Bruce:
I also don't make decisions in either my everyday or professional
life by creating a decision tree, calculating probabilities for each
branch and then assigning utilities to each outcome either on a
0-100
scale or by standard gamble (I've never tried administering them but
when I try to do them myself, I have enormous difficulty getting my
head round them). Changing the way I make or negotiate clinical
decisions would require considerable effort and there is likely to
be
an associated time cost.
Before doing this, I would want some kind of empirical evidence
that DA is better than me trying to tell the patient the gist of the
probabilities and trying to guage what their values are by 'normal'
consultation methods (talk, leaflets, time to think, agreeing to
defer the subject for six months, agreeing that they try
alternatives
first etc). This comes back to my original question as to how you
might judge which decision making method is 'better'. It sounds
like
either there isn't a simple answer to this, or that there isn't
research evidence directly addressing the issue.
I would again agree with you that it is not clear how to define
"gold standard" of decision-making. I would also reiterate that is
interesting to note that people may accept normative basis of EBM but not
that of decision analysis.
ben
Benjamin Djulbegovic, MD
Associate Professor of Medicine
H. Lee Moffitt Cancer Center & Research Institute
at the University of South Florida
Division of Blood and Bone Marrow Transplant
12902 Magnolia Drive
Tampa, FL 33612
Editor: Evidence-based Oncology
e-mail:[log in to unmask]
http://www.hsc.usf.edu/~bdjulbeg/
phone:(813)979-7202
fax:(813)979-3071
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