Trading off : a grounded theory of pharmaceutical decision-making
This thesis contains the findings of a study undertaken in the field of medical decision-making. The Glaserian approach to grounded theory (Glaser and Strauss, 1967; Glaser, 1978) was used in order to build a theoretical representation of this area. Four phases of data collection were used, the first to develop initial theoretical sampling points and obtaining permission to approach medical practitioners. Following this, 12 personal in-depth interviews were performed to collect the primary data. A period of secondary data collection was then performed and finally an appraisal of the draft theory. Trading Off emerged from the constant comparative method as the core category explaining how pharmaceutical decision-making (as a form of medical decisionmaking) is performed. Sub core categories that were integrated within the Trading Off process included Focusing as the initial period of analysis, Self-Referencing and Surrogating reflecting sources and use of information and the Shiftin g that occurs as physicians develop expertise. In order to develop and frame the contribution of this theory within relevant literature, an number of areas of decision-making and medical decision-making research were reviewed. Expertise and its development were also examined. The main conclusions and recommendations of this research are that physicians Trade Off levels of confidence held in behaviours and aspects of the behaviour in order to decide on a course of action. Trading Off can used to direct the efforts of pharmaceutical companies and healthcare providers in order to modify pharmaceutical decision-making and reduce the large volume of prescribing errors. These efforts should be based on an accurate analysis of the individual decision environment and involve a wide view of possible influencing factors. It is recommended that actual patient case studies supplied from clinical trials are used in these efforts and that an opinion leader should perform the delivery where possible.