Mapping clinical outcomes expectations to treatment decisions: an application to vestibular schwannoma management.
OBJECTIVE
Complex medical decision making obligates tradeoff assessments among treatment outcomes expectations, but an accessible tool to perform the necessary analysis is conspicuously absent. We aimed to demonstrate methodology and feasibility of adapting conjoint analysis for mapping clinical outcomes expectations to treatment decisions in vestibular schwannoma (VS) management.


METHODS
Prospective.


METHODS
Tertiary medical center and US-based otologists/neurotologists.


METHODS
Treatment preference profiles among VS stakeholders-61 younger and 74 older prospective patients, 61 observation patients, and 60 surgeons-were assessed for the synthetic VS case scenario of a 10-mm tumor in association with useful hearing and normal facial function.


METHODS
Treatment attribute utility.


METHODS
Conjoint analysis attribute levels were set in accordance to the results of a meta-analysis. Forty-five case series were disaggregated to formulate microsurgery facial nerve and hearing preservation outcomes expectations models. Attribute utilities were computed and mapped to the realistic treatment choices of translabyrinthine craniotomy, middle fossa craniotomy, and gamma knife radiosurgery.


RESULTS
Among the treatment attributes of likelihoods of causing deafness, temporary facial weakness for 2 months, and incurable cancer within 20 years, and recovery time, permanent deafness was less important to tumor surgeons, and temporary facial weakness was more important to tumor surgeons and observation patients (Wilcoxon rank-sum, p < 0.001). Inverse mapping of preference profiles to realistic treatment choices showed all study cohorts were inclined to choose gamma knife radiosurgery.


CONCLUSIONS
Mapping clinical outcomes expectations to treatment decisions for a synthetic clinical scenario revealed inhomogeneous drivers of choice selection among study cohorts. Medical decision engines that analyze personal preferences of outcomes expectations for VS and many other diseases may be developed to promote shared decision making among health care stakeholders and transparency in the informed consent process.
Cheung
Steven W
SW
Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California 94115, USA. scheung@ohns.ucsf.edu
Aranda
Derick
D
Driscoll
Colin L W
CL
Parsa
Andrew T
AT
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D019090:Case Management; D002755:Choice Behavior; D015331:Cohort Studies; D003638:Deafness / Q000453:epidemiology; D003657:Decision Making; D005154:Facial Nerve / Q000502:physiology; D020220:Facial Nerve Injuries / Q000453:epidemiology; D005260:Female; D006309:Hearing / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009464:Neuroma, Acoustic / Q000601:surgery*; D013506:Otologic Surgical Procedures; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome; D055815:Young Adult