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Objective consensus from decision trees.

Putora PM, Panje CM, Papachristofilou A, Dal Pra A, Hundsberger T, Plasswilm L - Radiat Oncol (2014)

Bottom Line: An objective consensus can be determined by means of mode recommendations without compromise or confrontation among the parties.Despite significant variations among the recommendations, a mode recommendation could be found for specific combinations of parameters.Recommendations represented as decision trees can serve as a basis for objective consensus among multiple parties.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology, Kantonsspital St. Gallen, Rorschacherstr. 95, 9007, St. Gallen, Switzerland. paul.putora@kssg.ch.

ABSTRACT

Background: Consensus-based approaches provide an alternative to evidence-based decision making, especially in situations where high-level evidence is limited. Our aim was to demonstrate a novel source of information, objective consensus based on recommendations in decision tree format from multiple sources.

Methods: Based on nine sample recommendations in decision tree format a representative analysis was performed. The most common (mode) recommendations for each eventuality (each permutation of parameters) were determined. The same procedure was applied to real clinical recommendations for primary radiotherapy for prostate cancer. Data was collected from 16 radiation oncology centres, converted into decision tree format and analyzed in order to determine the objective consensus.

Results: Based on information from multiple sources in decision tree format, treatment recommendations can be assessed for every parameter combination. An objective consensus can be determined by means of mode recommendations without compromise or confrontation among the parties. In the clinical example involving prostate cancer therapy, three parameters were used with two cut-off values each (Gleason score, PSA, T-stage) resulting in a total of 27 possible combinations per decision tree. Despite significant variations among the recommendations, a mode recommendation could be found for specific combinations of parameters.

Conclusion: Recommendations represented as decision trees can serve as a basis for objective consensus among multiple parties.

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Related in: MedlinePlus

The mode consensus for 9 input trees is displayed. All criteria relevant for recommendations are displayed and any parameter combination followed to reach the recommendations on the right. For the top row, when the appropriate criteria are fulfilled the most common recommendation (consensus) was “Operation” for six out of nine recommendation trees (6/9). In the second row, a consensus could not be established (no single dominant mode recommendation for this specific subset).
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Fig4: The mode consensus for 9 input trees is displayed. All criteria relevant for recommendations are displayed and any parameter combination followed to reach the recommendations on the right. For the top row, when the appropriate criteria are fulfilled the most common recommendation (consensus) was “Operation” for six out of nine recommendation trees (6/9). In the second row, a consensus could not be established (no single dominant mode recommendation for this specific subset).

Mentions: When all eventualities are analysed, the recommendations can be used as a basis for determining the most common (mode) recommendation for each eventuality separately. These can be used to construct a mode decision tree. In the provided example, consensus was considered to be available if any recommendation was provided as the most common. When two recommendations were equally represented (e.g. three centres “Drug A”, three centres “Radiotherapy”), this was considered no consensus. Where consensus was established, the percentage of congruence was also determined. Figure 4 shows the resulting mode decision tree of nine sample decision trees.Figure 4


Objective consensus from decision trees.

Putora PM, Panje CM, Papachristofilou A, Dal Pra A, Hundsberger T, Plasswilm L - Radiat Oncol (2014)

The mode consensus for 9 input trees is displayed. All criteria relevant for recommendations are displayed and any parameter combination followed to reach the recommendations on the right. For the top row, when the appropriate criteria are fulfilled the most common recommendation (consensus) was “Operation” for six out of nine recommendation trees (6/9). In the second row, a consensus could not be established (no single dominant mode recommendation for this specific subset).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4269842&req=5

Fig4: The mode consensus for 9 input trees is displayed. All criteria relevant for recommendations are displayed and any parameter combination followed to reach the recommendations on the right. For the top row, when the appropriate criteria are fulfilled the most common recommendation (consensus) was “Operation” for six out of nine recommendation trees (6/9). In the second row, a consensus could not be established (no single dominant mode recommendation for this specific subset).
Mentions: When all eventualities are analysed, the recommendations can be used as a basis for determining the most common (mode) recommendation for each eventuality separately. These can be used to construct a mode decision tree. In the provided example, consensus was considered to be available if any recommendation was provided as the most common. When two recommendations were equally represented (e.g. three centres “Drug A”, three centres “Radiotherapy”), this was considered no consensus. Where consensus was established, the percentage of congruence was also determined. Figure 4 shows the resulting mode decision tree of nine sample decision trees.Figure 4

Bottom Line: An objective consensus can be determined by means of mode recommendations without compromise or confrontation among the parties.Despite significant variations among the recommendations, a mode recommendation could be found for specific combinations of parameters.Recommendations represented as decision trees can serve as a basis for objective consensus among multiple parties.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology, Kantonsspital St. Gallen, Rorschacherstr. 95, 9007, St. Gallen, Switzerland. paul.putora@kssg.ch.

ABSTRACT

Background: Consensus-based approaches provide an alternative to evidence-based decision making, especially in situations where high-level evidence is limited. Our aim was to demonstrate a novel source of information, objective consensus based on recommendations in decision tree format from multiple sources.

Methods: Based on nine sample recommendations in decision tree format a representative analysis was performed. The most common (mode) recommendations for each eventuality (each permutation of parameters) were determined. The same procedure was applied to real clinical recommendations for primary radiotherapy for prostate cancer. Data was collected from 16 radiation oncology centres, converted into decision tree format and analyzed in order to determine the objective consensus.

Results: Based on information from multiple sources in decision tree format, treatment recommendations can be assessed for every parameter combination. An objective consensus can be determined by means of mode recommendations without compromise or confrontation among the parties. In the clinical example involving prostate cancer therapy, three parameters were used with two cut-off values each (Gleason score, PSA, T-stage) resulting in a total of 27 possible combinations per decision tree. Despite significant variations among the recommendations, a mode recommendation could be found for specific combinations of parameters.

Conclusion: Recommendations represented as decision trees can serve as a basis for objective consensus among multiple parties.

Show MeSH
Related in: MedlinePlus