thesis
Decision analysis in the clinical neurosciences
- Publication date
- 26 January 1994
- Publisher
- Diagnostic and therapeutic choice in neurology can fortunately be made without formal
decision support in the majority of cases. in many patients a diagnosis and treatment choice
are relatively easy to establish. This study however, concerns the application of a decision
support methodology - clinical decision analysis - to several problems in the clinical neurosdences
where diagnosis, prognosis and therapeutic choice are not obvious.
Sometimes decision making in clinical medicine can be extremely difficult There may be
large interests atstake,and theamount of information that has to beprocessed can be enormous.
Data from the patient's history, physical examination, diagnostic procedures, clinical knowledge
and the scientific information have to be combined in order to arrive at a prognosis and
to develop a diagnostic and therapeutic strategy. Add to this that most diagnostic tests are not
completely accurate, that therapy is not always and entirely effective, that diagnostic and
therapeutic procedures may be risky, unpleasant, expensive and time-consuming, and that
prognosis is most of the times uncertain.
The decision process itself is limited by time and by budgetary constraints. The clinician
has to recognize situations where the patient's preferences are important, and he has to know
when the clinical situation needs a doctor - patient relationship characterized by activity -
passivity, guidance - cooperation or mutual participation. Moreover, physicians and their
patients (as any human being) find it difficult to handle uncertainty.'" Oinicians often discuss
the pro' s and con' sof altemativemanagementstrategies with their senior and junior colleagues,
but a language that effectively and explicitly addresses uncertainty and preferences for health
outcomes is not part of the physician's standard equipment. Several other factors influence the
decision process as welL It has been demonstrated that patient characteristics, (such as social
class), physician's personal characteristics (such as age, type of specialty), and the physician's
interaction with his profession (for example whether he is in a solo- of group-practice) all may
be of influence.