Medical decision making : an international journal of the Society for Medical Decision Making
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American health care is transitioning to electronic physician ordering. These computerized systems are unique because they allow custom order interfaces. Although these systems provide great benefits, there are also potential pitfalls, as the behavioral sciences have shown that the very format of electronic interfaces can influence decision making. The current research specifically examines how defaults in electronic order templates affect physicians' treatment decisions and medical errors. ⋯ The defaults used in electronic order sets influence medical treatment decisions when the consequences to a patient's health are low. This pattern suggests that physicians cognitively override incorrect default choices but only to a point, and it implies tradeoffs that maximize accuracy and minimize cognitive effort. Results indicate that defaults for low-impact items on electronic templates warrant careful attention because physicians are unlikely to override them.
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Randomized Controlled Trial
Tables or bar graphs? Presenting test results in electronic medical records.
Electronic personal health records offer a promising way to communicate medical test results to patients. We compared the usability of tables and horizontal bar graphs for presenting medical test results electronically. ⋯ Compared to horizontal bar graphs, tables required more time and experience to achieve the same results, suggesting that tables can be a more burdensome format to use. The current practice of presenting medical test results in a tabular format merits reconsideration.
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Randomized Controlled Trial
The impact of a novel computer-based decision aid on shared decision making for colorectal cancer screening: a randomized trial.
Eliciting patients' preferences within a framework of shared decision making (SDM) has been advocated as a strategy for increasing colorectal cancer (CRC) screening adherence. Our objective was to assess the effectiveness of a novel decision aid on SDM in the primary care setting. ⋯ Our interactive computer-based decision aid facilitates SDM, but overall effectiveness is determined by the extent to which providers comply with patient preferences.
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Randomized Controlled Trial
Evaluating physician performance at individualizing care: a pilot study tracking contextual errors in medical decision making.
Clinical decision making requires 2 distinct cognitive skills: the ability to classify patients' conditions into diagnostic and management categories that permit the application of research evidence and the ability to individualize or-more specifically-to contextualize care for patients whose circumstances and needs require variation from the standard approach to care. The purpose of this study was to develop and test a methodology for measuring physicians' performance at contextualizing care and compare it to their performance at planning biomedically appropriate care. ⋯ This pilot study demonstrates a methodology for measuring physician performance at contextualizing care and illustrates the contribution of such information to an overall assessment of physician practice.
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Randomized Controlled Trial
The default effect in end-of-life medical treatment preferences.
Living wills are intended to preserve patient autonomy, but recent studies suggest that they do not always have their desired effect. One possible explanation is that living wills do not capture the authentic preferences of the patients who write them but instead reflect transient contextual effects on preferences. ⋯ The default manipulations in both experiments had potent but transient effects and influenced what participants wrote in their living wills but not their responses to later medical scenarios. Expression of end-of-life treatment preferences appears to be temporarily constructed from the decision-making context. These results have implications for surrogate decision making and the use of the living will as a tool to preserve patient autonomy.