Plante D A, Kassirer J P, Zarin D A, Pauker S G
Am J Med. 1986 Jun;80(6):1169-76. doi: 10.1016/0002-9343(86)90680-7.
Since 1978, decision analysis consultations have been offered to help physicians manage particularly vexing clinical problems. Consultations were requested for decisions perceived as difficult because: the diagnosis was uncertain; the available therapy had uncertain efficacy or risks; the patient had a short life expectancy that limited the potential benefit of therapy; the risk of a given test or therapy was increased and the usual rules for applying the test or giving the treatment did not apply; the need for a therapeutic procedure was acknowledged, but competing risks created uncertainty about the optimal timing of the procedure; the optimal sequence of multiple necessary procedures could not be discerned readily; explicit patient input into decision-making was required; certain medical information could not be interpreted easily; and a rare, unique, or new problem was encountered. To carry out these consultations, standard techniques were used, including decision tree models, Bayes' theorem, Markov analysis, and utility assessment, but old approaches were modified to adapt decision analysis to individual patient problems. This experience demonstrates that decision analysis can be carried out effectively on a consultative basis for individual patients. A consultation service can also train analysts in decision-making and drive research in medical problem solving.
自1978年以来，我们提供决策分析咨询服务，以帮助医生处理特别棘手的临床问题。之所以会有人请求提供咨询服务，是因为他们认为某些决策很困难，原因如下：诊断不确定；可用疗法的疗效或风险不确定；患者预期寿命较短，限制了治疗的潜在益处；特定检查或治疗的风险增加，且应用该检查或进行治疗的常规规则不适用；承认需要进行治疗性操作，但相互竞争的风险使操作的最佳时机存在不确定性；无法轻易辨别多个必要操作的最佳顺序；需要患者明确参与决策；某些医学信息难以解读；以及遇到了罕见、独特或新出现的问题。为了开展这些咨询服务，我们采用了标准技术，包括决策树模型、贝叶斯定理、马尔可夫分析和效用评估，但对旧方法进行了修改，以使决策分析适用于个体患者的问题。这一经验表明，决策分析可以在为个体患者提供咨询服务的基础上有效地进行。咨询服务还可以培训分析师进行决策，并推动医学问题解决方面的研究。
