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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

EUT and DPM testing thresholds as functions of type 1 benefits/harms of prostatectomy ratio.The chart progression (Fig 5a–5d) shows the effect of increasing type 1 harms of biopsy to the values of testing thresholds. The value of treatment threshold decreases as the ratio benefit/harms of prostatectomy increases (Fig 5a, 5b, 5c and 5d). The value of testing threshold also decreases as the ratio benefit/harms of prostatectomy increases but only when the harms of biopsy are zero (Fig 5a). If the decision maker perceives biopsy as harmful (Fig 5b, 5c and 5d) the testing threshold increases to the point that he will never choose biopsy. A prostatectomy becomes the preferred choice when BI > 2HI in Fig 5b; BI > HI in Fig 5c; BI > 0.8HI in Fig 5d.
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pone.0134800.g005: EUT and DPM testing thresholds as functions of type 1 benefits/harms of prostatectomy ratio.The chart progression (Fig 5a–5d) shows the effect of increasing type 1 harms of biopsy to the values of testing thresholds. The value of treatment threshold decreases as the ratio benefit/harms of prostatectomy increases (Fig 5a, 5b, 5c and 5d). The value of testing threshold also decreases as the ratio benefit/harms of prostatectomy increases but only when the harms of biopsy are zero (Fig 5a). If the decision maker perceives biopsy as harmful (Fig 5b, 5c and 5d) the testing threshold increases to the point that he will never choose biopsy. A prostatectomy becomes the preferred choice when BI > 2HI in Fig 5b; BI > HI in Fig 5c; BI > 0.8HI in Fig 5d.

Mentions: Figs 4 and 5 graph the values of the EUT and DPM thresholds for testing as functions of the type 1 treatment benefit/harm ratio (BI/HI) for different values of type 1 harms of biopsy (HI,T). Both figures are generated for maximum benefit of treatment (BII = 10%) however, Fig 4 assumes harms of treatment relate to survival (HII = 0.4%) and Fig 5 assumes harms of treatment relate to erectile dysfunction (HII = 37%).


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

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

EUT and DPM testing thresholds as functions of type 1 benefits/harms of prostatectomy ratio.The chart progression (Fig 5a–5d) shows the effect of increasing type 1 harms of biopsy to the values of testing thresholds. The value of treatment threshold decreases as the ratio benefit/harms of prostatectomy increases (Fig 5a, 5b, 5c and 5d). The value of testing threshold also decreases as the ratio benefit/harms of prostatectomy increases but only when the harms of biopsy are zero (Fig 5a). If the decision maker perceives biopsy as harmful (Fig 5b, 5c and 5d) the testing threshold increases to the point that he will never choose biopsy. A prostatectomy becomes the preferred choice when BI > 2HI in Fig 5b; BI > HI in Fig 5c; BI > 0.8HI in Fig 5d.
© Copyright Policy
Related In: Results  -  Collection

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

pone.0134800.g005: EUT and DPM testing thresholds as functions of type 1 benefits/harms of prostatectomy ratio.The chart progression (Fig 5a–5d) shows the effect of increasing type 1 harms of biopsy to the values of testing thresholds. The value of treatment threshold decreases as the ratio benefit/harms of prostatectomy increases (Fig 5a, 5b, 5c and 5d). The value of testing threshold also decreases as the ratio benefit/harms of prostatectomy increases but only when the harms of biopsy are zero (Fig 5a). If the decision maker perceives biopsy as harmful (Fig 5b, 5c and 5d) the testing threshold increases to the point that he will never choose biopsy. A prostatectomy becomes the preferred choice when BI > 2HI in Fig 5b; BI > HI in Fig 5c; BI > 0.8HI in Fig 5d.
Mentions: Figs 4 and 5 graph the values of the EUT and DPM thresholds for testing as functions of the type 1 treatment benefit/harm ratio (BI/HI) for different values of type 1 harms of biopsy (HI,T). Both figures are generated for maximum benefit of treatment (BII = 10%) however, Fig 4 assumes harms of treatment relate to survival (HII = 0.4%) and Fig 5 assumes harms of treatment relate to erectile dysfunction (HII = 37%).

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