德国耳鼻喉科医生扁桃体切除术指南依从性处方的社会扩散与同伴影响：一项横断面研究。
Social Diffusion and Peer Influence on Guideline-Adherent Tonsillectomy Prescribing in German Otolaryngologists: A Cross-Sectional Study.
文献信息
| PMID | 42799631 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Helge Giese |
| 作者单位 | Heisenberg Chair for Medical Risk Literacy and Evidence-Based Decisions, Charité - Universitätsmedizin Berlin, Berlin, Germany. |
| 期刊 | Medical decision making : an international journal of the Society for Medical Decision Making |
| SCI 分区 | Q3 |
| IF | 4 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 咽喉科 |
中文摘要
背景： 尽管循证指南明确建议限制对扁桃体炎发作不频繁的成年患者实施扁桃体切除术，但德国耳鼻喉科医生的采纳率仍然有限。社会影响，包括意见领袖和感知到的同伴社会规范，可能塑造从业者对指南的依从性。因此，本研究考察了德国耳鼻喉科医生如何看待关于扁桃体切除术指南的同伴社会规范和意见领袖，以及这些看法如何与其自身的指南依从性相关。
方法： 在一项横断面在线调查（N = 100）中，耳鼻喉科医生报告了其扁桃体切除术实践、对相关指南的态度以及对同伴和意见领袖行为的看法。指南依从性通过自我报告的临床决策进行评估。社会影响采用有序逻辑回归进行分析。
结果： 虽然大多数耳鼻喉科医生报告了与指南一致的态度和行为，但许多人认为其同伴和意见领袖的依从性较低。指南依从性与个体扁桃体切除术态度（比值比 [OR] = 0.18，P < 0.001）和感知到的意见领袖态度（OR = 0.33，P = 0.013）显著相关，但与对一般同伴群体的看法或人口学特征无关。
局限性： 该研究为横断面研究，并采用了便利样本，限制了因果推断和推广性。
结论： 耳鼻喉科医生对意见领袖的看法与其对扁桃体切除术指南的依从性显著相关，甚至超出其自身态度的影响。对同伴和领导者实践的误解可能阻碍指南的传播。
意义： 针对意见领袖并纠正误解的干预措施可能加速指南在临床实践中的采纳。
英文摘要
BACKGROUND: Despite clear recommendations from evidence-based guidelines to restrict tonsillectomies for adult patients with infrequent tonsillitis, adoption among German otolaryngologists remains limited. Social influences, including opinion leaders and perceived social norms across peers, may shape practitioners' adherence to these guidelines. Therefore, this study examined how German otolaryngologists perceive peer social norms and opinion leaders regarding tonsillectomy guidelines and how these perceptions relate to their own guideline adherence.
METHODS: In a cross-sectional online survey (N = 100), otolaryngologists reported their tonsillectomy practices, attitudes toward relevant guidelines, and perceptions of both peer and opinion leader behaviors. Guideline adherence was assessed via self-reported clinical decisions. Social influences were analyzed using ordinal logistic regression.
RESULTS: While most otolaryngologists reported guideline-consistent attitudes and behavior, many perceived their peers and opinion leaders as less adherent. Guideline adherence was significantly associated with individual tonsillectomy attitudes (odds ratio [OR] = 0.18, P < 0.001) and perceived opinion leader attitudes (OR = 0.33, P = 0.013) but not with perceptions of the general peer group or demographics.
LIMITATIONS: The study was cross-sectional and employed a convenience sample, limiting both causal inference and generalization.
CONCLUSIONS: Otolaryngologists' perceptions of opinion leaders are significantly associated with their adherence to tonsillectomy guidelines, even beyond their own attitudes. Misperceptions about peer and leader practices may hinder guideline diffusion.
IMPLICATIONS: Interventions targeting opinion leaders and correcting misperceptions may accelerate guideline adoption in clinical practice.