The stated and tacit impact of demographic and lifestyle factors on prioritization decisions for cardiac surgery

In a clinical judgement analysis, we used linear regression models toreflect the impact of clinical and non-clinical cues on priority decisions,by comparing the stated prioritization policies of 30 clinicians with theiractual policies as revealed by an appraisal of 50 'paper patients'.Correspondence was modest for some cues, e.g. 25 doctors said theyaccounted for age, but age only had a significant bearing in the deriveddecision models of two doctors. Correspondence between the derived andexpressed weights was greatest for clinical angina grade and the presenceof left main stem stenosis. Correlation between the rank order ofimportance between the two models was poor for most of the cues, andstatistically significant only for smoking. However, stated policies madeit appear that lifestyle factors such as smoking habit would influenceprioritization decisions for most clinicians but policies derived fromactual prioritization decisions seldom related to lifestyle or demographicvariables. There were significant differences in the degree of correlationbetween the two models according to the experience of the clinician.However, correspondence was not significantly better for doctors withcardiological training than those without. The overall contribution ofdemographic and lifestyle factors to decision making appears to be small,suggesting that they should be omitted from prioritization guidelines.