Improving the quality of surgeons' treatment decisions: a comparison of clinical decision making with a computerised evidence based decision analytical model

Abstract

Objectives-The purpose of this study is to demonstrate to what extent an evidence based decision model can improve physicians' decisions and whether a selective use of the decision model is feasible. Methods-Four experienced vascular surgeons were asked to make a treatment decision for 137 "paper patient" cases with asymptomatic abdominal aneurysms. Their decisions were compared with the optimal treatment as calculated by a computerised evidence based decision analytical model. Results-Surgeons agreed with the model's advice based on life expectancy in 81% of the cases, and decided to operate in only 12% of the cases for which there was no agreement. Surgeons' decisions diVered from the decision model's calculated optimal treatment, in particular, for older patients with aneurysms of intermediate size and with many risk factors, and for younger patients with small aneurysms and few risk factors. Not all these decisions, however, were reported to be more diYcult. Conclusion-Use of a decision analytical model might lead to more appropriate decisions and a better quality of care. Selective use of the decision tool for diYcult decisions only would be more eYcient but is not yet feasible because reported decision diYculty is not strongly related to disagreement with the decision tool.

The Fate of Patients Referred to a Specialist Vascular Unit with Large Infra-renal Abdominal Aortic Aneurysms over a Two-year Period

“…With the development of more accurate risk stratification, computer-aided decision modelling may represent a useful adjunct to clinical judgement in high-risk and complex cases. 33…”

Qualitative methods in a randomised controlled trial: the role of an integrated qualitative process evaluation in providing evidence to discontinue the intervention in one arm of a trial of a decision support tool

“…Interview transcript: (94Exp:[5][6][7][8][9][10][11][12][13][14] Int'er How did you feel when you had to answer the questions, you know when the doctor was asking you to imagine how you would feel and then asked you to choose between say, for example a mild stroke or forty sixty percent of something else, how did you feel answering those questions? Dave No bother.…”

First the facts, then the values? Implicit normativity in evidence-based decision aids for shared decision-making

“…The general research hypothesis of the study was that individualized evidence-based decision support could empower patients to take part in the decision-making process together with the surgeon and thus would encourage patients to become more autonomous according to the liberal individual approach of patient autonomy according to Beauchamp and Childress [12]. For that purpose, an evidence-based decision-analytic computer model for the treatment of abdominal aneurysm patients was developed [13,14]. Decision models provide an analytic framework based on expected utility theory for representing the evidence, the outcomes, and preferences involved in a clinical decision [15].…”