Medical decision making : an international journal of the Society for Medical Decision Making
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Randomized Controlled Trial Clinical Trial
Preference for equity as a framing effect.
In previous studies, the authors found that most people, given a fixed budget, would rather offer a less effective screening test to 100% of a Medicaid population than a more effective test to 50% of the population. In a subsequent study, the authors found that the number of people preferring the less effective screening test was dramatically reduced when the percentage of Medicaid enrollees receiving it was less than 100. In this article, 2 new studies are reported that explore whether people's preferences for equity versus efficiency are susceptible to a framing effect. ⋯ Policy planners should be careful about accepting public preferences for equity over efficiency at face value, because such preferences can be dramatically influenced by framing effects and order effects.
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Comparative Study Clinical Trial
Patient preference-based treatment thresholds and recommendations: a comparison of decision-analytic modeling with the probability-tradeoff technique.
Decision analysis (DA) and the probability-tradeoff technique (PTOT) are patient preference-based methods of determining optimal therapy for individuals. Using aspirin therapy for the primary prevention of stroke and myocardial infarction (MI) in elderly persons as an example, the objective of this study was to determine whether group-level treatment thresholds and individual-level treatment recommendations derived using PTOT are identical to those of DA incorporating the patients' own values. ⋯ Patient preference-based group-level treatment thresholds and individual-level treatment recommendations can differ significantly depending on whether PTOT or DA is used, apparently because the two emphasize different aspects of the decision-making process. DA theory assumes that effective therapeutic decision making should maximize both quality and quantity of life; with PTOT, the emphasis for effective clinical decision making allows patients to be fully engaged in the process, thus hopefully leading to fully informed decisions that may result in satisfaction and compliance.
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Comparative Study
Early surgery versus conservative management of dissecting aneurysms of the descending thoracic aorta.
Optimal management for patients who present acutely with uncomplicated type III dissections of the descending thoracic aorta remains controversial. Patients with dissecting aneurysms represent a subgroup at high risk of rupture who may benefit from early elective surgery as an alternative to standard medical therapy. METHODS. The authors constructed a Markov decision model to compare the following clinical strategies: 1) early elective surgery immediately after diagnosis (EARLY SURGERY), 2) medical therapy with periodic computed tomography and with elective surgery when aortic diameter is projected to reach 6 cm (CT FOLLOW-UP), and 3) medical therapy with urgent surgery for dissection-related complications (WATCHFUL WAITING). Data sources included Medline (1966-1995) and a case series of patients with type III dissecting aneurysms who received medical therapy with radiographic follow-up. ⋯ The choice between early surgery and medical therapy for uncomplicated dissecting aneurysm of the descending thoracic aorta should be tailored to the individual patient's operative risk, risk of dissection-related events, and age. Early surgery may be a reasonable alternative to medical therapy for carefully selected patients at centers with favorable perioperative mortality rates.
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Comparative Study
Determining the area under the ROC curve for a binary diagnostic test.
The authors provide a simple calculation for the unbiased estimation of the area under the ROC curve for a binary diagnostic test or a continuously valued test result that is effectively used in a binary way. The formula described can be used to interpret the discriminative ability of a diagnostic test.