title: Variability of the impact of adverse events on physicians' decision making.
abstract: BACKGROUND
  Physicians frequently differ in their treatment recommendations. However, few studies have examined the reasons underlying these differences. The objective of this study was to examine whether physicians vary in the importance they attach to specific adverse events for two treatment options found in recent randomized controlled trials to have equivalent efficacy and overall toxicity.
  
  
  METHODS
  A Max-Diff survey was administered to physicians attending a national scientific conference to quantify the influence of 23 specific adverse events on decision making related to two treatment options for vasculitis. This approach was chosen because it results in greater item discrimination compared to rating scales. We used Hierarchical Bayes modeling to generate the relative importance score for each adverse event and examined the association between physicians' characteristics and the five most influential factors.
  
  
  RESULTS
  118 physicians completed the survey. The mean age (SD) was 48 years (10); 68% were male and 81% reported spending the majority of time in clinical practice. There was significant variability in the ratings of the relative importance of all adverse events, except those that were mild and easily reversible. We found a positive correlation between increasing physician age with ratings of sepsis (r = 0.29, p = 0.002) and opportunistic infection (r = 0.23, p = 0.016), and an inverse association between age with progressive multifocal leukoencephalopathy (r = - 0.28, p = 0.003). Physician sex, work setting, location, and number of patients with vasculitis seen per year were not associated with the influence of specific adverse events on decision making.
  
  
  CONCLUSIONS
  Our findings demonstrate that physicians differ substantially in how they perceive the importance of specific adverse events which may help explain observed unwarranted variability in physicians' recommendations in clinical practice. Further efforts are needed to ensure that the reasons underlying variability in physicians' recommendations are transparent.
authors.forename: Raluca
authors.initials: R
authors.lastname: Cozmuta
authors.forename: Peter A
authors.initials: PA
authors.lastname: Merkel
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Wahl
authors.affiliation: Yale University School of Medicine, PO Box 208031, New Haven, CT 06520-8031, USA. Liana.Fraenkel@yale.edu.
authors.forename: Liana
authors.initials: L
authors.lastname: Fraenkel
mesh_terms: D000328:Adult; D003657:Decision Making; D064420:Drug-Related Side Effects and Adverse Reactions; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D010820:Physicians / Q000592:standards*