Clinical Decision Science: Proof of concept

Abstract

Clinical decision science, a newly identified area of scholarship, describes how clinical research is used for a patient, within the context of their unique social conditions. We hypothesize that physicians use sociocultural context as an important input to their decision making. We performed a prospective, randomized, double-blind mixed methods study. Family medicine faculty and residents at a community hospital family medicine residency were included in the study. After academic journal club discussing a primary research paper, physicians were asked if they would prescribe medication for a patient who was similar to the subjects in a research paper. However, social and cultural context was given to the cases. The physicians were block randomized into two groups; Group A was given a case with a patient who had a social and cultural context more conducive to lifestyle modification, while group B had a case more conducive to prescribing medication. Primary outcome was whether or not physicians prescribed medication, allowing for a 2x2 table for analysis. We also asked a free response question regarding the reasoning for their decision and performed qualitative analysis. In group A (n=14), no subjects prescribed medication. In group B (n=18), six subjects prescribed medication. (chi-square statistic with Yates correction 9.95, p=0.001). Thematic analysis in group A showed 22 statements related to medical practice or disease characteristics, and 25 statements related to familial relationships and patient preferences. In group B, subjects who prescribed medication made 30 statements related to medical practice, and 13 statements related to patient preference. Subjects who did not prescribe medication made 10 statements related to medical practice, and 1 statement related to patient preference. This study demonstrates social context of individual patients, together with evidence, affects clinical decision and management. We propose further study into how this affects physician decision making, a scholarly field we call Clinical Decision Science.