Abstract
Objective Considering as “clinically relevant” a therapy with proven albeit low —quantitatively— efficacy may depend, in practice, on atypical factors. This study evaluated the predisposition to treat (PT) in a theoretical and “blind” scenario based on the benefits and risks associated with endarterectomy in severe asymptomatic carotid stenosis. Participants and measurements Participants: 100 physicians randomly selected from a teaching hospital (mean age: 34.6 years, 48% male, 54% staff, 63% non-surgical speciality). Measurements: structured multidisciplinary survey, based on the aforementioned scenario, evaluating (Visual Analogic Scale) the influence of patient, treatment or professional characteristics on PT. Results Linear relationships between PT and younger age of patient (p < 0.001), lower treatment invasiveness (p < 0.001) and higher empirical support (p < 0.001) were observed. No statistically significant differences were observed between non-surgical and surgical specialists. Staff and male physicians showed higher PT levels at any patient age (staff + male, p < 0.05) and treatment invasiveness (staff, p < 0.01; male, p < 0.025). PT levels were also influenced by: a) residents favouring treatments with higher teaching interest (p < 0.04); b) staff promoting treatments according to their personal experience (p < 0.018); c) non-surgical specialists favouring treatments with scientific-technical interest (p < 0.041). The level of patient comprehension (p < 0.061) and VIPs (p < 0.065) marginally influenced PT. Conclusions The proven but low efficacy of some treatments, such as carotid endarterectomy for severe asymptomatic stenosis, seems to be due to contingent factors influencing the final decision to treat. The identification of subgroups of patients with higher therapeutic benefit would probably decrease the importance of those factors in clinical decision-making.
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