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视网膜病医师为视网膜静脉闭塞继发黄斑囊样水肿患者推荐的疗法不同于他们自身患该病时为自己所选择的疗法

Wang MD, Jeng-Miller KW, Feng HL, et al.

期刊名称:British Journal of Ophthalmology

卷期:2016年第100卷第10期

摘要

目的:评估视网膜病医师在为视网膜静脉闭塞(RVO)继发黄斑囊样水肿(CMO)患者推荐疗法时的认知偏差。方法:随机挑选两组视网膜病医师,调查他们治疗RVO继发CMO时方法和给药方案上的不同。这些疗法包括:三种抗血管内皮生长因子(anti-VEGF)生物制剂(阿柏西普,贝伐单抗和雷珠单抗),玻璃体腔内注射类固醇,以及局部激光治疗和观察。要求第一组视网膜病医师为两名假设患者推荐疗法,一名患者假设患有视网膜分指静脉阻塞(BRVO)继发黄斑囊样水肿(CMO),另一名患者假设患有视网膜中央静脉阻塞(CRVO)继发黄斑囊样水肿(CMO)。要求第二组视网膜病医师假设自己是患有相同疾病的患者,为自己推荐疗法。结果:该调查由492名受访者完成(20.1%)。在为BRVO患者推荐抗血管内皮生长因子制剂时,多数医师选择了贝伐单抗(60.5%),另有37.8%的医师选择了雷珠单抗,1.7%的医师选择了阿柏西普(p<0.0001)。在为自己推荐制剂时,医师们更倾向于选择雷珠单抗(44.9%),另外39.2%的医师选择了贝伐单抗,15.9%的选择了阿柏西普(p<0.0001)。在为CRVO患者推荐抗血管内皮生长因子制剂时,多数医师选择了贝伐单抗(56.7%),另有28.2%的医师选择了雷珠单抗,15.1%的医师选择了阿柏西普(p<0.0001)。但在为自己推荐制剂时,医师们的选择则比较均衡(阿柏西普占30.6%,贝伐单抗占36.5%,雷珠单抗占32.9%, p=0.559)。该结果受医师们所处地理位置的影响,但不受性别,工作时间和工作类型的影响。结论:视网膜病医师应该认识到认知偏差的存在,并在为病人推荐疗法时将这种偏差考虑在内。

AIMS:To evaluate the presence of cognitive bias among retinal specialists when recommending treatment options for cystoid macular oedema (CMO) secondary to retinal vein occlusion (RVO).METHODS:Two randomly chosen samples of retina specialists were surveyed regarding their treatment and dosing regimen choices among three antivascular endothelial growth factor (anti-VEGF) biologics (aflibercept, bevacizumab and ranibizumab), intravitreal steroid, focal laser and observation for the treatment of CMO secondary to RVO. The first group was asked to make recommendations for two hypothetical patients: one with CMO secondary to branch RVO (BRVO) and the second with CMO secondary to central RVO (CRVO). The second group was asked to make recommendations as if they themselves were the hypothetical patient with the same disease processes.RESULTS:The survey was completed by 492 respondents (20.1%). When comparing anti-VEGF agents for patients with BRVO, a majority of physicians recommended bevacizumab (60.5%) over ranibizumab (37.8%) and aflibercept (1.7%; p<0.0001). For themselves, physicians were more likely to recommend ranibizumab (44.9%) over bevacizumab (39.2%) and aflibercept (15.9%; p<0.0001). When comparing among the anti-VEGF agents chosen for patients with CRVO, a majority of physicians recommended bevacizumab (56.7%) over ranibizumab (28.2%) and aflibercept (15.1%; p<0.0001), but when choosing for themselves, retina specialists were equally divided among the three biologics (aflibercept 30.6%, bevacizumab 36.5% and ranibizumab 32.9%; p=0.559). The results were influenced by geographical location but not by the gender, the length of practice or the type of practice.CONCLUSIONS:Physicians should be aware that cognitive biases exist and take this into consideration when making treatment recommendations for their patients.


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