The structure of medical decisions: uncertainty, probability and risk in five common choice situations.
Increasingly, medical choices involve deciding whether to look for evidence of undetected, asymptomatic conditions, or increased risk of future conditions (i.e. screening). Those who screen at sufficiently high risk face decisions about interventions to prevent or postpone the onset of possible, but...
| Publicado en: | Health, Risk & Society Vol. 15; no. 1; pp. 27 - 51 |
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| Autores principales: | , , , |
| Formato: | tables/charts Journal Article |
| Publicado: |
Taylor & Francis Ltd
Feb2013
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104271805&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 104271805 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 13698575 35X jtl: Health, Risk & Society issn: 13698575 maglogo: N pubinfo: dt: Feb2013 vid: 15 iid: 1 pid: 377 pub: Taylor & Francis Ltd place: Philadelphia, Pennsylvania artinfo: ui: 104271805 86994487 10.1080/13698575.2012.746286 104271805 ppf: 27 ppct: 24 formats: fmt: @attributes: type: P tig: atl: The structure of medical decisions: uncertainty, probability and risk in five common choice situations. aug: au: Austin, Laurel C. Reventlow, Susanne Sandøe, Peter Brodersen, John affil: Department of Management,, Politics and Philosophy, Copenhagen Business School, Copenhagen, Denmark; The Research Unit and Section for General Practice, Department of Public Health,, University of Copenhagen, Denmark sug: subj: Decision Making, Clinical Methods Uncertainty Probability Risk Assessment Decision Trees Preventive Health Care Health Screening Psychological Theory Diagnostic Errors Critical Path Attitude to Illness ab: Increasingly, medical choices involve deciding whether to look for evidence of undetected, asymptomatic conditions, or increased risk of future conditions (i.e. screening). Those who screen at sufficiently high risk face decisions about interventions to prevent or postpone the onset of possible, but not certain, future symptomatic conditions. Other preventive decisions include whether or not to accept population-based intervention, such as vaccination. Using decision trees, we model the normative structures and associated uncertainties that underlie five medical decision situations, each of which involves assessing the probabilistic hypothesis that a person has, or will in the future have, a given symptomatic condition. The probability estimate that results from assessment becomes an input into predicting treatment benefit, with the probability of benefit decreasing as that of the symptomatic condition decreases. The five situations identified in this paper involve assessing: (1) a symptomatic patient; (2) an asymptomatic individual for an undetected condition; (3) an individual for risk of a future condition; (4) an individual for multiple risks simultaneously (shotgun assessment); and (5) an individual for a population-based intervention. Analysis of these situations facilitates examination of intuitive probabilistic reasoning. Drawing on evidence in related literature, we discuss some implications of decision-makers imposing the wrong structure or probabilistic reasoning when making medical choices. In particular, we discuss (1) overestimation of expected benefit due to systematic underestimation of uncertainty in a given decision; (2) overconfidence in probabilistic test results; and (3) failure to understand the implications of cumulative probabilities when ‘shot-gun’ testing. pubtype: Academic Journal doctype: tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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