Thursday, June 29, 2006

Playing the odds

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Recently, I was reading about some of the work being done by Dr. Phyllis Butow on the value of decision aids for patients in making treatment decisions.

Having all the information is only one part of the equation. Anxiety, denial, information overload, poor doctor-patient communication can all get in the way of understanding, particularly when faced with a serious illness.

Decision aids are tools that help people make difficult choices when faced with multiple treatment options by providing information on the options available and the associated possible outcomes. Decision aids can consist of pictures of squares, coloured dots and simple charts to graphically represent the probability of benefitting from a particular treatment.

One such decision aid is the 100 person diagram which consists of a large square box containing 100 smaller boxes, with each small box representing how one person in 100 responded to a given treatment for a disease or condition. By putting various colored dots in the correct number of boxes, doctors can show patients how high the probability is that they will benefit from a number of different treatments.

It was therefore interesting today to read about the work of researchers at the University of California who have developed a decision aid in the form of a roulette wheel. The developers, Dr. Jerome Hoffman and colleagues, say it can be used for any clinical question, although they have set up a working example for use in determining whether to be screened for prostate cancer with a standard prostate-specific antigen (PSA) test.

"Many of us have trouble understanding numbers, particularly in the context of risk and probability. It's hard for anyone to comprehend the difference between a 7% and 8% chance - is there a meaningul difference? And this is exacerbated when we try to deal in more extreme probabilities, such as three in 10,000."

The researchers hope that the roulette wheel will allow patients to visualise the probable outcomes associated with various treatment options more easily.

A demonstration version of the Prostate Cancer Decision Wheel can be accessed from the link below. How useful would you find such a tool?

Some further reading on decision aids:


Tiesha said...

This is a great idea and I can see how it could be very helpful to patients. Treatment options for people with diseases such as AIDS can be as overwhelming as having the disease itself.
A roulette wheel though? I like the square idea better!

healthpsych said...

Hi Tiesha,

The thing I'm unsure about with the roulette wheel is the gambling connotation, which seems somewhat at odds with making an informed decision. But, then again, some people might relate to that visual representation and odds presentation better.

I think I read somewhere that Dr. Butow said that sometimes people can find the 100-person diagram a little hard to take. If you've looked at some of the work of Dr. Susan Miller and informational preferences, this makes sense. So I guess, as with everything, it's about finding the right 'fit' for each individual.

jumpinginpuddles said...

i dont know if using a tool for gambling is a good idea. The roulette wheel is a game of chance is that what the patients are going to think choosing from such a thing. A bit iffy on this one.

healthpsych said...

My thoughts exactly, JIP. I think it's a great visual tool but there's that element of 'chance' and 'luck' implied in a gambling method.

Dr. Deborah Serani said...

It would be a very helpful tool for me becasue I have great difficulty with numbers, statistics and percentages. I'm not thrilled with the gambling piece to the roulette wheel, but the color dots may be helpful. As always, you bring great info to your blog.


healthpsych said...

Hi Deborah,
Same here. I wasn't even in the room when the maths brains were given out!