title: Plastic Surgeon Expertise in Predicting Breast Reconstruction Outcomes for Patient Decision Analysis.
abstract: BACKGROUND
  Decision analysis offers a framework that may help breast cancer patients make good breast reconstruction decisions. A requirement for this type of analysis is information about the possibility of outcomes occurring in the form of probabilities. The purpose of this study was to determine if plastic surgeons are good sources of probability information, both individually and as a group, when data are limited.
  
  
  METHODS
  Seven plastic surgeons were provided with pertinent medical information and preoperative photographs of patients, and were asked to assign probabilities to predict number of revisions, complications, and final aesthetic outcome using a questionnaire designed for the study. Logarithmic strictly proper scoring was used to evaluate the surgeons' abilities to predict breast reconstruction outcomes. Surgeons' responses were analyzed for calibration and confidence in their answers.
  
  
  RESULTS
  As individuals, there was variation in surgeons' ability to predict outcomes. For each prediction category, a different surgeon was more accurate. As a group, surgeons possessed knowledge of future events despite not being well calibrated in their probability assessments. Prediction accuracy for the group was up to six-fold greater than that of the best individual.
  
  
  CONCLUSIONS
  The use of individual plastic surgeon-elicited probability information is not encouraged unless the individual's prediction skill has been evaluated. In the absence of this information, a group consensus on the probability of outcomes is preferred. Without a large evidence base for calculating probabilities, estimates assessed from a group of plastic surgeons may be acceptable for purposes of breast reconstruction decision analysis.
authors.affiliation: Department of Biomedical Engineering, The University of Texas at Austin, Austin, TX ; Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Clement S
authors.initials: CS
authors.lastname: Sun
authors.affiliation: Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Gregory P
authors.initials: GP
authors.lastname: Reece
authors.affiliation: Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Crosby
authors.affiliation: Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX ; Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Michelle C
authors.initials: MC
authors.lastname: Fingeret
authors.affiliation: Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Roman J
authors.initials: RJ
authors.lastname: Skoracki
authors.affiliation: Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Mark T
authors.initials: MT
authors.lastname: Villa
authors.affiliation: Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Hanasono
authors.affiliation: Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Donald P
authors.initials: DP
authors.lastname: Baumann
authors.affiliation: Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: David W
authors.initials: DW
authors.lastname: Chang
authors.affiliation: Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Scott B
authors.initials: SB
authors.lastname: Cantor
authors.affiliation: Department of Biomedical Engineering, The University of Texas at Austin, Austin, TX ; Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Mia K
authors.initials: MK
authors.lastname: Markey