Prospective decision analysis modeling indicates that clinical decisions in vascular surgery often fail to maximize patient expected utility

The Journal of Surgical Research
Thomas E BrothersPaul Nietert

Abstract

Applied prospectively to patients with peripheral arterial disease, individualized decision analysis has the potential to improve the surgeon's ability to optimize patient outcome. A prospective, randomized trial comparing Markov surgical decision analysis to standard decision-making was performed in 206 patients with symptomatic lower extremity arterial disease. Utility assessment and quality of life were determined from individual patients prior to treatment. Vascular surgeons provided estimates of probability of treatment outcome, intended and actual treatment plans, and assessment of comfort with the decision (PDPI). Treatment plans and PDPI evaluations were repeated after each surgeon was made aware of model predictions for half of the patients in a randomized manner. Optimal treatments predicted by decision analysis differed significantly from the surgeon's initial plan and consisted of bypass for 30 versus 29%, respectively, angioplasty for 28 versus 11%, amputation for 31 versus 6%, and medical management for 34 versus 54% (agreement 50%, kappa 0.28). Surgeon awareness of the decision model results did not alter the verbalized final plan, but did trend toward less frequent use of bypass. Patients for whom the model agre...Continue Reading

References

Jan 1, 1989·Journal of Clinical Epidemiology·D G Froberg, R L Kane
Jan 1, 1982·Medical Decision Making : an International Journal of the Society for Medical Decision Making·H Llewellyn-ThomasN F Boyd
Apr 1, 1995·European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery·M M ThompsonP R Bell
May 1, 1995·European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery·J P Pell
Aug 1, 1995·European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery·W P Paaske, J Laustsen
Jan 1, 1995·Annals of Vascular Surgery·J G RobisonB M Elliott
Mar 1, 1995·Annals of Vascular Surgery·T E BrothersC Arens
Jan 1, 1995·Journal of Vascular Surgery·G W GibbonsF W LoGerfo
Mar 2, 1995·The New England Journal of Medicine·J M GuralnikR B Wallace
Aug 1, 1994·American Journal of Surgery·M M DugganJ O Menzoian
Jan 1, 1996·European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery·H S KhairaC P Shearman
Feb 1, 1997·Journal of Vascular Surgery·A M Abou-ZamzamJ M Porter
Jan 1, 1997·The Journal of Surgical Research·T E BrothersR J Friedman
Aug 1, 1997·Cardiovascular Surgery : Official Journal of the International Society for Cardiovascular Surgery·I C ChetterR C Kester
Dec 31, 1997·Journal of General Internal Medicine·C M MangioneT H Lee
Feb 10, 1998·Medical Decision Making : an International Journal of the Society for Medical Decision Making·L A LenertA Garber
Feb 12, 1998·JAMA : the Journal of the American Medical Association·J TsevatR S Phillips
May 5, 1998·Medical Decision Making : an International Journal of the Society for Medical Decision Making·H S Gravelle
Jan 23, 1999·Medical Decision Making : an International Journal of the Society for Medical Decision Making·J G Dolan
Mar 12, 1999·Cardiovascular Surgery : Official Journal of the International Society for Cardiovascular Surgery·T E BrothersB M Elliot
May 19, 2001·Journal of Health Services Research & Policy·A RobinsonM Eccles

❮ Previous
Next ❯

Citations

Mar 6, 2008·Surgical Endoscopy·Sudip K SarkerCharles Vincent
Nov 13, 2007·The Journal of Hand Surgery, European Volume·C A Brauer, B Graham
Sep 30, 2010·Clinical Journal of the American Society of Nephrology : CJASN·Hui XueSteven M Brunelli
Jun 12, 2014·Netherlands Heart Journal : Monthly Journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation·N M KortelandJ J M Takkenberg
Jun 17, 2010·Health Expectations : an International Journal of Public Participation in Health Care and Health Policy·Arwen H PieterseCorrie A M Marijnen
Sep 4, 2007·Journal of Vascular Surgery·Thomas E BrothersBruce M Elliott
Jul 21, 2006·Medical Decision Making : an International Journal of the Society for Medical Decision Making·France LégaréStéphane Tremblay
Jul 5, 2019·Annals of Oncology : Official Journal of the European Society for Medical Oncology·R J Simes, A J Martin
Aug 10, 2012·Diseases of the Colon and Rectum·Adena S ScheerRobin P Boushey

❮ Previous
Next ❯

Related Concepts

Trending Feeds

COVID-19

Coronaviruses encompass a large family of viruses that cause the common cold as well as more serious diseases, such as the ongoing outbreak of coronavirus disease 2019 (COVID-19; formally known as 2019-nCoV). Coronaviruses can spread from animals to humans; symptoms include fever, cough, shortness of breath, and breathing difficulties; in more severe cases, infection can lead to death. This feed covers recent research on COVID-19.

Blastomycosis

Blastomycosis fungal infections spread through inhaling Blastomyces dermatitidis spores. Discover the latest research on blastomycosis fungal infections here.

Nuclear Pore Complex in ALS/FTD

Alterations in nucleocytoplasmic transport, controlled by the nuclear pore complex, may be involved in the pathomechanism underlying multiple neurodegenerative diseases including Amyotrophic Lateral Sclerosis and Frontotemporal Dementia. Here is the latest research on the nuclear pore complex in ALS and FTD.

Applications of Molecular Barcoding

The concept of molecular barcoding is that each original DNA or RNA molecule is attached to a unique sequence barcode. Sequence reads having different barcodes represent different original molecules, while sequence reads having the same barcode are results of PCR duplication from one original molecule. Discover the latest research on molecular barcoding here.

Chronic Fatigue Syndrome

Chronic fatigue syndrome is a disease characterized by unexplained disabling fatigue; the pathology of which is incompletely understood. Discover the latest research on chronic fatigue syndrome here.

Evolution of Pluripotency

Pluripotency refers to the ability of a cell to develop into three primary germ cell layers of the embryo. This feed focuses on the mechanisms that underlie the evolution of pluripotency. Here is the latest research.

Position Effect Variegation

Position Effect Variagation occurs when a gene is inactivated due to its positioning near heterochromatic regions within a chromosome. Discover the latest research on Position Effect Variagation here.

STING Receptor Agonists

Stimulator of IFN genes (STING) are a group of transmembrane proteins that are involved in the induction of type I interferon that is important in the innate immune response. The stimulation of STING has been an active area of research in the treatment of cancer and infectious diseases. Here is the latest research on STING receptor agonists.

Microbicide

Microbicides are products that can be applied to vaginal or rectal mucosal surfaces with the goal of preventing, or at least significantly reducing, the transmission of sexually transmitted infections. Here is the latest research on microbicides.

© 2022 Meta ULC. All rights reserved