Kee Frank, Owen Tracy, Leathem Ruth
Department of Epidemiology and Public Health, Queen's University Belfast, Belfast Northern Ireland.
Med Decis Making. 2004 Nov-Dec;24(6):602-13. doi: 10.1177/0272989X04271047.
To establish whether treatment recommendations made by clinicians concur with the best outcomes predicted from their prognostic estimates and whether team discussion improves the quality or outcome of their decision making, the authors studied real-time decision making by a lung cancer team. Clinicians completed pre- and postdiscussion questionnaires for 50 newly diagnosed patients. For each patient/doctor pairing, a decision model determined the expected patient outcomes from the clinician's prognostic estimates. The difference between the expected utility of the recommended treatment and the maximum utility derived from the clinician's predictions of the outcomes (the net utility loss) following all potential treatment modalities was calculated as an indicator of quality of the decision. The proportion of treatment decisions changed by the multidisciplinary team discussion was also calculated. Insofar as the change in net utility loss brought about by multidisciplinary team discussion was not significantly different from zero, team discussion did not improve the quality of decision making overall. However, given the modest power of the study, these findings must be interpreted with caution. In only 23 of 87 instances (26%) in which an individual specialist's initial treatment preference differed from the final group judgment did the specialist finally concur with the group treatment choice after discussion. This study does not support the theory that team discussion improves decision making by closing a knowledge gap.
为了确定临床医生给出的治疗建议是否与其预后评估所预测的最佳结果相符，以及团队讨论是否能提高其决策质量或结果，作者对一个肺癌团队的实时决策进行了研究。临床医生为50名新诊断患者填写了讨论前和讨论后的问卷。对于每一对患者/医生，一个决策模型根据临床医生的预后评估来确定患者的预期结果。计算推荐治疗的预期效用与临床医生对所有潜在治疗方式的结果预测所产生的最大效用之间的差异（净效用损失），作为决策质量的一个指标。还计算了多学科团队讨论导致治疗决策改变的比例。由于多学科团队讨论带来的净效用损失变化与零没有显著差异，所以团队讨论总体上并没有提高决策质量。然而，鉴于该研究的效力有限，这些发现必须谨慎解读。在87个案例中，只有23个（26%）个体专家的初始治疗偏好与最终团队判断不同，且专家在讨论后最终同意了团队的治疗选择。这项研究不支持团队讨论通过弥合知识差距来改善决策的理论。
