Factors impacting physicians' decisions to prevent variceal hemorrhage.
BACKGROUND
Reasons underlying the variability of physicians' preferences for non-selective beta-blockers (BBs) and endoscopic variceal ligation (EVL) to prevent a first variceal bleed have not been empirically studied. Our aims were to examine whether 1) gastroenterologists can be classified into distinct subgroups based on how they prioritize specific treatment attributes and 2) physician characteristics are associated with treatment preference.


METHODS
We surveyed physicians to determine their preferred treatment for a standardized patient with large varices and examined the influence of treatment characteristics on physicians' decision making using best-worst scaling. Latent class analysis was used to examine whether physicians could be classified into groups with similar decision-making styles.


RESULTS
110 physicians were interviewed (participation rate 39%). The majority spent two or more days a week performing endoscopies and had practices comprising less than 25% of patients with liver disease. Latent class analysis demonstrated that physicians could be classified into at least two distinct groups. Most (n = 80, Group 1) were influenced solely by the ability to visually confirm eradication of varices. In contrast, members of Group 2 (n = 30) were influenced by the side effects and mechanism of action of BBs. Group 1 members were more likely to have practices that included fewer patients with liver disease and more likely to choose options including EVL (p = 0.01 for both).


CONCLUSIONS
Among physicians, where the majority performs endoscopy on two or more days per week, most prefer prevention strategies which include EVL. This may be due to the strong appeal of being able to visualize eradication of varices.
Section of Rheumatology, Yale University School of Medicine, 300 Cedar ST, TAC Bldg, RM #525, P.O. Box 208031, New Haven, CT, USA. kathleen.yan@yale.edu.|Yale University School of Medicine, New Haven, Connecticut and VA Connecticut Health Care System, West Haven, CT, USA. kathleen.yan@yale.edu.
Kathleen
K
Yan
Department of Health Policy and Management, John Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. jbridges@jhsph.edu.
John F P
JF
Bridges
Section of Rheumatology, Yale University School of Medicine, 300 Cedar ST, TAC Bldg, RM #525, P.O. Box 208031, New Haven, CT, USA. salva.augustin@gmail.com.|Yale University School of Medicine, New Haven, Connecticut and VA Connecticut Health Care System, West Haven, CT, USA. salva.augustin@gmail.com.
Salvador
S
Augustin
Section of Rheumatology, Yale University School of Medicine, 300 Cedar ST, TAC Bldg, RM #525, P.O. Box 208031, New Haven, CT, USA. loren.laine@yale.edu.|Yale University School of Medicine, New Haven, Connecticut and VA Connecticut Health Care System, West Haven, CT, USA. loren.laine@yale.edu.
Loren
L
Laine
Section of Rheumatology, Yale University School of Medicine, 300 Cedar ST, TAC Bldg, RM #525, P.O. Box 208031, New Haven, CT, USA. guadalupe.garcia-taso@yale.edu.|Yale University School of Medicine, New Haven, Connecticut and VA Connecticut Health Care System, West Haven, CT, USA. guadalupe.garcia-taso@yale.edu.
Guadalupe
G
Garcia-Tsao
Section of Rheumatology, Yale University School of Medicine, 300 Cedar ST, TAC Bldg, RM #525, P.O. Box 208031, New Haven, CT, USA. liana.fraenkel@yale.edu.|Yale University School of Medicine, New Haven, Connecticut and VA Connecticut Health Care System, West Haven, CT, USA. liana.fraenkel@yale.edu.
Liana
L
Fraenkel
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D000066491:Clinical Decision-Making / Q000379:methods*; D016099:Endoscopy, Gastrointestinal; D004932:Esophageal and Gastric Varices / Q000150:complications* / Q000188:drug therapy / Q000601:surgery; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D008026:Ligation; D008103:Liver Cirrhosis / Q000150:complications; D008297:Male; D008875:Middle Aged; D011795:Surveys and Questionnaires; D014481:United States
D000319:Adrenergic beta-Antagonists