THE STATED AND TACIT IMPACT OF DEMOGRAPHIC AND LIFE-STYLE FACTORS ON PRIORITIZATION DECISIONS FOR CARDIAC-SURGERY

In a clinical judgement analysis, we used linear regression models to reflect the impact of clinical and non-clinical cues on priority decis ions, by comparing the stated prioritization policies of 30 clinicians with their actual policies as revealed by an appraisal of 50 'paper p atients'. Correspondence was modest for some cues, e.g. 25 doctors sai d they accounted for age, but age only had a significant bearing in th e derived decision models of two doctors. Correspondence between the d erived and expressed weights was greatest for clinical angina grade an d the presence of left main stem stenosis. Correlation between the ran k order of importance between the two models was poor for most of the cues, and statistically significant only for smoking. However, stated policies made it appear that lifestyle factors such as smoking habit w ould influence prioritization decisions for most clinicians but polici es derived from actual prioritization decisions seldom related to life style or demographic variables. There were significant differences in the degree of correlation between the two models according to the expe rience of the clinician. However, correspondence was not significantly better for doctors with cardiological training than those without. Th e overall contribution of demographic and lifestyle factors to decisio n making appears to be small, suggesting that they should be omitted f rom prioritization guidelines.