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Dual Processing Model for Medical Decision-Making: An Extension to Diagnostic Testing.

Tsalatsanis A, Hozo I, Kumar A, Djulbegovic B - PLoS ONE (2015)

Bottom Line: The DPM model indicates that doctors decide to treat when treatment benefits outweigh its harms, which occurs when the probability of the disease is greater than the so called "threshold probability" at which treatment benefits are equal to treatment harms.This is because such decisions depend on objective evidence of test/treatment benefits and harms as well as type 1 cognition of benefits and harms, which are not considered under EUT.These findings could explain variations in the treatment and diagnostic patterns documented in today's clinical practice.

View Article: PubMed Central - PubMed

Affiliation: Comparative Effectiveness Research, University of South Florida, Tampa, FL, United States of America; Department of Internal Medicine, University of South Florida, Tampa, FL, United States of America.

ABSTRACT
Dual Processing Theories (DPT) assume that human cognition is governed by two distinct types of processes typically referred to as type 1 (intuitive) and type 2 (deliberative). Based on DPT we have derived a Dual Processing Model (DPM) to describe and explain therapeutic medical decision-making. The DPM model indicates that doctors decide to treat when treatment benefits outweigh its harms, which occurs when the probability of the disease is greater than the so called "threshold probability" at which treatment benefits are equal to treatment harms. Here we extend our work to include a wider class of decision problems that involve diagnostic testing. We illustrate applicability of the proposed model in a typical clinical scenario considering the management of a patient with prostate cancer. To that end, we calculate and compare two types of decision-thresholds: one that adheres to expected utility theory (EUT) and the second according to DPM. Our results showed that the decisions to administer a diagnostic test could be better explained using the DPM threshold. This is because such decisions depend on objective evidence of test/treatment benefits and harms as well as type 1 cognition of benefits and harms, which are not considered under EUT. Given that type 1 processes are unique to each decision-maker, this means that the DPM threshold will vary among different individuals. We also showed that when type 1 processes exclusively dominate decisions, ordering a diagnostic test does not affect a decision; the decision is based on the assessment of benefits and harms of treatment. These findings could explain variations in the treatment and diagnostic patterns documented in today's clinical practice.

No MeSH data available.


Related in: MedlinePlus

Decision tree describing a typical scenario in which a physician is considering one the following three strategies: administering treatment (Rx); withholding treatment (NoRx); and performing a diagnostic test before deciding on treatment (Test).xi represents an outcome; γ is the involvement of type 1 in the decision process; p is the probability of disease; UI,i is the utility of the outcome xi under type 1 and UII,i is the utility of outcome xi under type 2 cognitive processes; HI,T denotes the harms of test as realized by type 1 and HII,T denotes the harms of test as realized by type 2 processes; P1 = pS+(1-p)(1-Sp); P11 = pS/P1; P12 = (1-p)(1-Sp)/P1; P2 = (1-p)Sp+p(1-s); P21 = p(1-s)/P2; P22 = (1-p)Sp/P2; S is the test’s sensitivity and Sp the test’s specificity. The valuation of an outcome xi under type 1 is estimated as the regret associated with the outcome xi; the valuation of an outcome xi under type 2 is estimated as the utility of the outcome xi.
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pone.0134800.g003: Decision tree describing a typical scenario in which a physician is considering one the following three strategies: administering treatment (Rx); withholding treatment (NoRx); and performing a diagnostic test before deciding on treatment (Test).xi represents an outcome; γ is the involvement of type 1 in the decision process; p is the probability of disease; UI,i is the utility of the outcome xi under type 1 and UII,i is the utility of outcome xi under type 2 cognitive processes; HI,T denotes the harms of test as realized by type 1 and HII,T denotes the harms of test as realized by type 2 processes; P1 = pS+(1-p)(1-Sp); P11 = pS/P1; P12 = (1-p)(1-Sp)/P1; P2 = (1-p)Sp+p(1-s); P21 = p(1-s)/P2; P22 = (1-p)Sp/P2; S is the test’s sensitivity and Sp the test’s specificity. The valuation of an outcome xi under type 1 is estimated as the regret associated with the outcome xi; the valuation of an outcome xi under type 2 is estimated as the utility of the outcome xi.

Mentions: We consider a generic scenario in clinical decision-making in which a decision maker is considering one of three strategies for the management of a patient’s condition (Fig 3). These strategies are: 1. do nothing (NoRx), 2. perform a diagnostic test (T), and 3. administer treatment (Rx). The patient may have a disease (D) with probability p. Each strategy results in an outcome xi, which is associated with a certain valuation, when type 1 processes are involved and when type 2 processes are employed. Each outcome has a utility UI,i ≥ 0 for type 1 processes and UII,i ≥ 0 for type 2 processes. As described earlier, valuation of outcomes under type 1 processes is performed using regret elicited using the Dual Visual Analogue Scale (DVAS) while valuation of outcomes under type 2 processes is based on EUT and the latest available evidence [12].


Dual Processing Model for Medical Decision-Making: An Extension to Diagnostic Testing.

Tsalatsanis A, Hozo I, Kumar A, Djulbegovic B - PLoS ONE (2015)

Decision tree describing a typical scenario in which a physician is considering one the following three strategies: administering treatment (Rx); withholding treatment (NoRx); and performing a diagnostic test before deciding on treatment (Test).xi represents an outcome; γ is the involvement of type 1 in the decision process; p is the probability of disease; UI,i is the utility of the outcome xi under type 1 and UII,i is the utility of outcome xi under type 2 cognitive processes; HI,T denotes the harms of test as realized by type 1 and HII,T denotes the harms of test as realized by type 2 processes; P1 = pS+(1-p)(1-Sp); P11 = pS/P1; P12 = (1-p)(1-Sp)/P1; P2 = (1-p)Sp+p(1-s); P21 = p(1-s)/P2; P22 = (1-p)Sp/P2; S is the test’s sensitivity and Sp the test’s specificity. The valuation of an outcome xi under type 1 is estimated as the regret associated with the outcome xi; the valuation of an outcome xi under type 2 is estimated as the utility of the outcome xi.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4526559&req=5

pone.0134800.g003: Decision tree describing a typical scenario in which a physician is considering one the following three strategies: administering treatment (Rx); withholding treatment (NoRx); and performing a diagnostic test before deciding on treatment (Test).xi represents an outcome; γ is the involvement of type 1 in the decision process; p is the probability of disease; UI,i is the utility of the outcome xi under type 1 and UII,i is the utility of outcome xi under type 2 cognitive processes; HI,T denotes the harms of test as realized by type 1 and HII,T denotes the harms of test as realized by type 2 processes; P1 = pS+(1-p)(1-Sp); P11 = pS/P1; P12 = (1-p)(1-Sp)/P1; P2 = (1-p)Sp+p(1-s); P21 = p(1-s)/P2; P22 = (1-p)Sp/P2; S is the test’s sensitivity and Sp the test’s specificity. The valuation of an outcome xi under type 1 is estimated as the regret associated with the outcome xi; the valuation of an outcome xi under type 2 is estimated as the utility of the outcome xi.
Mentions: We consider a generic scenario in clinical decision-making in which a decision maker is considering one of three strategies for the management of a patient’s condition (Fig 3). These strategies are: 1. do nothing (NoRx), 2. perform a diagnostic test (T), and 3. administer treatment (Rx). The patient may have a disease (D) with probability p. Each strategy results in an outcome xi, which is associated with a certain valuation, when type 1 processes are involved and when type 2 processes are employed. Each outcome has a utility UI,i ≥ 0 for type 1 processes and UII,i ≥ 0 for type 2 processes. As described earlier, valuation of outcomes under type 1 processes is performed using regret elicited using the Dual Visual Analogue Scale (DVAS) while valuation of outcomes under type 2 processes is based on EUT and the latest available evidence [12].

Bottom Line: The DPM model indicates that doctors decide to treat when treatment benefits outweigh its harms, which occurs when the probability of the disease is greater than the so called "threshold probability" at which treatment benefits are equal to treatment harms.This is because such decisions depend on objective evidence of test/treatment benefits and harms as well as type 1 cognition of benefits and harms, which are not considered under EUT.These findings could explain variations in the treatment and diagnostic patterns documented in today's clinical practice.

View Article: PubMed Central - PubMed

Affiliation: Comparative Effectiveness Research, University of South Florida, Tampa, FL, United States of America; Department of Internal Medicine, University of South Florida, Tampa, FL, United States of America.

ABSTRACT
Dual Processing Theories (DPT) assume that human cognition is governed by two distinct types of processes typically referred to as type 1 (intuitive) and type 2 (deliberative). Based on DPT we have derived a Dual Processing Model (DPM) to describe and explain therapeutic medical decision-making. The DPM model indicates that doctors decide to treat when treatment benefits outweigh its harms, which occurs when the probability of the disease is greater than the so called "threshold probability" at which treatment benefits are equal to treatment harms. Here we extend our work to include a wider class of decision problems that involve diagnostic testing. We illustrate applicability of the proposed model in a typical clinical scenario considering the management of a patient with prostate cancer. To that end, we calculate and compare two types of decision-thresholds: one that adheres to expected utility theory (EUT) and the second according to DPM. Our results showed that the decisions to administer a diagnostic test could be better explained using the DPM threshold. This is because such decisions depend on objective evidence of test/treatment benefits and harms as well as type 1 cognition of benefits and harms, which are not considered under EUT. Given that type 1 processes are unique to each decision-maker, this means that the DPM threshold will vary among different individuals. We also showed that when type 1 processes exclusively dominate decisions, ordering a diagnostic test does not affect a decision; the decision is based on the assessment of benefits and harms of treatment. These findings could explain variations in the treatment and diagnostic patterns documented in today's clinical practice.

No MeSH data available.


Related in: MedlinePlus