Heckerling P S, Verp M S, Albert N
Department of Medicine, University of Illinois, Chicago 60612, USA.
Med Decis Making. 1999 Jan-Mar;19(1):66-77. doi: 10.1177/0272989X9901900109.
The choice between amniocentesis and chorionic villus sampling for prenatal genetic testing involves tradeoffs of the benefits and risks of the tests. Decision analysis is a method of explicitly weighing such tradeoffs. The authors examined the relationship between prenatal test choices made by patients and the choices prescribed by decision-analytic models based on their preferences, and separate models based on the preferences of their physicians. Preferences were assessed using written scenarios describing prenatal testing outcomes, and were recorded on linear rating scales. After adjustment for sociodemographic and obstetric confounders, test choice was significantly associated with the choice of decision models based on patient preferences (odds ratio 4.44; Cl, 2.53 to 7.78), but not with the choice of models based on the preferences of the physicians (odds ratio 1.60; Cl, 0.79 to 3.26). Agreement between decision analyses based on patient preferences and on physician preferences was little better than chance (kappa = 0.085+/-0.063). These results were robust both to changes in the decision-analytic probabilities and to changes in the model structure itself to simulate non-expected utility decision rules. The authors conclude that patient but not physician preferences, incorporated in decision models, correspond to the choice of amniocentesis or chorionic villus sampling made by the patient. Nevertheless, because patient preferences were assessed after referral for genetic testing, prospective preference-assessment studies will be necessary to confirm this association.
在羊膜穿刺术和绒毛取样用于产前基因检测之间做出选择，涉及到检测的益处和风险的权衡。决策分析是一种明确权衡此类取舍的方法。作者研究了患者做出的产前检测选择与基于患者偏好的决策分析模型以及基于医生偏好的单独模型所规定的选择之间的关系。使用描述产前检测结果的书面情景评估偏好，并记录在线性评分量表上。在对社会人口统计学和产科混杂因素进行调整后，检测选择与基于患者偏好的决策模型选择显著相关（优势比4.44；可信区间，2.53至7.78），但与基于医生偏好的模型选择无关（优势比1.60；可信区间，0.79至3.26）。基于患者偏好和医生偏好的决策分析之间的一致性略高于随机水平（kappa = 0.085±0.063）。这些结果对于决策分析概率的变化以及模型结构本身的变化（以模拟非预期效用决策规则）都是稳健的。作者得出结论，纳入决策模型中的是患者而非医生的偏好，这与患者对羊膜穿刺术或绒毛取样的选择相对应。然而，由于患者偏好是在转诊进行基因检测后评估的，因此需要进行前瞻性偏好评估研究来证实这种关联。
