HPRHealth Psychology ResearchTBA2420-8124Health Psychology Research10.4081/hpr.2014.1621GeneralRegulatory focus affects  physician risk tolerancehttps://healthpr.org/journal/HPR/2/2/10.4081/hpr.2014.1621J. VeaziePeter,McIntoshScott,P. ChapmanBenjamin,G. DolanJames2014222014-04-26Risk tolerance is a source of variation in physician decision-making. This variation, if independent of clinical concerns, can result in mistaken utilization of health services. To address such problems, it will be helpful to iden tify nonclinical factors of risk tolerance, partic ularly those amendable to intervention – regu latory focus theory suggests such a factor. This study tested whether regulatory focus affects risk tolerance among primary care physicians. Twenty-seven primary care physicians were assigned to promotion-focused or prevention focused manipulations and compared on the Risk Taking Attitudes in Medical Decision Making scale using a randomization test. Results provide evidence that physicians assigned to the promotion-focus manipulation adopted an attitude of greater risk tolerance than the physicians assigned to the prevention focused manipulation (P=0.01). The Cohen’s d statistic was conventionally large at 0.92. Results imply that situational regulatory focus in primary care physicians affects risk tolerance and may thereby be a nonclinical source of prac tice variation. Results also provide marginal evi dence that chronic regulatory focus is associat ed with risk tolerance (P=0.05), but the mecha nism remains unclear. Research and interven tion targeting physician risk tolerance may ben efit by considering situational regulatory focus as an explanatory factor. regulatory focus theory, risk toler ance, medical decision making, primary care

1. Cesario J, Higgins ET, Scholer AA. Regulatory fit and persuasion: basic principles and remaining questions. Soc Personal Psychol Compass 2008;2:444-63.2. Pines JM, Hollander JE, Isserman JA, et al. The association between physician risk tolerance and imaging use in abdominal pain. Am J Emerg Med 2009;27:552-7.3. Pines JM, Isserman JA, Szyld D, et al. The effect of physician risk tolerance and the presence of an observation unit on decision making for ED patients with chest pain. Am J Emerg Med 2010;28:771-9.4. Holtgrave DR, Lawler F, Spann SJ. Physicians’ risk attitudes, laboratory usage, and referral decisions: the case of an academic family practice center. Med Decis Making 1991;11:125-30.5. Sirovich B, Gallagher PM, Wennberg DE, Fisher ES. Discretionary decision making by primary care physicians and the cost of US health care. Health Aff (Millwood) 2008;27:813-23.6. Reyna VF, Lloyd FJ. Physician decision making and cardiac risk: effects of knowledge, risk perception, risk tolerance, and fuzzy processing. J Exp Psychol Appl 2006;12:179-95.7. Higgins ET. Beyond pleasure and pain. Am Psychol 1997;52:1280-300.8. Shah J, Higgins ET, Friedman RH. Performance incentives and means: how regulatory focus influences goal attainment. J Pers Soc Psychol 1998;74:285-93.9. Higgins ET, Friedman RS, Harlow RE, et al. Achievement orientations from subjective histories of success: promotion pride versus prevention pride. Eur J Soc Psychol 2001;31:3-23.10. Förster J, Higgins ET, Idson LC. Approach and avoidance strength during goal attainment: regulatory focus and the Goal Looms Larger effect. J Pers Soc Psychol 1998;75:1115-31.11. Grant H, Higgins ET. Optimism, promotion pride, and prevention pride as predictors of quality of life. Pers Soc Psychol Bull 2003;29:1521-32.12. Liberman N, Molden DC, Idson LC, Higgins ET. Promotion and prevention focus on alternative hypotheses: implications for attributional functions. J Pers Soc Psychol 2001;80:5-18.13. Sitkin SB, Weingart LR. Determinants of risky decision-making behavior: a test of the mediating role of risk perceptions and propensity. Acad Manage J 1995;38:1573-92.14. Noussair C, Wu P. Risk tolerance in the present and the future: an experimental study. Manag Decis Econ 2006;27:401-12.15. Driskill WE, Weissmuller JJ, Quebe J, et al. Evaluating the decision-making skills of general aviation pilots. Federal Aviation Administration, Washington D.C. 1998. DOT/FAA/AM-98/7.16. Bryant P, Dunford R. The influence of regulatory focus on risky decision-making. Appl Psychol 2008;57:335-59.17. Förster J, Higgins ET, Bianco AT. Speed/accuracy decisions in task performance: built-in trade-off or separate strategic concerns? Organ Behav Hum Decis Process 2003;90:148-64.18. Higgins ET, Roney CJR, Crowe E, Hymes C. Ideal versus ought predilections for approach and avoidance: distinct self-regulatory systems. J Pers Soc Psychol 1994;66:276-86.19. Molden DC, Higgins ET. Categorization under uncertainty: resolving vagueness and ambiguity with eager versus vigilant strategies. Soc Cogn 2004;22:248-77.20. Fellner B, Holler M, Kirchler E, Schabmann A. Regulatory focus scale (RFS): Development of a scale to record dispositional regulatory focus. Swiss J Psychol 2007;66:109-16.21. Grol R, Whitfield M, De Maeseneer J, Mokkink H. Attitudes to risk taking in medical decision making among British, Dutch, and Belgian general practitioners. Br J Gen Pract 1990;40:134-6.22. Mielke PW, Berry KJ. Permutation methods: a distance function approach. New York: Springer-Verlag; 2001.23. Ernst MD. Permutation methods: a basis for exact inference. Stat Sci 2004;19:676-85.24. Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Hillsdale: L. Erlbaum Associates; 1988. p 26.25. Pearson SD, Goldman L, Orav EJ, et al. Triage decisions for emergency department patients with chest pain: do physicians’ risk attitudes make the difference? J Gen Intern Med 1995;10:557-64.26. Cesario J, Grant H, Higgins ET. Regulatory fit and persuasion: transfer from feeling right. J Pers Soc Psychol 2004;86:388-404.27. Higgins ET, Idson LC, Freitas AL, et al. Transfer of value from fit. J Pers Soc Psychol 2003;84:1140-53.28. Ross S, Grant A, Counsell C, et al. Barriers to participation in randomised controlled trials: a systematic review. J Clin Epidemiol 1999;52:1143-56.29. Veazie PJ, Qian F. A role for regulatory focus in explaining and combating clinical inertia. J Eval Clin Pract 2011;17:1147-52.30. Qian F, Phelps CE, Ling FS, et al. Attitudes toward drug-eluting stent use and the distribution of motivation type among interventional cardiologists. J Eval Clin Pract 2012;18:528-33.