医学决策中框架描述对病人家属行为和态度的影响

Impact of framing description on the attitude and behavior of patients' families in medical decision making

目的探讨医学情境中决策行为-态度的分离现象及其与框架描述的交互作用。方法使用Ficchhoff等开发的医疗决策问题,分别以正框架/负框架×决策行为/对冒险决策的态度/对保守决策的态度进行描述。300名临床专业本科生被随机分为6组,每组被试完成一道决策问题。结果医学情境中,决策行为与态度存在显著的不一致,面对两难的医疗决策问题,当以存活率描述,被试决策行为无倾向性(t=-1.48,P>0.05),而以死亡率描述时,则倾向采用保守治疗方案(t=2.92,P<0.01);但无论医生采用怎样的方案,被试始终持显著反对态度(P<0.05)。框架描述对决策行为与态度均存在显著影响(t决策行为=-3.08,P<0.01;t冒险态度=3.69,P<0.01;t保守态度=-2.12,P<0.05)。结论医学情境中,存在决策行为-态度的不一致现象,框架描述能够影响医学决策。

Objective To explore the discrepancy between attitude and behavior existed in medical situation and its interaction with framing description.Methods A total of 300 clinical undergraduates were randomly assigned to six groups and investigated with questionnaire of Ficchhoff＇s medical decision making problems which were described in a positive or negative frame×decision making behavior/altitude to risky plan/altitude to conservative plan.Results The discrepancy between attitude and behavior did exist in medical situation.In the face of the medical dilemma,if described in mortal rate,subjects had a significant tendency to choose the conservative plan（t=2.92,P0.01）,but if described in survival rate,there was no such preference（t=-1.48,P0.05）.However,no matter which plan was chased by doctors,subjects held a significant opposing attitude（P0.05）.Framing description had a significant impact on both decision making behavior and attitude（tbehavior=-3.08,P0.01;trisk attitude=3.69,P0.01;tconservative attitude=-2.12,P0.05）.Conclusion The discrepancy of attitude-behavior exists in medical situation.The framing description has an impact on medical decision making.