@article{01JDSFZHAYSFE9X22TP3BSP06W,
  abstract     = {{Background: Despite growing awareness of sex differences in inappropriate prescribing among older adults, including the initiation of prescribing cascades, the impact of gender bias remains largely unexplored.
Objectives: We explored how a patient's sex and gender-related sociocultural factors influence physicians' prescribing decisions, potentially leading to prescribing cascades in older adults. A secondary objective was to explore if and how physician sex affected prescribing decisions for female and male patients.
Methods: Physicians in Canada and Italy were presented with a clinical vignette describing either an older male or female patient on amlodipine presenting with peripheral edema. Physicians were interviewed using the ‘think-aloud’ method to describe their thought processes. Thematic multi-site analysis was used to analyze the data. 
Results: Out of thirty physicians, only two considered prescribing a diuretic for an older female patient. Most physicians identified amlodipine as the cause of the edema and adjusted or substituted the medication, often making these treatment decisions without considering sex- and gender-related sociocultural factors. When prompted, physicians acknowledged the relevance of these factors, but their responses varied. Some adapted their treatment plans, noting the challenges of managing edema, particularly for female patients, while others did not incorporate these considerations. Interestingly, some physicians adjusted their plans based on gender-related factors, yet still stated that gender did not influence their treatment decisions. No variations in treatment decisions were observed based on physician sex.
Conclusion: The study reveals a gap between physicians' recognition of gender-related sociocultural factors and their consistent integration into clinical decision-making, highlighting the need for more nuanced approaches in prescribing practices.}},
  author       = {{Kthupi, Altea and Rochon, Paula A. and Santini, Sara and Paoletti, Luca and Mason, Robin and McCarthy, Lisa M. and Carrieri, Barbara and Dalton, Kieran and Li, Joyce and Sivayoganathan, Kawsika and Borhani, Parya and Sternberg, Shelley A. and Zwas, Donna R. and Savage, Rachel D. and Gurwitz, Jerry and Cherubini, Antonio and Onder, Graziano and Pegreffi, Francesco and Petrovic, Mirko and O’Mahony, Denis and the iKASCADE Team, [missing]}},
  issn         = {{1170-229X}},
  journal      = {{DRUGS & AGING}},
  keywords     = {{sex,gender,sociocultural factors,older adults,prescribing cascade vignette,clinical decision-making,EDEMA,PRESCRIPTIONS,DIURETICS,HEALTH,RISK}},
  language     = {{eng}},
  number       = {{12}},
  pages        = {{977--988}},
  title        = {{Exploring sex, gender, and gender-related sociocultural factors in clinical decision-making for older adults using a prescribing cascade vignette : a transnational qualitative study}},
  url          = {{http://doi.org/10.1007/s40266-024-01158-1}},
  volume       = {{41}},
  year         = {{2024}},
}

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