The impact of a physician’s recommendation and gender on informed decision making: A randomized controlled study
Date Submitted: Jul 25, 2019
Open Peer Review Period: Jul 29, 2019 - Sep 23, 2019
Background: When making decisions regarding their own health, patients are affected by a variety of influencing factors. The attending physician plays a particularly important role in this context. This also applies in situations that are preference-sensitive and in which therefore the needs and wishes of the patient should be particularly acknowledged. The influence of physicians can emanate both from their statements and from their physical presence. Objective: This study examined the influence of physicians’ recommendations and their gender on the decision-making process in a preference-sensitive situation. The participants were asked to imagine a hypothetical scenario in which they themselves suffered from a rupture of the anterior cruciate ligament (ACL). Methods: The participants (n=202) received general information on the ACL and on treatment options for an ACL rupture (surgical treatment vs. physiotherapeutic treatment). They were explicitly informed that both treatment options showed the same treatment success in the medical research literature, and that this was therefore a preference-sensitive decision situation. Subsequently, the participants indicated their decision for a treatment option, their certainty and satisfaction regarding their decision, and their attitude toward the two treatment options. The participants were then randomly assigned to one of four conditions in a 2 (physician’s recommendation: surgery vs. physiotherapy) x 2 (physician’s gender: female vs. male) design. They watched a video with a still picture of a drawn female or male doctor and with the audio track of a medical consultation with a female or male voice. They received further information about the treatment options and the female or male doctor’s recommendation for one option. The participants then indicated again their decision, certainty, satisfaction, and attitude. They also assessed the physician’s professional and social competence. Results: We found that the participants changed their decision in the direction of the physician’s recommendation (P<.001). The data also showed that certainty (P<.001) and satisfaction (P<.001) regarding the decision increased more strongly if the physician’s recommendation was in line with the participant’s prior attitude than if the recommendation was contrary to the participant’s prior attitude. Finally, we found that participants’ attitude toward the recommended treatment became more positive (surgery recommendation: P<.001; physiotherapy recommendation: P<.001). However, we found no influence of the physician’s gender on participants’ decision, attitude, or competence assessment. Conclusions: This research indicates that physicians should be careful with recommendations when aiming for shared decisions, as they might influence patients even if the patients have been made aware that they should take their personal preferences into account. This could be particularly problematic if the doctor’s recommendation is not in line with the patient’s preferences, as this contradiction may lead to less certainty and satisfaction regarding the decision. Clinical Trial: The study was pre-registered on the pre-registration platform AsPredicted (aspredicted.org) before we began data collection (registration number: #12946).