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Med Care. 1985 Feb;23(2):95-109.

The impact of selected patient characteristics on practitioners' treatment recommendations for end-stage renal disease.


Medical decision making under uncertainty was tested using an empirical study of practitioner judgments concerning the preferred treatment(s) for end-stage renal disease (ESRD) patients. Patient-specific factors were varied systematically in written case vignettes, which were mailed to physician and nonphysician practitioners who treated ESRD patients in Canada and Michigan. Respondents were asked to indicate for each vignette: a preferred treatment and all other acceptable treatments. Overall patterns of choice were analyzed; the clear preferences shown for certain treatment modalities (e.g., for continuous ambulatory peritoneal dialysis over home hemodialysis) have planning implications. The apparent receptivity to new ESRD treatments may affect the success of government policies aimed at encouraging greater use of home hemodialysis. The impact of each patient-specific variable on treatment choice was also examined. Factors such as the patient's age proved to be major determinants both of the preferred treatment modalities and of the number of alternatives considered acceptable. The research method allowed areas of medical consensus to be distinguished from those 'grey areas' in which patient characteristics alone could not explain treatment selection. The resulting 'controversy' cases are being used as the dependent variables in further studies.

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