Modelling reassurances of clinicians with hidden Markov models.

BACKGROUND

A key element in the interaction between clinicians and patients with cancer is reassurance giving. Learning about the stochastic nature of reassurances as well as making inferential statements about the influence of covariates such as patient response and time spent on previous reassurances are of particular importance.

METHODS

We fit Hidden Markov Models (HMMs) to reassurance type from multiple time series of clinicians' reassurances, decoded from audio files of review consultations between patients with breast cancer and their therapeutic radiographer. Assuming a latent state process driving the observations process, HMMs naturally accommodate serial dependence in the data. Extensions to the baseline model such as including covariates as well as allowing for fixed effects for the different clinicians are straightforward to implement.

RESULTS

We found that clinicians undergo different states, in which they are more or less inclined to provide a particular type of reassurance. The states are very persistent, however switches occasionally occur. The lengthier the previous reassurance, the more likely the clinician is to stay in the current state.

CONCLUSIONS

HMMs prove to be a valuable tool and provide important insights for practitioners.

TRIAL REGISTRATION

Trial Registration number: ClinicalTrials.gov: NCT02599506. Prospectively registered on 11th March 2015.