研究结果的表述方式是否会影响治疗决策  

Same Information, But Different Decisions: Postgraduates’ Perception of Risk

作　　者：李静[1] 艾昌林[1] 张鸣明[1] 袁文明[1] 徐琳[1] 张小利[1] 刘关键[1] 李幼平[1] 

机构地区：[1]四川大学华西医院循证医学与临床流行病学教研室,成都610041

出　　处：《中国循证医学杂志》2007年第5期344-347,共4页Chinese Journal of Evidence-based Medicine

摘　　要：目的在循证临床实践中,医务人员需要正确理解临床研究中疗效指标的意义。本研究旨在评价相同临床研究结果的不同表述方式对研究生选择和推荐治疗措施的影响,从而了解已经过“临床科研设计”课程学习的研究生对疗效指标的理解。方法将同一系统评价的结果采用4种疗效指标表述,设计问卷对参与“临床科研设计”课程考试的研究生进行调查。结果共发出和收回问卷342份,排除4份未回答所有结果的问卷,有效问卷338份。结果显示,研究生选择绝对危险度降低率(ARR)与需要治疗的患者数(NNT)、相对危险度降低率(RRR)与NNT、试验组和对照组未发生事件率的差异(EFP)与NNT间的分值差异和治疗推荐级别差异均有统计学意义(P<0.01);ARR、RRR与EFP间差异无统计学意义。但279名研究生选择4种疗效指标得分的极差大于4分。结论经过“临床科研设计”课程学习的研究生在理解疗效指标意义上仍然存在问题。因此,课堂教学应加强对临床研究结果的不同表述方式和相关指标临床意义的讲解。Objective To assess whether the results of clinical trials on systematic reviews presented in different ways would influence postgraduates' perception of risk and clinical decision after attending a research design course. Methods We distributed a questionnaire to all postgraduates who attended the final examination. The questionnaire presented the results of a systematic review. Data were presented in four different ways in the following order: as a relative risk reduction (RRR) , as an absolute risk reduction (ARR) , as the proportion of difference in event-free patients (EFP) , and as the number of patients who needed to be treated to prevent one death (NNT). We asked all postgraduates to mark their decisions along a linear scale. Results We distributed and retrieved 342 questionnaires. Three were incomplete and excluded from our analyses. The results showed that the mean score and recommended level were significantly higher when data were expressed as NNT compared with RRR , ARR and EFP (P<0.01). There was no difference among RRR , ARR and EFP. However , 279 postgraduates’ score ranges were greater than 4 among the four different presentations. Conclusion The way of presenting data has significant influence on postgraduates’ perception of risk and their clinical decisions , even after a course teaching them about research design. Further improvements are needed for teachers on how to interprete different ways of presenting risk and their clinical importance.

关 键 词：研究生教育 临床科研设计 治疗决策 

分 类 号：R-03[医药卫生]