Introduction: The treatment strategy for elderly patients with acute myeloid leukemia (AML) is individualized due to the heterogeneity of the disease biology and the paucity of strong evidence in clinical practice. In general, regimens for elderly AML patients can be divided into standard intensive induction, low-intensity therapy, and best supportive care. Such medical decision-making regarding elderly patients with AML might be affected by physicians' occupational and non-occupational factors.
Methods: We performed a national vignette-based survey of hematologists in China, to explore the impact of hematologists' personality and behavioral traits on medical decision-making for elderly AML patients. The medical decision-making for elderly AML patients was evaluated using 6 clinical vignettes. Hematologists' attitudes toward risk and uncertainty, personality traits, and decision-making styles were assessed using binary lottery choices and well-recognized self-report inventories.
Results: Of the 820 eligible hematologists contacted, a total of 529 completed the survey; the response rate was 64.5%. In total, 354 (67%) were women. The mean age of the participants was 41.0 ± 7.4 years (range, 27-64 years). Senior hematologists accounted for 60% (n = 318) of the participants, including associate chief physicians (185, 35%) and chief physicians (133, 25%). The rest attending physicians, which are considered as junior hematologists, accounted for 40% of the participants (n = 211). The resulting binary regression model in predicting the therapy intensity preference of medical decision-making for elderly AML patients contained the following factors: hematologists' professional title group (OR = 0.012, 95% CI, 0.001 to 0.136, P < 0.001), conscientiousness (OR = 0.336, 95% CI, 0.121 to 0.932, P = 0.036), extraversion (OR = 0.403, 95% CI, 0.166 to 0.974, P = 0.044), conscientiousness by title group (OR = 2.009, 95% CI, 1.100 to 3.667, P = 0.023), and extraversion by title group (OR = 1.627, 95% CI, 0.965 to 2.743, P = 0.068). Using interaction analyses, we found that junior hematologists with a higher level of extraversion (mean difference = 0.27; 95% CI, 0.07 to 0.45; P = 0.009) or conscientiousness (mean difference = 0.19; 95% CI, 0.01 to 0.36; P = 0.028) tended to prescribe more intensive therapy. Meanwhile, no significant correlations between physicians' nonoccupational characteristics and medical decision-making for elderly AML patients were observed in senior hematologists.
Conclusions: Our study suggests that hematologists' personalities contribute to medical decision-making for elderly AML patients, depending on the hematologists' professional titles. Among attending physicians, those with a higher level of extraversion or conscientiousness tended to prescribe more intensive therapy. Meanwhile, in chief and associate chief physicians, there was no significant correlation observed between hematologists' personality traits and medical decision-making for elderly AML patients.
Disclosures
No relevant conflicts of interest to declare.
Physician uncertainty aversion impacts medical decision making for older patients with acute myeloid leukemia: results of a national survey