Eisenberg J M, Hershey J C
Med Decis Making. 1983;3(2):155-68. doi: 10.1177/0272989X8300300203.
The medical decision making literature has previously considered the test and test-treatment thresholds in a normative fashion. In the normative approach, the analyst calculates the optimal threshold--the likelihood of disease at which testing or treatment should be undertaken. In contrast, we describe a method of deriving the threshold in a descriptive fashion, by determining the probabilities of disease at which clinicians actually make the decision to test or to initiate specific treatment without further testing. In applying this method, the analyst first asks clinicians to provide an estimate of the prior probability of disease, and to select one of three options: test, treat, or do neither. After receiving new information about the patient, the clinicians are asked to revise the probability estimate and to select a new option. Correlation of changes in the probability of a disease with changes in the clinicians' selections of options to test or treat enables the analyst to estimate the test and test-treatment thresholds used by the clinicians in medical decision making. Knowledge of these thresholds also enables the analyst to calculate the clinicians' ratio of the benefits to the costs of the therapy being considered, considering the risks of the test itself.
医学决策文献此前一直以规范的方式考虑检查阈值和检查-治疗阈值。在规范方法中，分析人员计算最佳阈值，即进行检查或治疗时的疾病可能性。相比之下，我们描述了一种以描述性方式得出阈值的方法，即通过确定临床医生实际做出检查决定或在不进行进一步检查的情况下开始特定治疗时的疾病概率。在应用此方法时，分析人员首先要求临床医生提供疾病先验概率的估计值，并从三个选项中选择一个：检查、治疗或两者都不做。在收到有关患者的新信息后，要求临床医生修订概率估计值并选择一个新选项。疾病概率的变化与临床医生对检查或治疗选项选择的变化之间的相关性，使分析人员能够估计临床医生在医学决策中使用的检查阈值和检查-治疗阈值。了解这些阈值还使分析人员能够在考虑检查本身风险的情况下，计算临床医生对所考虑治疗的收益与成本的比率。
