Selecting representative case vignettes for Clinical Judgement studies: Examples from two heart failure studies

In the Clinical Judgement Analysis (CJA) tradition there are strong arguments in favour of using representative case vignettes. Due to methodological and practical constraints, however, it is often necessary to make compromises regarding representativity. In this article, we discuss our experiences...

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Bibliographic Details
Published in:Quality & quantity 2004-10, Vol.38 (5), p.621-635
Main Authors: SKANER, Ylva, BRING, Johan, STRENDER, Lars-Erik
Format: Article
Language:English
Subjects:
Case Studies
Decision making
Diagnosis
Generalization
Heart disease
Heart Diseases
History, theory and methodology
Judgement
Medical Decision Making
Medical Research
Medicine
Methodology
Patients
Physicians
Representation
Social sciences
Sociology
Sociology of health and medicine
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Summary:In the Clinical Judgement Analysis (CJA) tradition there are strong arguments in favour of using representative case vignettes. Due to methodological and practical constraints, however, it is often necessary to make compromises regarding representativity. In this article, we discuss our experiences in working with these problems in connection with two studies about general practitioners' heart failure diagnoses. CJA is a method for investigating and describing decision-making in which both judges and judgement situations are taken into consideration. This means that when we want to study physicians' diagnoses, both the participating physicians as well as the case vignettes should be sampled to be representative for the diagnostic situation. If representativity is interpreted in a strictly statistical sense, the case vignettes should reflect a well identified population of patients regarding values, distribution and intercorrelations of the relevant patient characteristics (variables). Creating a set of representative case vignettes meeting all theoretical requirements will often be difficult. Selecting a relevant population and relevant variables, deciding about the appropriate number of variables and case vignettes, and deciding whether authentic patients or constructed case vignettes should be used are some of the problems that must be dealt with. Reprinted by permission of Springer
ISSN:0033-5177