Dear Bruce:
I ask to the list for references and Roy Poses sent to the list a mail with
very usefull discussion and reference list on the topic.
In particular the JAMA 2000 reference convinced me that the method is valid,
and probably as useful as chart review in a problem such the one I are
analyzing.
Here is the answer Roy sent to the list.
> -----Mensaje original-----
> De: Roy Poses [SMTP:[log in to unmask]]
> Enviado el: 27 de diciembre de 2000 18:44
> Para: [log in to unmask]
> Asunto: Fwd: Question about A study about agreement (fwd)
>
> > Dr. Martin O'Flaherty said:
> >
> > Do you know references about using vignettes in biomedical research?
> > ------------------------------------------------
> >
> A brief discussion of the validity of vignettes, with citations, follows:
>
> -------------
>
> Surveys, and specifically case vignette based instruments, are
> frequently used to assess physicians' judgments and decisions. Our
> experience indicates that physicians find it easier to respond to case
> vignettes of prototypical patients than questions about general propensity
> to
> treat or about the proportion of patients in abstract populations that
> might
> treat. Further, there is evidence that physicians' self-reports of their
> propensity to use particular tests or treatments do not correspond to
> their
> actual rates of use.(1-3) There is some evidence of the validity of case
> vignette studies generated by orthogonal fractional factorial designs.(4)
> A
> review of the validity of vigneetes suggested attributes that increase
> validity.(5) These include 1) using vignettes with face validity; 2)
> allowing for responses similar to those one might make in real life; 3)
> avoiding "cueing" subjects by listing responses they are unlikely to
> consider
> in real life; and 4) avoiding suggesting which responses are expected.
> More
> recently, evidence has appeared that physicians" decision making in
> response
> to case-vignettes is generally a good to excellent approximation of their
> decision making for simulated patients with the same clinical problem, and
> approximates this decision making much better than does data from standard
> chart abstraction.(6-7).
>
> REFERENCES
>
> 1. Woo B, Woo B, Cook EF, Weisberg M, Goldman L. Screening procedures in
> the
> asymptomatic adult: comparison of physicians' recommendations, patients'
> desires, published guidelines, and actual practice. JAMA 1985; 254:
> 1480-1484.
>
> 2. Leaf DA, Neighbor WE, Schaad D, Scott CS. A comparison of self-report
> and
> chart audit in studying resident physician assessment of cardiac risk
> factors. J Gen Intern Med 1995; 10: 194-198.
>
> 3. Wennberg DE, Dickens JD, Biener L, Fowler FJ, Soule DN, Keller RB. Do
> physicians do what they say? - the inclination to test and its association
> with coronary angiography rates. J Gen Intern Med 1997; 12: 172-176.
>
> 4. van der Meulen JHP, Bouma BJ, van den Brink RBA. Comparison of
> therapeutic
> decision making in simulated paper cases and actual patients with aortic
> stenosis. Med Decis Making 1995; 15: 428.
>
> 5. Jones TV, Gerrity MS, Earp J. Written case simulations: do they
> predict
> physicians' behavior. J Clin Epidemiol 1990; 43: 805-815.
> >
> 6. Peabody JW, Luck J, Glassman P, Dresselhaus TR, Lee M. Comparison of
> vignettes, standardized patients, and chart abstraction: a prospective
> validation study of 3 methods for measuring quality. JAMA 2000; 283:
> 1715-1722.
>
> 7. Dresselhaus TR, Peabody JW, Lee M, Wang MM, Luck J. Measuring
> compliance
> with preventive care guidelines: standardized patients, clinical
> vignettes,
> and the medical record. J Gen Intern Med 2000; 15: 782-788.
>
>
> ---------------------------------------------------------
> Roy M. Poses MD
> Brown University Center for Primary Care and Prevention
> Memorial Hospital of RI
> 111 Brewster St.
> Pawtucket, RI 02860
> USA
> 401 729-2383
> fax: 401 729-2494
> [log in to unmask]
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