Date of Award

11-3-2006

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

First Advisor

Margaret Drickamer

Abstract

Background: As the field of medicine is often described as one that combines science and art, it must be noted that data are only considered influential if understood by the person or persons deciding whether or not to use such data. Thus, psychological principles that govern the use of data play almost as equal a role as the medical development of that data. This study applies the psychologically-derived concepts of framing effects to the field of medicine, in an attempt to determine whether risk order should be considered as a framing effect. Specifically, this study used a randomized double-blinded controlled study to determine whether the presented order of risks involved with an abdominal aortic aneurysm surgical repair significantly affected patients decisions as to whether or not they would hypothetically undergo the surgery. Methods: Participants (n = 90) were shown a video interaction between a doctor and a patient whereby the doctor explained to the patient that he had an abdominal aortic aneurysm, and then detailed the surgical repair option along with the possible risks of the surgery. Participants were randomized to three different experimental conditions (A, B, and C) that differed solely on the order that participants saw the risks being outlined to the patient by the doctor. Participants in condition A (n = 30) saw the risks presented in a most grave to least grave order, participants in condition C (n = 30) saw the risks presented in a least grave to most grave order, and participants in condition B (n = 30) saw the risks presented in crescendo-decrescendo order of gravity. This study predicts that the more salient the grave risk(s), the less likely that participants would indicate that they would theoretically decide to undergo the surgery. Results: In comparing the data from participants responses as to whether they would undergo the surgery if they were in the patients position, the results showed a statistically significant difference (p-value of 0.015) between three experimental conditions, with results according to the predicted direction (surgery selection rate of B > surgery selection rate of C > surgery selection rate of A). Additionally, participants were asked to rank how dangerous they believed the surgery to be on a 0 (least dangerous) to 10 (most dangerous) scale. The data showed a statistically significant difference among the three conditions (p-value of < 0.001), with the direction of association again consistent with the predicted results (i.e. mean danger scorings of condition A > mean danger scorings of condition C > mean danger scorings of condition B). Conclusion: This study presents strong evidence for including the order of presented risks for a particular medical or surgical treatment as a subset of framing effects. The author believes this finding to necessitate that presentation order be included in the discussion of ethics governing how doctors communicate with their patients about treatment options.

Comments

This is an Open Access Thesis.

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