Levels in Decision Making and Techniques for Clinicians

Abstract

In the last century, there has been tremendous advancements in medicine and surgery and this progress has resulted in an over expansion of the number of treatment options that are available to treat many conditions. The enlarging armamentarium available to modern physicians should be celebrated. However, this has come with a significant increase in the complexity of decisions that physicians have to make when they select a therapy among many that have comparable efficacy. For example, small hepatocellular carcinomas can be treated with liver transplantation, surgical resection or locoregional therapies, with similar overall survival but different disease free survival and morbidities. One of the primary goals of decision analysis is to help decision makers. In healthcare, this translates in more cost-effective treatments, higher patients’ satisfaction and overall better outcomes. Because judgments of uncertainty are a critical part of medical decision-making, decision analysis tends to improve the accuracy of these judgments by using specific algorithms and techniques. The main aim of this review is to make clinicians familiar with the different levels of decision analysis. In this paper, we will describe common techniques that are used to elicit patients’ preferences, the meaning of utilities and the benefit and limitations of decision analysis in health care.