Computer-based decision making in medicine: A model for surgery of colorectal liver metastases.
OBJECTIVE
Seeking the best available treatment for patients with colorectal liver metastases may be complex due to the interpretation of many variables. In this study conjoint analysis is used to develop a decision model to help clinicians selecting patients eligible for surgery of liver metastases.


METHODS
Patient and tumor characteristics decisive for surgery of colorectal liver metastases were selected from literature. A factorial design was used to construct virtual patient cases by balanced combinations of these characteristics. Surgeons experienced in liver surgery (n=25) were asked to give their advised treatment (resection and/or local ablation, or chemotherapy). Different tumor and patient variables were weighted in the analysis for their contribution to treatment choices.


RESULTS
Patient's age, the involvement of lobes and location of metastases in relation to large vessels were most important for treatment decisions. The number of metastases, size of the lesions, presence of resectable extrahepatic disease and time interval from primary tumor to metastases proved of less importance. Based on the analysis a computer-based decision model was designed.


CONCLUSIONS
Conjoint analysis can be a valuable tool in clinical decision making. The computer-based decision model can assist clinicians in defining which patient should be referred for liver surgery.
Langenhoff
B S
BS
Department of Surgery, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
Krabbe
P F M
PF
Ruers
T J M
TJ
D000368:Aged; D000465:Algorithms; D015179:Colorectal Neoplasms / Q000473:pathology / Q000601:surgery*; D003658:Decision Making, Computer-Assisted; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery*; D008954:Models, Biological