The effect of decision analysis on clinical uncertainty at tumor board.
Decision analysis is a formal approach to clinical decision making in the setting of uncertainty. Computer assisted clinical decision analysis was used at tumor board to help examine difficult oncological cases. Patients were identified early in the week and the decisions, possible outcomes, and uncertainties of each decision were modeled. These models were then presented at tumor board where the calculated expected utilities of each decision could be discussed. A description of decision analysis and three representative cases are presented here. These exercises were valuable for at least two reasons. First, modeling the problems confronting practicing oncologists was instructive as such. Second, the mathematical treatment of the probabilities and the utilities of the various outcomes for each decision stimulated a lively debate among the board members, forcing them to quantify probabilities and outcomes that they had previously ascertained qualitatively.
Kelsey
J V
JV
Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Hanover, New Hampshire.
Beck
J R
JR
D001499:Bayes Theorem; D001706:Biopsy / Q000706:statistics & numerical data; D001932:Brain Neoplasms / Q000175:diagnosis / Q000628:therapy; D018288:Carcinoma, Small Cell / Q000175:diagnosis / Q000628:therapy; D003661:Decision Support Techniques; D003663:Decision Trees; D003937:Diagnosis, Differential; D005260:Female; D005909:Glioblastoma / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis / Q000628:therapy; D008223:Lymphoma / Q000175:diagnosis / Q000628:therapy; D008297:Male; D008495:Medical Oncology / Q000706:statistics & numerical data*; D008875:Middle Aged; D010347:Patient Care Planning / Q000706:statistics & numerical data*; D010348:Patient Care Team; D011336:Probability; D011340:Problem Solving