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Medical Decision Making
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Hormonal Replacement Therapy

Analysis of Clinical Strategies Used by Residents

Arthur S. Elstein

Gerald B. Holzman

Laurie J. Belzer

Ruth D. Ellis

The authors investigated strategies employed by resident physicians to decide whether to prescribe hormonal replacement therapy (HRT) for menopausal women, a matter of contin uing clinical controversy. Verbal protocols were obtained from 21 residents in three specialties as they responded to 12 brief case descriptions. The cases incorporated three levels of cancer risk and two levels of osteoporosis risk in a 3 x 2 factorial design with two replications in each cell. Substantial variation in willingness to prescribe HRT was observed. By clustering subjects with relatively similar approaches to the problem, three treatment strategies were formulated that accounted for the decisions of 20 subjects. Each strategy is a simplified representation of the conflicting considerations in this clinical dilemma that facilitates rapid decision making. The differences between these representations and formal decision-analytic models help to explain why observed clinical decisions were inconsistent with expected utility maximization. Key words: hormonal replacement therapy; decision making; subjective prob ability estimates; regret; intuitive clinical reasoning. (Med Decis Making 1992;12:265-273)

Medical Decision Making, Vol. 12, No. 4, 265-273 (1992)
DOI: 10.1177/0272989X9201200404
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