I’ve taken a little break from the “Improving Your Critical Appraisal Skills” series but I’m returning with a few more. Decision analyses determine the best course of action when faced with two or more alternatives considering everything important in actual clinical decisions.
I realize the numbers used were neatly curated for purposes of demonstration. And this concept is ideal when there are no on-point studies that directly compare treatment A Vs treatment B. The “utility” variable i find most helpful, as it is a specific reflection of the values of each patient. But are those probabilities themselves evidence based? I say this because the likelihood of “well” after disc surgery might be 70% on average among all comers (I have no idea if that number is based on evidence)….but I’m not sure how you specify it for “Mrs. Smith” sitting across from you.
And as the earlier comments noted, this seems very time consuming.
Great information, but do any doctors actually DO this in practice? I had a (useless) C5 fusion years ago, and sure wish my doctor had! When I told him I still had pain afterwards, he insisted the operation was a success because I didn't have tingling in my hands, even though I never had that before the surgery. He kept insisting that I told him I had tingling before, even though I never did, and I'm pretty sure I know what I said and what I actually experienced! If smart surgeons fool themselves so easily, do you think you can get them to take the time to do a decision tree with their patients?!
Thanks for this. New concept for me.
I realize the numbers used were neatly curated for purposes of demonstration. And this concept is ideal when there are no on-point studies that directly compare treatment A Vs treatment B. The “utility” variable i find most helpful, as it is a specific reflection of the values of each patient. But are those probabilities themselves evidence based? I say this because the likelihood of “well” after disc surgery might be 70% on average among all comers (I have no idea if that number is based on evidence)….but I’m not sure how you specify it for “Mrs. Smith” sitting across from you.
And as the earlier comments noted, this seems very time consuming.
Adam — this decision process sounds ideal for AI. Do you or other docs use it? Is it helpful? Accurate?
Great information, but do any doctors actually DO this in practice? I had a (useless) C5 fusion years ago, and sure wish my doctor had! When I told him I still had pain afterwards, he insisted the operation was a success because I didn't have tingling in my hands, even though I never had that before the surgery. He kept insisting that I told him I had tingling before, even though I never did, and I'm pretty sure I know what I said and what I actually experienced! If smart surgeons fool themselves so easily, do you think you can get them to take the time to do a decision tree with their patients?!