Health Services Research & Policy, Vol. 8 No. 1, p. 40–47.

Bories, P., Lamy, S., Simand, C., Bertoli, S., Delpierre, C., Malak, S., Nebout, A. (2018) Physician uncertainty aversion impacts medical decision making for older patients with acute myeloid leukemia: results of a national survey, Haematologica, Vol. 103 No. 12, p. 2040–2048.

Borkhoff, C.M., Hawker, G.A., Kreder, H.J., Glazier, R.H., Mahomed, N.N., Wright, J.G. (2008) The effect of patients’ sex on physicians’ recommendations for total knee arthroplasty, Canadian Medical Association Journal, Vol. 178, No. 6, p. 681–687.

Bowling, A., Ebrahim, S. (2001) Measuring patients’ preferences for treatment and perceptions of risk, Quality and Safety in Health Care, Vol. 10 (Supplement 1), p. i2–i8.

Burykin I.M., Aleeva G.N., Hafiz’yanova R.H. (2012) Metodologicheskie osnovy razrabotki ehffektivnoj sistemy vozmeshcheniya zatrat v gosudarstvennoj sisteme zdravoohraneniya [Methodological basis for the development of an effective cost recovery system in the public health system], Vestnik SPbGU [Bulletin of St. Petersburg State University], ser. 11, issue 2, p. 177–189.

Chakravarty, S., Harrison, G., Haruvy, E., Rutström, E. (2011) Are you risk averse over other people’s money? Southern Economic Journal, Vol. 77, No. 4, p. 901–913.

Charles, C., Gafni, A., Whelan, T. (1997) Shared decision-making in the medical encounter: What does it mean? (or it takes at least two to tango), Social Science & Medicine, Vol. 44 No. 5, p. 681–692.

Charles, C., Gafni, A., Whelan, T. (1999) Decision-making in the physician–patient encounter: revisiting the shared treatment decision-making model, Social Science & Medicine, Vol. 49 No. 5, p. 651–661.

Christensen, C., Heckerung, P., Mackesy-Amiti, M. E., Bernstein, L.M., Elstein, A.S. (1995) Pervasiveness of framing effects among physicians and medical students, Journal of Behavioral Decision Making, Vol. 8 No. 3, p. 169–180.

Clark, J.A., Potter, D.A., McKinlay, J.B. (1991) Bringing social structure back into clinical decision making, Social Science & Medicine, Vol. 32 No. 8, p. 853–866.

Cohen, J.M., Burgin, S. (2016) Cognitive Biases in Clinical Decision Making, JAMA Dermatology, Vol. 152 No. 3, p. 253–254.

Crilly, M., Bundred, P., Hu, X., Leckey, L., Johnstone, F. (2007) Gender differences in the clinical management of patients with angina pectoris: a cross-sectional survey in primary care, BMC Health Services Research, Vol. 7 No. 1, 142.

Croskerry, P. (2013) From Mindless to Mindful Practice – Cognitive Bias and Clinical Decision Making, New England Journal of Medicine, Vol. 368 No. 26, p. 2445–2448.

Daly, C. (2006) Gender Differences in the Management and Clinical Outcome of Stable Angina, Circulation, Vol. 113 No. 4, p. 490–498.

De Marco, M.A., Nogueira-Martins, L.A., Yazigi, L. (2005) Difficult patients or difficult encounters? QJM: An International Journal of Medicine, Vol. 98 No. 7, p. 542–543.

DeKay, M.L., Asch, D.A. (1998) Is the Defensive Use of Diagnostic Tests Good for Patients, or Bad?Medical Decision Making, Vol. 18 No. 1, p. 19–28.

Denes-Raj, V., Epstein, S. (1994) Conflict between intuitive and rational processing: When people behave against their better judgment. Journal of Personality and Social Psychology Vol. 66 No. 5, p. 819–829.

Djulbegovic, B., Elqayam, S., Reljic, T., Hozo, I., Miladinovic, B., Tsalatsanis, A., Cannon-Bowers, J. (2014) How do physicians decide to treat: an empirical evaluation of the threshold model, BMC Medical Informatics and Decision Making, Vol. 14 No. 1, 47.

Djulbegovic, B., Guyatt, G. H. (2014) Evidence-Based Practice Is Not Synonymous with Delivery of Uniform Health Care, Journal of the American Medical Association, Vol. 12 No. 13, 1293–1294.

Djulbegovic, B., Hozo, I., Beckstead, J., Tsalatsanis, A., Pauker, S.G. (2012) Dual processing model of medical decision-making, BMC Medical Informatics and Decision Making, Vol. 12 No. 1, 94.

Djulbegovic, B., Hozo, I., Mayrhofer, T. van den Ende, J., Guyatt, G.H. (2014) The threshold model revisited, Journal of Evaluation in Clinical Practice, Vol. 25 No. 2, p. 186–195.

Djulbegovic, B., Hozo, I., Schwartz, A., McMasters, K.M. (1999) Acceptable regret in medical decision making, Medical Hypotheses, Vol. 53 No. 3, p. 253–259.

Djulbegovic, M., Beckstead, J., Elqayam, S., Reljic, T., Kumar, A., Paidas, C. (2015) Thinking Styles and Regret in Physicians, PLOS ONE, Vol. 10 No. 8.

Dunlop, S., Coyte, P.C., McIsaac, W. (2000) Socio-economic status and the utilisation of physicians’ services: results from the Canadian National Population Health Survey, Social Science & Medicine, Vol. 51 No. 1, p. 123–133.

Eeckhoudt, L., Lebrun, T., Sailly, J.C. (1985) Risk-aversion and physicians’ medical decision-making, Journal of Health Economics, Vol. 4 No. 3, p. 273–281.

Eisenberg, J.M., Hershey, J.C. (1983) Derived Thresholds, Medical Decision Making, Vol. 3 No. 2, p. 155–168.

Elwyn, G., Edwards, A., Gwyn, R., Grol, R. (1999) Towards a feasible model for shared decision making: focus group study with general practice registrars, BMJ, Vol. 319 No. 7212, p. 753–756.

Eva, K.W., Norman, G.R. (2005) Heuristics and biases – a biased perspective on clinical reasoning,Medical Education, Vol. 39 No. 9, p. 870–872.

Evans, J.S.B.T. (1984) Heuristic and analytic processes in reasoning, British Journal of Psychology,Vol. 75, p. 451–468.

Evans, J.S.B.T. (1989) Bias in human reasoning: causes and consequences. London: Erlbaum.

Evans, J.S.B.T. (2008) Dual-Processing Accounts of Reasoning, Judgment, and Social Cognition, Annual Review of Psychology, Vol. 59 No. 1, p. 255–278.

Feinstein, A.R. (1985) The “Chagrin Factor” and Qualitative Decision Analysis, Archives of Internal Medicine, Vol. 145 No. 7, p. 1257–1259.

Feinstein, A.R. (1992) Invidious comparisons and unmet clinical challenges, The American Journal of Medicine, Vol. 92 No. 2, p. 117–120.

Felder, S., Mayrhofer, T. (2017) Medical Decision Making: A Health Economic Primer. 2nd ed. Springer.

Fernandez-Duque, D. (2007) Actor/observer asymmetry in risky decision making, Judgment and Decision Making, Vol. 2 No. 1, p. 1–8.

Franz, C.E., Barker, J.C., Kravitz, R.L., Flores, Y., Krishnan, S., Hinton, L. (2007) Non-medical influences on the use of cholinesterase inhibitors in dementia care, Alzheimer Disease and Associated Disorders, Vol. 21, p. 241–248.

Gabe J., Bury M., Elston M.A. (2004) Key Concepts in Medical Sociology. London: Sage.

Gigerenzer, G., Goldstein, D.G. (1996) Reasoning the fast and frugal way: Models of bounded rationality, Psychological Review, Vol. 103 No. 4, p. 650–669.

Graber, M.L., Franklin, N., Gordon, R. (2005) Diagnostic Error in Internal Medicine, Archives of Internal Medicine, Vol. 165, No. 13, p. 1493–1499.

Hajjaj, F., Salek, M., Basra, M., Finlay, A. (2010) Non-clinical influences on clinical decision-making: a major challenge to evidence-based practice, Journal of the Royal Society of Medicine, Vol. 103, No. 5, p. 178–187.

Harries, C., Forrest, D., Harvey, N., McClelland, A., Bowling, A. (2007) Which doctors are influenced by a patient’s age? A multi-method study of angina treatment in general practice, cardiology and gerontology, Quality and Safety in Health Care, Vol. 16(1), p. 23–27.

Hatala, R., Norman, G.R., Brooks, L.R. (1999) Impact of a clinical scenario on accuracy of electrocardiogram interpretation, Journal of General Internal Medicine, Vol. 14 No. 2, p. 126–129.

Haug, M.R., Ory, M.G. (1987) Issues in Elderly Patient-Provider Interactions, Research on Aging, Vol. 9 No. 1, p. 3–44.

Hilden, J., Glasziou, P. (1996) Regret graphs, diagnostic uncertainty and Youden’s index, Statistics in Medicine, Vol. 15 No. 10, p. 969–986.

Hsee C. (1997) A fundamental prediction error: Self-others discrepancies in risk preference, Journal of Experimental Psychology: General, Vol. 126, p. 45–53.

Hurwicz, M.-L. (1995) Physicians’ Norms and Health Care Decisions of Elderly Medicare Recipients, Medical Anthropology Quarterly, Vol. 9 No. 2, p. 211–235.

Huttin, C., Andral, J. (2000) How the reimbursement system may influence physicians’ decisions. Results from focus groups interview in France, Health Policy, Vol. 54, p. 67–86.

Iverson, G.D., Coleridge, S.T., Fulda, K.G., Licciardone, J.C. (2005) What factors influence a family physician’s decision to refer a patient to a specialist? Rural Remote Health, Vol. 5 No. 3, 413.

Johnson-Laird, P.N. (1983) Mental Models. Towards a Cognitive Science of Language, Inference and Consciousness. Cambridge, UK: Cambridge University Press.

Kahneman, D., Tversky, A. (1974) Judgment under Uncertainty: Heuristics and Biases, Science, Vol. 185 No. 4157, p. 1124–1131.

Kahneman, D., Tversky, A. (1979) Prospect Theory: An Analysis of Decision under Risk, Econometrica, Vol. 47 No. 2, p. 263–292.

Kahneman, D., Tversky, A. (1984) Choices, values, and frames, American Psychologist, Vol. 39 No. 4, p. 341–350.

Kamenshchikova, A. (2017) Medico-economic standards in Russia: balancing legal requirements and patient’s needs. O. Zvonareva, E. Popova, K. Horstman (eds.), Health, technologies, and politics in post-soviet settings: navigating uncertainties, Palgrave Macmillan, p. 117–142.

Kim, S., Goldstein, D., Hasher, L., Zacks, R.T. (2006) Framing Effects in Younger and Older Adults, The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences, Vol. 60 No. 4, p. P215–P218.

Klein, J.G. (2005) Five pitfalls in decisions about diagnosis and prescribing. BMJ, Vol. 330 No. 7494, p. 781–783.

Klocko, D.J. (2016) Are Cognitive Biases Influencing Your Clinical Decisions? Clinician Reviews, Vol. 26 No. 3, p. 32–39.

Kressin, N.R., Petersen, L.A. (2001) Racial differences in the use of invasive cardiovascular procedures: review of the literature and prescription for future research, Annals of Internal Medicine, Vol. 135 No. 5, p. 352–66.

LeBlanc, V.R., Brooks, L.R., Norman, G.R. (2002) Believing is seeing: the influence of a diagnos­tic hypothesis on the interpretation of clinical features, Academic Medicine, Vol. 77, p. 67–69.

Leblanc, V.R., Norman, G.R., Brooks, L.R. (2001) Effect of a Diagnostic Suggestion on Diagnostic Accuracy and Identification of Clinical Features, Academic Medicine, Vol. 76 (Supplement), p. 18–20.

Loomes, G., Sugden, R. (1982) Regret Theory: An Alternative Theory of Rational Choice Under Uncertainty, The Economic Journal, Vol. 92, No. 368, p. 805–824.

Mamede, S., Schmidt, H.G., Rikers, R. (2007) Diagnostic errors and reflective practice in medicine, Journal of Evaluation in Clinical Practice, Vol. 13 No. 1, p. 138–145.

Marco, C.A., Moskop, J.C., Solomon, R.C., Geiderman, J.M., Larkin, G.L. (2006) Gifts to Physicians from the Pharmaceutical Industry: An Ethical Analysis, Annals of Emergency Medicine, Vol. 48 No. 5, p. 513–521.

Markowitz, H. (1952) The Utility of Wealth, Journal of Political Economy, Vol. 60, p. 151–158.

Maynard, C., Fisher, L.D., Passamani, E.R., Pullum, T. (1986) Blacks in the coronary artery surgery study (CASS): race and clinical decision making, American Journal of Public Health, Vol. 76 No. 12, p. 1446–1448.

McKinlay, J.B., Potter, D.A., Feldman, H.A. (1996) Non-medical influences on medical decision-making, Social Science & Medicine, Vol. 42, No. 5, p. 769–776.

McKinley, J.B., Lin, T., Freud, K., Moskowitz, M.  (2002) The unexpected influence of physician attributes on clinical decisions: results of an experiment, Journal of Health and Social Behavior, Vol. 43, p. 92–106.

McNeil, B.J., Pauker, S.G., Sox, H.C., Tversky, A. (1982) On the Elicitation of Preferences for Alternative Therapies, New England Journal of Medicine, Vol. 306 No. 21, p. 1259–1262.

McNeil, B.J., Pauker, S.G., Tversky, A. (1988) On the framing of medical decisions. Bell, D.E., Raiffa, H., Tversky, A. (eds.), Decision making: Descriptive, normative, and prescriptive interactions, Cambridge University Press, p. 562–568.

Murray, S.F. (2000) Relation between private health insurance and high rates of caesarean section in Chile: qualitative and quantitative study, BMJ, Vol. 321, p. 1501–1505.

Nickerson, R.S. (1998) Confirmation bias: A ubiquitous phenomenon in many guises, Review of General Psychology, Vol. 2 No. 2, p. 175–220.

Norman, G.R., Eva, K.W. (2010) Diagnostic error and clinical reasoning, Medical Education, Vol. 44 No. 1, p. 94–100.

Norman, G.R., Young, M., Brooks, L.R. (2007) Non-analytical models of clinical reasoning: the role of experience, Medical Education, Vol. 41, p. 1140–1145.

O’Connor, A. M. (1989) Effects of framing and level of probability on patients’ preferences for cancer chemotherapy, Journal of Clinical Epidemiology, Vol. 42 No. 2, p.119–126.

O’Sullivan, E., Schofield, S. (2018) Cognitive bias in clinical medicine, Journal of the Royal College of Physicians of Edinburgh, Vol. 48 No. 3, p. 225–232.

Park D.C. (1999) Aging and the controlled and automatic processing of medical information and medical intentions. Park, D.C., Morrell, R.W., Shifren, K. (eds.) Processing of medical information in aging patients, London: Lawrence Erlbaum Associates, p. 3–22.

Pauker, S.G., Kassirer, J.P. (1975) Therapeutic Decision Making: A Cost-Benefit Analysis, New England Journal of Medicine, Vol. 293, No. 5, p. 229–234.

Pauker, S.G., Kassirer, J.P. (1980) The Threshold Approach to Clinical Decision Making, New England Journal of Medicine, Vol. 302 No. 20, p. 1109–1117.

Peng, J., Jiang, Y., Miao, D., Li, R., Xiao, W. (2013) Framing effects in medical situations: Distinctions of attribute, goal and risky choice frames, Journal of International Medical Research, Vol. 41 No. 3, p. 771–776.

Petursson, P. (2005) GPs’ reasons for “non-pharmacological” prescribing of antibiotics: A phenomenological study, Scandinavian Journal of Primary Health Care, Vol. 23 No. 2, p. 120–125.

Pineda, L.A., Hathwar, V.S., Grant, B.J.B. (2001) Clinical Suspicion of Fatal Pulmonary Embolism, Chest, Vol. 120 No. 3, p. 791–795.

Pollai M, Kirchler E. (2012) Differences in risk-defusing behavior in deciding for oneself versus deciding for other people, Acta Psychologica, Vol. 139 No. 1, p. 239–243.

Poses, R.M., Anthony, M. (1991) Availability, Wishful Thinking, and Physicians’ Diagnostic Judgments for Patients with Suspected Bacteremia, Medical Decision Making, Vol. 11 No. 3, p. 159–168.

Posner, M.I., Snyder, C.R.R. (1975) Attention and Cognitive Control. Solso R.L. (ed.) Information Processing and Cognition, Hillsdale, NJ: Erlbaum, p. 55–85.

Prosser, H., Walley, T. (2003) New drug uptake: qualitative comparison of high and low prescribing GPs’ attitudes and approach, Family Practice, Vol. 20 No. 5, p. 583–591.

Rapley, T. (2008) Distributed decision making: the anatomy of decisions-in-action, Sociology of Health & Illness, Vol. 30 No. 3, p. 429–444.

Reber, A.S. (1993) Implicit learning and tacit knowledge. Oxford University Press.

Reyna, V.F. (2004) How People Make Decisions That Involve Risk: A Dual-Processes Approach, Current Directions in Psychological Science, Vol. 13, p. 60–66.

Risør, T. (2016) Trail Blazing or Jam Session? Towards a New Concept of Clinical Decision-making, Anthropology & Medicine, Vol. 24 No. 1, p. 47–64.

Saposnik, G., Redelmeier, D., Ruff, C.C., Tobler, P.N. (2016) Cognitive biases associated with medical decisions: a systematic review, BMC Medical Informatics and Decision Making, Vol. 16 No. 1, 138.

Schattner, A. (2014) Are Physicians’ Decisions Affected by Multiple Nonclinical Factors? Internal Medicine, Vol. 4 No. 3.

Schumock, G.T., Walton, S.M., Park, H.Y., Nutescu, E.A., Blackburn, J.C., Finley, J.M., Lewis, R.K. (2004) Factors that Influence Prescribing Decisions, Annals of Pharmacotherapy, Vol. 38 No. 4, p. 557–562.

Scott, A., Shiell, A., King, M. (1996) Is general practitioner decision making associated with patient socio-economic status? Social Science & Medicine, Vol. 42 No. 1, p. 35–46.

Sheiman, I., Terentʹeva, S. (2015) Mezhdunarodnoe sravnenie effektivnosti biudzhetnoi i strakhovoi modelei finansirovaniia zdravookhraneniia [International comparison of the effectiveness of budget and insurance models for financing health care], Ekonomicheskaia politika [Economic policy], Vol. 10 No. 6, p. 1–23.

Shi, L. (2000) Type of health insurance and the quality of primary care experience, American Journal of Public Health, Vol. 90 No. 12, p. 1848–1855.

Shiffrin, R.M., Schneider, W. (1977) Controlled and automatic human information processing: II. Perceptual learning, automatic attending, and a general theory, Psychological Review, Vol. 84, p. 127–190.

Shumeiker, P. (1994) Modelʹ ozhidaemoi poleznosti: raznovidnosti, podkhody, rezulʹtaty, predely vozmozhnostei [Model of Expected Utility: Varieties, Approaches, Results, Limits of Opportunity], THESIS, Vol. 5. p. 29–80.

Silvestri, G.A., Knittig, S., Zoller, J.S., & Nietert, P.J. (2003) Importance of Faith on Medical Decisions Regarding Cancer Care, Journal of Clinical Oncology, Vol. 21 No. 7, p. 1379–1382.

Simianu, V.V., Grounds, M.A., Joslyn, S.L., LeClerc, J.E., Ehlers, A.P., Flum, D.R. (2016) Understanding clinical and non-clinical decisions under uncertainty: a scenario-based survey. BMC Medical Informatics and Decision Making, Vol. 16 No. 1, p. 153–161.

Sloman S. (1996) The empirical case for two systems of reasoning, Psychological Bulletin, Vol. 119 No. 1, p. 3–22.

Smith, M., Higgs, J., Ellis, E. (2008) Factors influencing clinical decision making. Clinical reasoning in the health professions (3rd ed), Sydney: Butterworth-Heinemann, p. 89–100.

Soumerai, S.B., McLaughlin, T.J., Spiegelman, D., Hertzmark, E., Thibault, G., Goldman, L. (1997) Adverse outcomes of underuse of beta-blockers in elderly survivors of acute myocardial infarction, Journal of the American Medical Association, Vol. 277 No. 2, p. 115–121.

Sreeramareddy, C.T., Rahman, M., Harsha Kumar, H., Shah, M., Hossain, A.M., Sayem, M.A., Van den Ende, J. (2014) Intuitive weights of harm for therapeutic decision making in smear-negative pulmonary Tuberculosis: an interview study of physicians in India, Pakistan and Bangladesh, BMC Medical Informatics and Decision Making, Vol. 14 No. 1, 67.

Stanovich, K.E. (2013) Why humans are (sometimes) less rational than other animals: Cognitive complexity and the axioms of rational choice, Thinking & Reasoning, Vol. 19 No. 1, p. 1–26.

Stanovich, K.E., West, R.F. (2000) Individual differences in reasoning: Implications for the rationality debate? Behavioral and Brain Sciences, Vol. 23 No. 5, p. 645-726.

Stein, M.D., Piette, J., Mor, V., Wachtel, T.J., Fleishman, J., Mayer, K.H, Carpenter, C.C. (1991) Differences in access to zidovudine (AZT) among symptomatic HIV-infected persons, Journal of General Internal Medicine, Vol. 6(1), p. 35–40.

Stone, E.R., Yates, A.J., Caruthers, A.S. (2002) Risk taking in decision making for others versus the self, Journal of Applied Social Psychology, Vol. 32, p. 1–28.

Tracy, C.S., Dantas, G.C., Moineddin, R., Upshur, R.E. (2005) Contextual factors in clinical decision making: national survey of Canadian family physicians, Canadian Family Physician, Vol. 51, p. 1107–1117.

Tsalatsanis, A., Hozo, I., Kumar, A., Djulbegovic, B. (2015) Dual Processing Model for Medical Decision-Making: An Extension to Diagnostic Testing, PLOS ONE, Vol. 10 No. 8.

Tsalatsanis, A., Hozo, I., Vickers, A., Djulbegovic, B. (2010) A regret theory approach to decision curve analysis: A novel method for eliciting decision makers’ preferences and decision-making, BMC Medical Informatics and Decision Making, Vol. 10 No. 1, 51.

Tversky, A., Kahneman, D. (1981) The framing of decisions and the psychology of choice, Science, Vol. 211 No. 4481, p. 453–458.

Van den Berge, K., Mamede, S. (2013) Cognitive diagnostic error in internal medicine, European Journal of Internal Medicine, Vol. 24 No. 6, p. 525–529.

Van den Berge, K., Mamede, S., van Gog, T., Romijn, J.A., van Guldener, C., van Saase, J.L., Rikers, R.M. (2012) Accepting Diagnostic Suggestions by Residents: A Potential Cause of Diagnostic Error in Medicine, Teaching and Learning in Medicine, Vol. 24 No. 2, p. 149–154.

Verbrugge, L.M., Steiner, R.P. (1981) Physician treatment of men and women patients: sex bias or appropriate care? Medical Care, Vol. 19 No. 6, p. 609–632.

von Neumann, J., Morgenstern, O. (1947) The Theory of Games and Economic Behavior. 2nd ed. Princeton: Princeton University Press.

Wason, P.C. Evans, J.S.B.T. (1975) Dual processes in reasoning? Cognition, Vol. 3, p. 141–154.

Wazana, A. (2000) Physicians and the Pharmaceutical Industry, Journal of the American Medical Association, Vol. 283 No. 3, p. 373–380.

Wennberg, E. (2010) Tracking Medicine: A Researcher’s Quest to Understand Health Care. Oxford University Press, New York.

Wennberg, J. (1986). Which Rate Is Right? New England Journal of Medicine, Vol. 314 No. 5, p. 310–311.

Williams, C.A. (1966) Attitudes toward Speculative Risks as an Indicator of Attitudes toward Pure Risks, The Journal of Risk and Insurance, Vol. 33, No. 4, p. 577–586.

Wilson, T.D., Schooler, J.W. (1991) Thinking too much: Introspection can reduce the quality of preferences and decisions, Journal of Personality and Social Psychology, Vol. 60 No. 2, p. 181–192.

Wofford, J.L., Ohl, C.A. (2005) Teaching appropriate interactions with pharmaceutical company representatives: The impact of an innovative workshop on student attitudes, BMC Medical Education, Vol. 5 No. 1.

Wu, Z.H., Freeman, J.L., Greer, A.L., Freeman D.H., Goodman, J.S. (2001) The influence of patients’ concerns on surgeons’ recommendations for early breast cancer, European Journal of Cancer Care, Vol.10, p. 100–106.

Zaitseva, E.A. (2018) Klinicheskii vybor vrachei v krupnom rossiiskom gorode: opyt kachestvennogo analiza [Clinical decision-making in a big Russian city: qualitative analysis], Meditsinskaia Antropologiia i Bioetika [Medical Anthropology and Bioethics], Vol. 15 No. 1.


Citation link:

Zaitseva E. A. (2019). Clinical Decision-making: Overview of Concepts, Studies and Methods [Prinjatie klinicheskih reshenij: obzor koncepcij, issledovanij, metodov]. Medical Anthropology and Bioethics [Medicinskaja antropologija i biojetika], 2 (18).