Risk Rate Neglect in Decisions Involving Invasive Diagnostic Procedures

Abstract:

To investigate whether the risk of life-threatening complications influence the decisions involving invasive diagnostic procedures, a study was conducted that focused on the use of coronary angiography and endomyocardial biopsy with risk rates of either 1 % or 2%. The participants included 38 physicians from two university-affiliated hospitals. Of their 76 pairs of decisions, 53% were of the “risk-avoidance” type and 26% were of the “risk-taking” type. Only 13% of decisions were of the “risk-conscious” type. The practical implication of these biases can be substantial in real-life decisions regarding events with low-probability, but high-consequence risks.

Key-Words:

Risk Perception - Diagnostic Procedures

• REFERENCES

• 1 Lichtenstein S, Slovic P, Fischoff B, Layman M, Combs B. Judged frequency of lethal events. J Exp Psychol (Human Learning and Memory) 1978; 4: 551-78.
• 2 Manu P, Runge LA, Lee JY, Oppenheim AD. Judged frequency of complications after invasive diagnostic procedures. Systematic Biases of a Physician Population. Medical Care 1984; 22: 366-70.
• 3 Starr C, Whipple C. Risks of risk decisions. Science 1980; 208: 1114-9.
• 4 Kemp HG, Evans H, Elliott WC, Gorlin R. Diagnostic accuracy of selective coronary cinearteriography. Circulation 1967; 36: 526-33.
• 5 Arnett EN, Isner JM, Redwood DR, Kent K, Baker WP, Ackerstein H, Roberts WC. Coronary artery narrowing in coronary heart disease: comparison of cineangiographic and necropsy findings. Ann Intern Med 1979; 91: 350-56.
• 6 Kennedy JW, Killip T, Fisher LD, Alderman EL, Gillespie MJ, Mock MB. The clinical spectrum of coronary artery disease and its surgical and medical management, 1974–1979 The coronary artery surgery study. Circulation 1982; 66 suppl (Suppl. 111) 16-23.
• 7 CASS Principal Investigators and Their Associates: Coronary Artery Surgery Study (CASS). A randomized trial of coronary artery bypass surgery. Survival data. Circulation 1983; 68: 939-50.
• 8 Wiener DA, Ryan TJ, McCabe CH, Kennedy JW, Schloss M, Tristani F, Chaitman BR, Fisher LD. Correlations among history of angina, ST-segment response and prevalence of coronaryartery disease in the coronary artery surgery study (CASS). N Engl J Med 1979; 301: 230-35.
• 9 McNeer JF, Margolis JR, Lee KL, Kisslo JA, Peter RH, Kong Y, Behar VS, Wallace AG, McCants CM, Rosati RA. The role of the exercise test in the evaluation of patients for ischemic heart disease. Circulation 1978; 57: 64-70.
• 10 Dec DW, Palacios IF, Fallon JT, Aretz HT, Mills J, Lee DC, Johnson RA. Active myocarditis in the spectrum of acute dilated cardiomyopathies. N Engl J Med 1985; 312: 885-90.
• 11 Edwards WD, Holmes DR, Reeder GS. Diagnosis of active lymphocytic myocar- ditis by endomyocardial biopsy. Mayo Clin Proc 1982; 57: 419-25.
• 12 Davis JD, Muss JB, Turner RA. Cytotoxic agents in the treatment of rheumatoid arthritis. South Med J 1978; 71: 58-72.
• 13 Fischoff B, Slovic P, Lichtenstein S. Fault trees: Sensitivity of estimated failure probabilities to problem representation. J Exp Psychology (Human Perception and Performance) 1978; 4: 330-44.
• 14 Kong A, Barnett GO, Mosteller F, Youtz C. How medical professionals evaluate expressions of probability. N Engl J Med 1986; 315: 740-44.
• 15 Christensen-Szalanski JJJ, Beck DE. Christensen-Szalanski CM, Koepsell TD. Effects of expertise and experience on risk judgments. J Appl Psychology 1983; 68: 278-84.
• 16 Pauker SG, Kassirer JP. The threshold approach in clinical decision making. N Engl J Med 1980; 302: 1109-17.
• 17 Manu P, Runge LA. Testing stable angina: expert opinion versus decision analysis. Med Care 1985; 23: 1381-90.
• 18 Manu P, Lane TJ, White P, Voytovich AE. Riskrate fallacy in decisions involving invasive diagnostic procedures. Clin Res 1986; 34: 872A