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目的:考察医疗情境中,自我决策与为他人提供建议是否存在决策偏差,并基于解释水平的理论,解释这种偏差的由来。方法:改编Ficchhoff等使用过的医疗决策问题,分别以正/负框架(2)×自我/他人(2)进行描述。355名临床专业大学生被随机分为四组完成决策任务。结果:社会距离对医疗决策影响显著(χ2=8.636,P=0.003),自我决策与向他人建议相比,被试更倾向短期获益,长期受损的保守方案。框架效应对医疗决策影响显著(χ2=9.804,P=0.002),正性框架相比负性框架,被试更倾向短期受损,长期获益的手术方案。解释水平与框架效应交互作用显著:正性框架中,自我-他人决策差异显著(χ2=12.309,P<0.001),自我决策更倾向手术方案,负性框架中,自我-他人决策无显著差异(χ2=0.706,P=0.401);自我决策中,框架效应不显著(χ2=0.91,P=0.340),向他人建议,框架效应显著(χ2=13.256,P<0.001)。结论:社会距离与框架描述对医疗决策存在影响。
OBJECTIVE: To examine the existence of discrepancies in decision-making in self-decision-making and in providing advice to others in medical settings and to explain the origin of such deviations based on the theory of level of interpretation. METHODS: Adapted medical decision-making questions used by Ficchhoff et al., Described in positive / negative frame (2) × self / others (2), respectively. 355 clinical majors were randomly divided into four groups to complete the decision-making task. Results: Social distance had a significant effect on medical decision-making (χ2 = 8.636, P = 0.003). Self-decision-making compared with others suggested that subjects were more likely to benefit from short-term and long-term impairment. The frame effect has a significant impact on medical decision-making (χ2 = 9.804, P = 0.002). Compared with the negative frame, the positive frame is more likely to be short-term and long-term benefit surgical plan. There was significant interaction between the level of explanation and the frame effect: In the positive frame, there was significant difference between self-decision (χ2 = 12.309, P <0.001), self-decision more inclined to surgery plan, negative frame, χ2 = 0.706, P = 0.401). In the self-decision-making, the frame effect was not significant (χ2 = 0.91, P = 0.340), suggesting to others that the framework effect was significant (χ2 = 13.256, P <0.001). Conclusion: Social distance and framework description have an impact on medical decision-making.