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Theory and Decision

Erschienen in:

01.04.2014

Helping patients and physicians reach individualized medical decisions: theory and application to prenatal diagnostic testing

verfasst von: Edi Karni, Moshe Leshno, Sivan Rapaport

Erschienen in: Theory and Decision | Ausgabe 4/2014

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Abstract

This paper presents a procedure designed to aid physicians and patients in the process of making medical decisions, and illustrates its implementation to aid pregnant women, who decided to undergo prenatal diagnostic test choose a physician to administer it. The procedure is based on a medical decision-making model of Karni (J Risk Uncertain 39: 1–16, 2009). This model accommodates the possibility that the decision maker’s risk attitudes may vary with her state of health and incorporates other costs, such as pain and inconvenience, associated with alternative treatments. The medical decision problem was chosen for its relative simplicity and the transparency it affords.

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For a more detailed description of the shared decision-making model in medical context, see Charles et al. (1997; 1999a; b) and Lewis et al. (2005).

See “Discussion” in Kremer et al. (2007); Hudak et al. (2008) and Holmes-Rovner et al. (2007).

See account of this in Savage (1954), Sect. 5.6.

For details regarding this point and information concerning the procedures described below, see the Genetics and Public Policy Center on the web site www.dnapolicy.org.

The fact that in general the utility cost associated with a procedure has additive and multiplicative factors is a consequence of the axiomatic structure of the underlying preference relation. It is quit possible that in application it will turn out that the estimated value of $\lambda $ is one.

Outcomes represent states of health, and the utility functions in this model are state-dependent functions of the patient’s wealth.

The expo-power family of utility function was first proposed by Saha (1993). The one parameter variation invoked in this study was used in Abdellaoui et al. (2007). The two parameter variation

$$\begin{aligned} u\left( x\right) =\frac{1-\exp \left( -\alpha x^{1-r}\right) }{\alpha }, \end{aligned}$$

where $x$ denotes the decision maker’s wealth; $\alpha >0$ and $1\ge r\ge 0 $, was used by Holt and Laury (2002).

Note that $-\frac{u^{\prime \prime }\left( x,\omega \right) }{u^{\prime }\left( x,\omega \right) }=x^{-\left( 1-r\left( \omega \right) \right) }+\left( 1-r\left( \omega \right) \right) x^{-1}$.

Outcomes in these instance refer to medical conditions following the test and are not the test results.

The term expert pertains to a physician that performs larger than average number of procedures per unit of time and, as result, has higher success rate than average physician.

See Wijnberger et al. (2000).

These data are most familiar to the participants in our study since they appear on the agreement document that each woman in Israel must sign before undergoing CVS or amniocentesis.

Partial responses were checked. No specific question was found in which the respondents quit the online questionnaires.

Rarely abortions may have long-term consequences such as loss of ability to bear children. We did not consider this possibility as an element of our set of outcomes.

Note that, this characterization of risk attitude is consistent with plausible behavior. A fact that lands credence to our measurement method.

Abdellaoui, M., Carolina, B., & Wakker, P. P. (2007). Reconciling introspective utility with revealed preference: Experimental arguments based on prospect theory. Journal of Econometrics, 138, 356–378.CrossRef

Charles, C., Gafni, A., & Whelan, T. (1997). Shared decision-making in medical encounter: What does it mean? (or it takes at least two to tango). Social Science and Medicine, 44, 681–692.CrossRef

Charles, C., Gafni, A., & Whelan, T. (1999a). Waht do we mean by partnership in making decisions about treatment? British Medical Journal, 319, 780.CrossRef

Charles, C., Gafni, A., & Whelan, T. (1999b). Decision-making in physicain–patient encounter: Revisiting the shared treatment decision-making model. Social Science and Medicine, 49, 651–661.CrossRef

Holmes-Rovner, M., Nelson, W., Pignone, M., et al. (2007). Are patient decision aids the best way to improve clinical decision making? Report of the IPDAS symposium. Medical Decision Making, 27, 599.CrossRef

Holt, Charles A., & Laury, K. Susan. (2002). Risk aversion and incentive effects. American Economic Review, 92, 1644–1655.CrossRef

Hudak, P. L., Frankel, R. M., Braddock, C, Iii, et al. (2008). Do patients’ communication behaviors provide insight into their preferences for participation in decision making? Medical Decision Making, 28, 385.

Karni, Edi. (2009). A theory of medical decision making under uncertainty. Journal of Risk and Uncertainty, 39, 1–16.CrossRef

Kremer, H., Ironson, G., Schneiderman, N., & Hautzinger, M. (2007). “It’s My Body” : Does patient involvement in decision making reduce decisional conflict? Medical Decision Making, 27, 522.CrossRef

Lewis, D. A., Eysenbach, G., Kukla, R., Stavri, P. Z., & Jimison, H. (Eds.). (2005). Consumer health informatics: Informing consumers and improving health care. Springer.

Saha, Atanu. (1993). Expo-power utility: A flexible form for absolute and relative risk aversion. American Journal of Agricultural Economics, 75, 905–913.CrossRef

Savage, Leonard J. (1954). The foundations of statistics. New York: Wiley.

Wijnberger, L. D. E., van der Schouw, Y. T., & Christiaens, G. (2000). Learning in medicine: Chorionic villus sampling. Prenatal Diagnosis, 20, 6–241.CrossRef

Titel: Helping patients and physicians reach individualized medical decisions: theory and application to prenatal diagnostic testing
verfasst von: Edi Karni
Moshe Leshno
Sivan Rapaport
Publikationsdatum: 01.04.2014
Verlag: Springer US
Erschienen in: Theory and Decision / Ausgabe 4/2014
Print ISSN: 0040-5833
Elektronische ISSN: 1573-7187
DOI: https://doi.org/10.1007/s11238-013-9379-y

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