Limits...
Intuitive weights of harm for therapeutic decision making in smear-negative pulmonary Tuberculosis: an interview study of physicians in India, Pakistan and Bangladesh.

Sreeramareddy CT, Rahman M, Harsha Kumar HN, Shah M, Hossain AM, Sayem MA, Moreira JM, Van den Ende J - BMC Med Inform Decis Mak (2014)

Bottom Line: Median probability of morbidity and mortality in case of occurrence of side effects was 15% (IQR 10-30) and 8% (IQR 5-20) respectively.The mortality related to treatment was eightfold overestimated.Adjusting expected utility thresholds for subjective regret had little effect.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Population Medicine, Faculty of Medicine and Health Sciences, University Tunku Abdul Rahman, Sungai Long Campus, Bandar Sungai Long, Kajang 43000, Cheras, Selangor, Malaysia. chandrashekharats@yahoo.com.

ABSTRACT

Background: To estimate the amount of regret and weights of harm by omission and commission during therapeutic decisions for smear-negative pulmonary Tuberculosis.

Methods: An interviewer-administered survey was done among young physicians in India, Pakistan and Bangladesh with a previously used questionnaire. The physicians were asked to estimate probabilities of morbidity and mortality related with disease and treatment and intuitive weights of omission and commission for treatment of suspected pulmonary Tuberculosis. A comparison with weights based on literature data was made.

Results: A total of 242 physicians completed the interview. Their mean age was 28 years, 158 (65.3%) were males. Median probability (%) of mortality and morbidity of disease was estimated at 65% (inter quartile range [IQR] 50-75) and 20% (IQR 8-30) respectively. Median probability of morbidity and mortality in case of occurrence of side effects was 15% (IQR 10-30) and 8% (IQR 5-20) respectively. Probability of absolute treatment mortality was 0.7% which was nearly eight times higher than 0.09% reported in the literature data. The omission vs. commission harm ratios based on intuitive weights, weights calculated with literature data, weights calculated with intuitive estimates of determinants adjusted without and with regret were 3.0 (1.4-5.0), 16 (11-26), 33 (11-98) and 48 (11-132) respectively. Thresholds based on pure regret and hybrid model (clinicians' intuitive estimates and regret) were 25 (16.7-41.7), and 2(0.75-7.5) respectively but utility-based thresholds for clinicians' estimates and literature data were 2.9 (1-8.3) and 5.9 (3.7-7.7) respectively.

Conclusion: Intuitive weight of harm related to false-negatives was estimated higher than that to false-positives. The mortality related to treatment was eightfold overestimated. Adjusting expected utility thresholds for subjective regret had little effect.

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Related in: MedlinePlus

Thresholds (median and quartiles) for treatment of smear-negative PTB calculated by four different approaches. Regret-based holistic: threshold calculation on the basis of regret estimations of omission and commission on a Likert scale (pure regret based). Utility-based clinicians’ estimates: threshold based on clinicians’ intuitive estimates for disease and treatment morbidity and mortality without clinicians’ regret. Utility-based literature: threshold based on literature data for disease and treatment morbidity and mortality without clinicians’ regret. Hybrid model: threshold based on clinicians’ intuitive estimates for disease and treatment morbidity and mortality combined with clinicians’ regret for death by omission or commission.
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Figure 1: Thresholds (median and quartiles) for treatment of smear-negative PTB calculated by four different approaches. Regret-based holistic: threshold calculation on the basis of regret estimations of omission and commission on a Likert scale (pure regret based). Utility-based clinicians’ estimates: threshold based on clinicians’ intuitive estimates for disease and treatment morbidity and mortality without clinicians’ regret. Utility-based literature: threshold based on literature data for disease and treatment morbidity and mortality without clinicians’ regret. Hybrid model: threshold based on clinicians’ intuitive estimates for disease and treatment morbidity and mortality combined with clinicians’ regret for death by omission or commission.

Mentions: The omission vs. commission harm ratio based on intuitive weights given on a 10-point Likert scale was 3.0 (1.4-5.0), corresponding to a threshold of 25%. This ratio based on expected utility theory with weights calculated with literature data was 16 (11-26), with a threshold of 5.9. The same with estimations by the clinicians instead of literature data gave a ratio of 33 (11-98) and a threshold of 2.9%. The hybrid approach, where regret for an unjustified death was applied to mortality estimations by the clinicians gave a ratio of 48 (11-132), with a threshold of 2 (Table 7 and Figure 1).


Intuitive weights of harm for therapeutic decision making in smear-negative pulmonary Tuberculosis: an interview study of physicians in India, Pakistan and Bangladesh.

Sreeramareddy CT, Rahman M, Harsha Kumar HN, Shah M, Hossain AM, Sayem MA, Moreira JM, Van den Ende J - BMC Med Inform Decis Mak (2014)

Thresholds (median and quartiles) for treatment of smear-negative PTB calculated by four different approaches. Regret-based holistic: threshold calculation on the basis of regret estimations of omission and commission on a Likert scale (pure regret based). Utility-based clinicians’ estimates: threshold based on clinicians’ intuitive estimates for disease and treatment morbidity and mortality without clinicians’ regret. Utility-based literature: threshold based on literature data for disease and treatment morbidity and mortality without clinicians’ regret. Hybrid model: threshold based on clinicians’ intuitive estimates for disease and treatment morbidity and mortality combined with clinicians’ regret for death by omission or commission.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4127046&req=5

Figure 1: Thresholds (median and quartiles) for treatment of smear-negative PTB calculated by four different approaches. Regret-based holistic: threshold calculation on the basis of regret estimations of omission and commission on a Likert scale (pure regret based). Utility-based clinicians’ estimates: threshold based on clinicians’ intuitive estimates for disease and treatment morbidity and mortality without clinicians’ regret. Utility-based literature: threshold based on literature data for disease and treatment morbidity and mortality without clinicians’ regret. Hybrid model: threshold based on clinicians’ intuitive estimates for disease and treatment morbidity and mortality combined with clinicians’ regret for death by omission or commission.
Mentions: The omission vs. commission harm ratio based on intuitive weights given on a 10-point Likert scale was 3.0 (1.4-5.0), corresponding to a threshold of 25%. This ratio based on expected utility theory with weights calculated with literature data was 16 (11-26), with a threshold of 5.9. The same with estimations by the clinicians instead of literature data gave a ratio of 33 (11-98) and a threshold of 2.9%. The hybrid approach, where regret for an unjustified death was applied to mortality estimations by the clinicians gave a ratio of 48 (11-132), with a threshold of 2 (Table 7 and Figure 1).

Bottom Line: Median probability of morbidity and mortality in case of occurrence of side effects was 15% (IQR 10-30) and 8% (IQR 5-20) respectively.The mortality related to treatment was eightfold overestimated.Adjusting expected utility thresholds for subjective regret had little effect.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Population Medicine, Faculty of Medicine and Health Sciences, University Tunku Abdul Rahman, Sungai Long Campus, Bandar Sungai Long, Kajang 43000, Cheras, Selangor, Malaysia. chandrashekharats@yahoo.com.

ABSTRACT

Background: To estimate the amount of regret and weights of harm by omission and commission during therapeutic decisions for smear-negative pulmonary Tuberculosis.

Methods: An interviewer-administered survey was done among young physicians in India, Pakistan and Bangladesh with a previously used questionnaire. The physicians were asked to estimate probabilities of morbidity and mortality related with disease and treatment and intuitive weights of omission and commission for treatment of suspected pulmonary Tuberculosis. A comparison with weights based on literature data was made.

Results: A total of 242 physicians completed the interview. Their mean age was 28 years, 158 (65.3%) were males. Median probability (%) of mortality and morbidity of disease was estimated at 65% (inter quartile range [IQR] 50-75) and 20% (IQR 8-30) respectively. Median probability of morbidity and mortality in case of occurrence of side effects was 15% (IQR 10-30) and 8% (IQR 5-20) respectively. Probability of absolute treatment mortality was 0.7% which was nearly eight times higher than 0.09% reported in the literature data. The omission vs. commission harm ratios based on intuitive weights, weights calculated with literature data, weights calculated with intuitive estimates of determinants adjusted without and with regret were 3.0 (1.4-5.0), 16 (11-26), 33 (11-98) and 48 (11-132) respectively. Thresholds based on pure regret and hybrid model (clinicians' intuitive estimates and regret) were 25 (16.7-41.7), and 2(0.75-7.5) respectively but utility-based thresholds for clinicians' estimates and literature data were 2.9 (1-8.3) and 5.9 (3.7-7.7) respectively.

Conclusion: Intuitive weight of harm related to false-negatives was estimated higher than that to false-positives. The mortality related to treatment was eightfold overestimated. Adjusting expected utility thresholds for subjective regret had little effect.

Show MeSH
Related in: MedlinePlus