title: Understanding clinical and non-clinical decisions under uncertainty: a scenario-based survey.
abstract: Prospect theory suggests that when faced with an uncertain outcome, people display loss aversion by preferring to risk a greater loss rather than incurring certain, lesser cost. Providing probability information improves decision making towards the economically optimal choice in these situations. Clinicians frequently make decisions when the outcome is uncertain, and loss aversion may influence choices. This study explores the extent to which prospect theory, loss aversion, and probability information in a non-clinical domain explains clinical decision making under uncertainty.
  
  
  
  Four hundred sixty two participants (n = 117 non-medical undergraduates, n = 113 medical students, n = 117 resident trainees, and n = 115 medical/surgical faculty) completed a three-part online task. First, participants completed an iced-road salting task using temperature forecasts with or without explicit probability information. Second, participants chose between less or more risk-averse ("defensive medicine") decisions in standardized scenarios. Last, participants chose between recommending therapy with certain outcomes or risking additional years gained or lost.
  
  
  
  In the road salting task, the mean expected value for decisions made by clinicians was better than for non-clinicians(-$1,022 vs -$1,061; <0.001). Probability information improved decision making for all participants, but non-clinicians improved more (mean improvement of $64 versus $33; p = 0.027). Mean defensive decisions decreased across training level (medical students 2.1 ± 0.9, residents 1.6 ± 0.8, faculty1.6 ± 1.1; p-trend < 0.001) and prospect-theory-concordant decisions increased (25.4%, 33.9%, and 40.7%;p-trend = 0.016). There was no relationship identified between road salting choices with defensive medicine and prospect-theory-concordant decisions.
  
  
  
  All participants made more economically-rational decisions when provided explicit probability information in a non-clinical domain. However, choices in the non-clinical domain were not related to prospect-theory concordant decision making and risk aversion tendencies in the clinical domain. Recognizing this discordance may be important when applying prospect theory to interventions aimed at improving clinical care.
authors.affiliation: Department of Surgery, University of Washington, Seattle, WA, USA. vsimianu@uw.edu.|Surgical Outcomes Research Center (SORCE), University of Washington Medical Center, Box 354808, 1107 NE 45th St., Suite 502, Seattle, WA, 98105, USA. vsimianu@uw.edu.
authors.forename: Vlad V
authors.initials: VV
authors.lastname: Simianu
authors.affiliation: Department of Psychology, University of Washington, Seattle, WA, USA.
authors.forename: Margaret A
authors.initials: MA
authors.lastname: Grounds
authors.affiliation: Department of Psychology, University of Washington, Seattle, WA, USA.
authors.forename: Susan L
authors.initials: SL
authors.lastname: Joslyn
authors.affiliation: Department of Psychology, University of Washington, Seattle, WA, USA.
authors.forename: Jared E
authors.initials: JE
authors.lastname: LeClerc
authors.affiliation: Department of Surgery, University of Washington, Seattle, WA, USA.
authors.forename: Anne P
authors.initials: AP
authors.lastname: Ehlers
authors.affiliation: Foster School of Business, University of Washington, Seattle, WA, USA.
authors.forename: Nidhi
authors.initials: N
authors.lastname: Agrawal
authors.affiliation: Surgical Outcomes Research Center (SORCE), University of Washington Medical Center, Box 354808, 1107 NE 45th St., Suite 502, Seattle, WA, 98105, USA.
authors.forename: Rafael
authors.initials: R
authors.lastname: Alfonso-Cristancho
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
authors.forename: Abraham D
authors.initials: AD
authors.lastname: Flaxman
authors.affiliation: Department of Surgery, University of Washington, Seattle, WA, USA.|Surgical Outcomes Research Center (SORCE), University of Washington Medical Center, Box 354808, 1107 NE 45th St., Suite 502, Seattle, WA, 98105, USA.
authors.forename: David R
authors.initials: DR
authors.lastname: Flum
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000066491:Clinical Decision-Making; D003657:Decision Making; D005178:Faculty; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010820:Physicians; D013334:Students; D013337:Students, Medical; D035501:Uncertainty; D014495:Universities; D055815:Young Adult
keywords: Decision making; Defensive medicine; Probability; Uncertainty