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Abstract
To determine the attitudes of physicians and trainees in regard to the roles of both cost-effectiveness and equity in clinical decision making.In this cross-sectional study, electronic surveys containing a hypothetical decision-making scenario were sent to medical professionals to select between two colon cancer screening tests for a population.Three Greater Boston academic medical institutions: Tufts University School of Medicine, Tufts Medical Centre and Lahey Hospital and Medical Centre.819 medical students, 497 residents-in-training and 671 practising physicians were contacted electronically using institutional and organisational directories.Stratified opinions of medical providers and trainee subgroups regarding cost-effectiveness and equity.A total of 881 respondents comprising 512 medical students, 133 medical residents-in-training and 236 practising physicians completed the survey (total response rate 44.3%). Thirty-six per cent of medical students, 44% of residents-in-training and 53% of practising physicians favoured the less effective and more equitable screening test. Residents-in-training (OR 1.49,?CI 1.01 to 2.21; p=0.044) and practising physicians (OR 2.12,?CI 1.54 to 2.92; p<0.001) were more likely to favour the equitable option compared with medical students. Moreover, female responders across all three cohorts favoured the more equitable screening test to a greater degree than did male responders (OR 1.70,?CI 1.29 to 2.24; p<0.001).Cost-effectiveness analysis does not accurately reflect the importance that medical professionals place on equity. Among medical professionals, practising physicians appear to be more egalitarian than residents-in-training, while medical students appear to be most utilitarian and cost-effective. Meanwhile, female respondents in all three cohorts favoured the more equitable option to a greater degree than their male counterparts. Healthcare policies that trade off equity in favour of cost-effectiveness may be unacceptable to many medical professionals, especially practising physicians and women.
View details for DOI 10.1136/bmjopen-2017-017251
View details for Web of Science ID 000410203700222
View details for PubMedID 28765138
View details for PubMedCentralID PMC5642791