title: Intuitive weights of harm for therapeutic decision making in smear-negative pulmonary Tuberculosis: an interview study of physicians in India, Pakistan and Bangladesh.
abstract: BACKGROUND
  To estimate the amount of regret and weights of harm by omission and commission during therapeutic decisions for smear-negative pulmonary Tuberculosis.
  
  
  METHODS
  An interviewer-administered survey was done among young physicians in India, Pakistan and Bangladesh with a previously used questionnaire. The physicians were asked to estimate probabilities of morbidity and mortality related with disease and treatment and intuitive weights of omission and commission for treatment of suspected pulmonary Tuberculosis. A comparison with weights based on literature data was made.
  
  
  RESULTS
  A total of 242 physicians completed the interview. Their mean age was 28 years, 158 (65.3%) were males. Median probability (%) of mortality and morbidity of disease was estimated at 65% (inter quartile range [IQR] 50-75) and 20% (IQR 8-30) respectively. Median probability of morbidity and mortality in case of occurrence of side effects was 15% (IQR 10-30) and 8% (IQR 5-20) respectively. Probability of absolute treatment mortality was 0.7% which was nearly eight times higher than 0.09% reported in the literature data. The omission vs. commission harm ratios based on intuitive weights, weights calculated with literature data, weights calculated with intuitive estimates of determinants adjusted without and with regret were 3.0 (1.4-5.0), 16 (11-26), 33 (11-98) and 48 (11-132) respectively. Thresholds based on pure regret and hybrid model (clinicians' intuitive estimates and regret) were 25 (16.7-41.7), and 2(0.75-7.5) respectively but utility-based thresholds for clinicians' estimates and literature data were 2.9 (1-8.3) and 5.9 (3.7-7.7) respectively.
  
  
  CONCLUSIONS
  Intuitive weight of harm related to false-negatives was estimated higher than that to false-positives. The mortality related to treatment was eightfold overestimated. Adjusting expected utility thresholds for subjective regret had little effect.
authors.affiliation: Department of Population Medicine, Faculty of Medicine and Health Sciences, University Tunku Abdul Rahman, Sungai Long Campus, Bandar Sungai Long, Kajang 43000, Cheras, Selangor, Malaysia. chandrashekharats@yahoo.com.
authors.forename: Chandrashekhar T
authors.initials: CT
authors.lastname: Sreeramareddy
authors.forename: Mahbubur
authors.initials: M
authors.lastname: Rahman
authors.forename: H N
authors.initials: HN
authors.lastname: Harsha Kumar
authors.forename: Mohsin
authors.initials: M
authors.lastname: Shah
authors.forename: Ahmed Manadir
authors.initials: AM
authors.lastname: Hossain
authors.forename: Md Abu
authors.initials: MA
authors.lastname: Sayem
authors.forename: Juan M
authors.initials: JM
authors.lastname: Moreira
authors.forename: Jef
authors.initials: J
authors.lastname: Van den Ende
mesh_terms: D000328:Adult; D001459:Bangladesh; D003657:Decision Making; D003951:Diagnostic Errors / Q000401:mortality / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007194:India; D008297:Male; D019300:Medical Errors / Q000401:mortality / Q000706:statistics & numerical data*; D010154:Pakistan; D011336:Probability; D014397:Tuberculosis, Pulmonary / Q000628:therapy*
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