@article{01H7JPD3EFXC805GJQ159G5FVE,
  abstract     = {{Introduction: A prescribing cascade occurs when a drug is prescribed to manage the often unrecognized side effect of another drug; these cascades are of particular concern for older adults who are at heightened risk for drug-related harm. It is unknown whether, and to what extent, gender bias influences physician decision-making in the context of prescribing cascades. The aim of this transnational study is to explore the potential impact of physician implicit gender biases on prescribing decisions that may lead to the initiation of prescribing cascades in older men and women in two countries: Canada and Italy.
Methods and Analysis: Male and female primary care physicians at each site will be randomized 1:1 to a case vignette that features either a male or female older patient who presents with concerns consistent with the side effect of a medication they are taking. During individual interviews, while masked to the true purpose of the study, participants will read the vignette and use the think-aloud method to describe their ongoing thought processes as they consider the patient’s concerns and determine a course of action. Interviews will be recorded, transcribed verbatim and thematic analysis will be conducted to highlight differences in decisions in the interviews/transcripts, using a common analytical
framework across the sites.
Ethics and Dissemination: This study has received ethics approval at each study site. Verbal informed consent will be received from participants prior to data collection and all data will be deidentified and stored on password-protected servers. Results of this study will be disseminated through peer-reviewed journal articles and presented at relevant national and international conferences.

STRENGTHS & LIMITATIONS:
-	This will be the first study to explore the influence of physician gender bias on the risk of initiating prescribing cascades among older men and women.
-	The rigorous and iterative process of the vignette development, including choosing the prescribing cascade among the international study team, will help to ensure its clinical accuracy, relevance, and suitability for examining gender bias.
-	The transnational design of the study, including primary care physicians from two different countries, will improve the transferability and generalizability of findings.
-	This study only reflects the decision-making of primary care physicians (i.e., not physicians in other settings or non-medical prescribers).
-	Evaluation of hypothetical behaviour of physicians cannot definitively determine whether actual behaviour would be consistent with real-life clinical scenarios.}},
  articleno    = {{e070405}},
  author       = {{Borhani, Parya and Rochon, Paula and Carrieri, Barbara and Dalton, Kieran and Lawson, Andrea and Li, Joyce and Mason, Robin and McCarthy, Lisa and Paoletti, Luca and Santini, Sara and Sivayoganathan, Kawsika and Sternberg, Shelley and Zwas, Donna and Savage, Rachel and Gurwitz J, Jerry and Cherubini, Antonio and Onder, Graziano and Pegreffi, Francesco and Petrovic, Mirko and O'Mahony, Denis and iKASCADE Team, [missing]}},
  issn         = {{2044-6055}},
  journal      = {{BMJ OPEN}},
  keywords     = {{physician gender bias,initiation of prescribing cascades,older men and women,qualitative clinical vignette study protocol}},
  language     = {{eng}},
  number       = {{7}},
  pages        = {{7}},
  title        = {{Exploring physician gender bias in the initiation of prescribing cascades for older men and women : a qualitative clinical vignette study protocol}},
  url          = {{http://doi.org/10.1136/bmjopen-2022-070405}},
  volume       = {{13}},
  year         = {{2023}},
}

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