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Decision-making Models (decision-making + models)

Distribution by Scientific Domains

Medical Sciences	75%

Selected Abstracts

Decision-making models in the analysis of portal films: A clinical pilot study

JOURNAL OF MEDICAL IMAGING AND RADIATION ONCOLOGY, Issue 1 2000
Andrew See
SUMMARY Portal films continue to play an important role in the verification of radiotherapy treatment. There is still some discussion, however, as to what action should be taken after a port film has shown a radiation field deviation from the prescribed volume. It was the aim of the present pilot study to investigate the performance of three decision-making models (,Amsterdam', ,Quebec' and ,Newcastle') and an expert panel basing their decision on intuition rather than formal rules after portal film acquisition in a clinical setting. Portal films were acquired on every day during the first week of treatment for five head and neck and five prostate cancer patients (diagnostic phase). If required, the field position was modified according to our normal practice following the recommendation of the expert panel. In order to analyse the results of the models, however, additional port films were taken in the following 3 treatment weeks with the patient moved as required by the different models (intervention phase). The portal films were taken over 4 consecutive days, positioning the patient according to each of the different models on one day each. None of the models diagnosed a field misplacement in the head and neck patients, while the ,Amsterdam' and ,Quebec' models predicted a move in one prostate patient. The ,Newcastle' model, which is based on Hotelling's T 2 statistic, proved to be more sensitive and diagnosed a systematic displacement for three prostate patients. The intervention phase confirmed the diagnosis of the model, even if the three portal films taken with the patient position adjusted as required by the model proved to be insufficient to demonstrate an improvement. The ,Newcastle' model does not rely on assumptions about the random movement of patients and requires five portal films before a decision can be reached. This approach lends itself well to incorporation into electronic portal imaging ,packages', where repeated image acquisitions present no logistical difficulty. [source]

Eliciting patients' preferences for adjuvant chemotherapy in breast cancer: development and validation of a bedside decision-making instrument in a French Regional Cancer Centre

HEALTH EXPECTATIONS, Issue 2 2000
Marie-Odile Carrère PhD
Introduction In developed countries, the physician-patient relationship is moving from a paternalistic model to new decision-making models that take patient preferences into account. Objectives Our aim was to develop a Decision Board (DB) and to test its acceptability in a French Regional Cancer Centre regarding the decision on whether or not to use chemotherapy after surgery in postmenopausal women with breast cancer. This paper presents the development process for this instrument and reports the pretesting phase, as well as the corresponding results. Methods A working group was created with oncologists, psychologists and economists. Following the first phase, i.e. the development process, a first version of the instrument was presented to health professionals. Their feedback led to important modifications of the instrument. The DB was then presented to experienced patients, which resulted in slight changes. The second phase consisted of pretesting the comprehension, internal and across-time consistency of the DB on healthy volunteers. Results The DB was pretested in a group of 40 healthy volunteers. Eighteen respondents chose chemotherapy and 22 chose not to have chemotherapy. Comprehension rates were very high (,87.5%). Internal consistency was assessed considering option attitudes based on outcomes and option attitudes based on process. Women shifted their choices in a predictable way. Across-time consistency was appraised using the test-retest method with Visual Analog Scales. The Intraclass Correlation Coefficient was 0.97. Discussion-conclusion Due to cultural differences, the DB developed in our French Cancer Centre is quite different from the DBs previously developed elsewhere. Our instrument showed good comprehension and consistency properties, which are corroborated by the DB literature. Whether our DB is acceptable for patients with breast cancer must still be tested. Patients' reactions will tell us which type of decision-making model is at work. Further research is needed in order to explore the shared decision-making process and clarify the concept. [source]

Perceived Risk and Worry: The Effects of 9/11 on Willingness to Fly,

JOURNAL OF APPLIED SOCIAL PSYCHOLOGY, Issue 9 2004
Rochelle L. Bergstrom
Most decision-making models rely on affect-free variables to understand the decisions that people make. We tested an affectively-loaded variable,worry,as a predictor of decision making in an affectively laden context: willingness to fly after 9/11. College students rated their willingness to fly to New York City or Washington, DC, in a study conducted 34 days after 9/11. They also recorded their beliefs about the likelihood that more terrorist attacks would occur, the severity of such attacks if they were to occur, and how much they worried about flying. Finally, they made these estimates for similar others. Results showed that worry was the most powerful predictor of one's own and similar others' willingness to fly. These findings suggest that models of how people make decisions may sometimes need to take feelings into account. [source]