Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California 94115, USA.
Otol Neurotol. 2010 Feb;31(2):284-93. doi: 10.1097/MAO.0b013e3181cc06cb.
Complex medical decision making obligates tradeoff assessments among treatment outcomes expectations, but an accessible tool to perform the necessary analysis is conspicuously absent. We aimed to demonstrate methodology and feasibility of adapting conjoint analysis for mapping clinical outcomes expectations to treatment decisions in vestibular schwannoma (VS) management.
Prospective.
Tertiary medical center and US-based otologists/neurotologists.
Treatment preference profiles among VS stakeholders-61 younger and 74 older prospective patients, 61 observation patients, and 60 surgeons-were assessed for the synthetic VS case scenario of a 10-mm tumor in association with useful hearing and normal facial function.
Treatment attribute utility.
Conjoint analysis attribute levels were set in accordance to the results of a meta-analysis. Forty-five case series were disaggregated to formulate microsurgery facial nerve and hearing preservation outcomes expectations models. Attribute utilities were computed and mapped to the realistic treatment choices of translabyrinthine craniotomy, middle fossa craniotomy, and gamma knife radiosurgery.
Among the treatment attributes of likelihoods of causing deafness, temporary facial weakness for 2 months, and incurable cancer within 20 years, and recovery time, permanent deafness was less important to tumor surgeons, and temporary facial weakness was more important to tumor surgeons and observation patients (Wilcoxon rank-sum, p < 0.001). Inverse mapping of preference profiles to realistic treatment choices showed all study cohorts were inclined to choose gamma knife radiosurgery.
Mapping clinical outcomes expectations to treatment decisions for a synthetic clinical scenario revealed inhomogeneous drivers of choice selection among study cohorts. Medical decision engines that analyze personal preferences of outcomes expectations for VS and many other diseases may be developed to promote shared decision making among health care stakeholders and transparency in the informed consent process.
复杂的医学决策需要在治疗结果预期之间进行权衡评估，但缺乏一种易于使用的工具来进行必要的分析。我们旨在展示将联合分析方法用于映射前庭神经鞘瘤（VS）管理中临床结果预期与治疗决策的方法和可行性。
前瞻性研究。
三级医疗中心和美国的耳鼻喉科医生/神经外科医生。
VS 利益相关者的治疗偏好概况-61 名年轻患者和 74 名老年患者、61 名观察患者和 60 名外科医生，对一个 10 毫米肿瘤伴有有用听力和正常面神经功能的合成 VS 病例进行了评估。
治疗属性效用。
根据荟萃分析的结果设定联合分析属性水平。将 45 项病例系列分解以制定显微手术面神经和听力保留结果预期模型。计算属性效用并映射到现实的治疗选择：经迷路颅底切除术、中颅窝颅底切除术和伽玛刀放射外科手术。
在导致耳聋的可能性、2 个月内暂时性面神经无力和 20 年内无法治愈的癌症以及恢复时间等治疗属性中，永久性耳聋对肿瘤外科医生来说不太重要，而暂时性面神经无力对肿瘤外科医生和观察患者更为重要（Wilcoxon 秩和检验，p<0.001）。偏好概况与现实治疗选择的逆向映射显示，所有研究队列都倾向于选择伽玛刀放射外科手术。
将临床结果预期映射到合成临床场景的治疗决策中，揭示了研究队列中选择决策的不同驱动因素。可以开发用于分析 VS 和许多其他疾病的个人结果预期偏好的医疗决策引擎，以促进医疗保健利益相关者之间的共同决策和知情同意过程的透明度。
