Medical decision making in the treatment of depression – results from the german algorithm project

Background: Which intentional factors influence physician's selection of a certain treatment in individual patients? Based on psychological action theory clinicians' choice of a certain drug or treatment regimen results from a complex interaction of competing alternatives as well as non-competing factors. The aim of this study was to evaluate an instrument to measure clinicians' motivations to choose a specific medication. Method: With reference to the action theory and to clinical experience we developed a 22-item physician decision questionnaire (PDQ). The psychiatrist is requested to indicate reasons and relevance of his motivation for each treatment choice. We evaluated each treatment decision throughout the treatment process for 85 inpatients with depressive disorders being attended by 25 ward physicians of an academic psychiatric department. Results: Factor analysis revealed five dimensions of significant relevance resulting in the following main motivation clusters primarily driving physicians' treatment choice: urgent indication, experience & evidence, side effects & reciprocity, patient's pre-experience, treatment expense. Discussion: Our data confirm the multidimensionality of medical decisions. Caregivers, costpayers, authors of treatment guidelines, as well as medical educators targeting at measures for improving medical decisions have to take into account the specific dynamics of medical decision making in the treatment of depression.