Decision Analysis in Individual Clinical Decision Making : A Real-World Application in Treatment of Renal Disease^[*]

The methodological framework of decision analysis is applied to a given physician’s decision making process with respect to a given, identified patient. The paper demonstrates how some of the subjective assessments and value judgments can be systematically incorporated and applied in a real-world setting. Direct subjective assessment of all probabilities was necessary because the specific characteristics of the given patient did not enable use of data in the literature. Explicit tradeoffs between longevity and quality of life were elicited from the decision maker and used in quantifying his relative preferences for the possible outcomes. The paper demonstrates the usefulness of decision analysis in structuring and analyzing a real-world problem, especially one where little or no data are available.

Der methodologische Rahmen der Entscheidungsanalyse wird auf den ärztlichen Entscheidungsprozeß bei einem ganz bestimmten Patienten angewandt. Die Arbeit zeigt, wie einige der subjektiven Annahmen und Werturteile systematisch eingebaut und auf ein reales Beispiel angewandt werden können. Dabei war die direkte subjektive Entscheidung aller Wahrscheinlichkeiten erforderlich, weil die spezifischen Besonderheiten des Patienten es nicht zuließen, Daten aus dem Schrifttum zu verwenden. Ausdrückliche Entscheidungen zwischen Lebensverlängerung und Lebensqualität wurden dem die Entscheidung Treffenden »entlockt« und zur Quantifizierung seiner relativen Präferenzen der möglichen Endergebnisse benutzt. Die Arbeit erweist die Nützlichkeit der Strukturierung und Zergliederung eines Problems aus dem wirklichen Leben, insbesondere dann, wenn nur wenige oder keine Daten verfügbar sind.

Key-Words

Decision Analysis - Subjective Probability - Utility Functions - Hemodiatysis - Transplantation

Schlüssel-Wörter

Entscheidungsanalyse - subjektive Wahrscheinlichkeit - Nutzenfunktionen - Hämodialyse - Transplantation

^* This research was supported in part by grants from the Robert Wood Johnson Foundation and the Commonwealth Fund through the Conter for the Analysis of Health Practices, Harvard School of Public Health.

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