title: Treatment Availability Influences Physicians' Portrayal of Robotic Surgery During Clinical Appointments.
abstract: In order to empower patients as decision makers, physicians must educate them about their treatment options in a factual, nonbiased manner. We propose that site-specific availability of treatment options may be a novel source of bias, whereby physicians describe treatments more positively when they are available. We performed a content analysis of physicians' descriptions of robotic prostatectomy within 252 appointments at four Veterans Affairs medical centers where robotic surgery was either available or unavailable. We coded how physicians portrayed robotic versus open prostatectomy across specific clinical categories and in the appointment overall. We found that physicians were more likely to describe robotic prostatectomy as superior when it was available [F(1, 42) = 8.65, p = .005]. We also provide initial qualitative evidence that physicians may be shaping their descriptions of robotic prostatectomy in an effort to manage patients' emotions and demand for the robotic technology. To our knowledge, this is the first study to provide empirical evidence that treatment availability influences how physicians describe the advantages and disadvantages of treatment alternatives to patients during clinical encounters, which has important practical implications for patient empowerment and patient satisfaction.
authors.affiliation: a Fuqua School of Business and School of Medicine , Duke University.
authors.forename: Karen A
authors.initials: KA
authors.lastname: Scherr
authors.affiliation: b Departments of Internal Medicine and Psychology , University of Michigan and Ann Arbor VA Center for Clinical Management Research.
authors.forename: Angela
authors.initials: A
authors.lastname: Fagerlin
authors.affiliation: c Department of Urology , University of Michigan.
authors.forename: John T
authors.initials: JT
authors.lastname: Wei
authors.affiliation: d Fuqua School of Business , Duke University.
authors.forename: Lillie D
authors.initials: LD
authors.lastname: Williamson
authors.affiliation: e Fuqua School of Business and Sanford School of Public Policy , Duke University.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Ubel
mesh_terms: D000328:Adult; D000368:Aged; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods*; D010817:Physician-Patient Relations; D010820:Physicians / Q000523:psychology*; D011468:Prostatectomy / Q000379:methods*; D065287:Robotic Surgical Procedures / Q000379:methods*; D014481:United States; D014493:United States Department of Veterans Affairs