Evidence for Anchoring Bias During Physician Decision-Making

作者：Dan P. Ly, Paul G Shekelle, Zirui Song · 发表于：JAMA Internal Medicine · 年份：2023 · DOI：10.1001/jamainternmed.2023.2366 · 被引用次数：113 · 研究领域：Clinical Reasoning and Diagnostic Skills、Sepsis Diagnosis and Treatment、Healthcare cost, quality, practices

Introduction: Cognitive biases are hypothesized to influence physician decision-making, but large-scale evidence consistent with their influence is limited. One such bias is anchoring bias, or the focus on a single-often initial-piece of information when making clinical decisions without sufficiently adjusting to later information. Objective: To examine whether physicians were less likely to test patients with congestive heart failure (CHF) presenting to the emergency department (ED) with shortness of breath (SOB) for pulmonary embolism (PE) when the patient visit reason section, documented in triage before physicians see the patient, mentioned CHF. Design, Setting, and Participants: In this cross-sectional study of 2011 to 2018 national Veterans Affairs data, patients with CHF presenting with SOB in Veterans Affairs EDs were included in the analysis. Analyses were performed from July 2019 to January 2023. Exposure: The patient visit reason section, documented in triage before physicians see the patient, mentions CHF. Main Outcomes and Measures: The main outcomes were testing for PE (D-dimer, computed tomography scan of the chest with contrast, ventilation/perfusion scan, lower-extremity ultrasonography), time to PE testing (among those tested for PE), B-type natriuretic peptide (BNP) testing, acute PE diagnosed in the ED, and acute PE ultimately diagnosed (within 30 days of ED visit). Results: The present sample included 108 019 patients (mean [SD] age, 71.9 [10.8] years; 2....