The Influence of Genotype Information on Psychiatrists’ Treatment Recommendations: More Experienced Clinicians Know Better What to Ignore

• Published in: Value in health 2017-01, Vol.20 (1), p.126-131
• Main Authors: McMichael, Alan J., BSc, Boeri, Marco, PhD, Rolison, Jonathan J., PhD, Kane, Joe, PhD, O’Neill, Francis A., MD, Scarpa, Ric, PhD, Kee, Frank, MD
• Format: Article
• Language: English
• Subjects: Adult; Antipsychotic Agents - therapeutic use; Attitude of Health Personnel; attribute nonattendance; Attributes; Biomarkers; Clinical decision making; Decision making; discrete choice; Female; Genetics; Genotype; Genotype & phenotype; Genotypes; Humans; Influence; Internal Medicine; Male; Medical decision making; Medical treatment; Mental disorders; Middle Aged; Patients; Pharmacogenetics; Practice Patterns, Physicians' - statistics & numerical data; Psychiatrists; Psychiatry - statistics & numerical data; Responsiveness; Schizophrenia; Schizophrenia - drug therapy
• ISSN: 1098-3015; 1524-4733
• DOI: 10.1016/j.jval.2016.09.2395

Abstract Background This study applies attribute nonattendance to medical decision making. We aimed to demonstrate how this type of analysis can be used in medical decision making to assess whether psychiatrists were influenced in their treatment recommendations by information on the genotype of a patient, despite knowing the patient’s response to treatment as measured by the Positive and Negative Syndrome Scale. A patient’s genetic information may be used to predict their response to therapy; such information, however, becomes redundant, and should not influence decisions, once a clinician knows the patient’s actual response to treatment. Methods Sixty-seven psychiatrists were presented with patients’ pre- or post-treatment scores on the Positive and Negative Syndrome Scale for two hypothetical treatments for schizophrenia. Psychiatrists were also informed whether the patient possessed a genotype linked to hyper-responsiveness to one of the treatments, and were asked to recommend one of these two treatments. Attribute nonattendance assessed whether the information on genotype influenced psychiatrists’ treatment recommendations. Results Years of experience predicted whether psychiatrists were influenced by the genetic information. Psychiatrists with 1 year or less of experience had a 46% probability of considering genetic information, whereas psychiatrists with at least 15 years of experience had a lower probability (7%). Conclusions Psychiatrists and other clinicians should be cautious about allowing a patient’s genetic information to carry unnecessary weight in their clinical decision making.