A decision-analysis methodology for consideration of morbidity factors in clinical decision-making

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Abstract
An explicit and systematic means of incorporation of good medical practice plus individual patient preferences (utilities) for pretreatment and treatment options for a serious but curable neoplastic disease was investigated. The methodology allows important quality-of-life information to be transmitted to patients, with the goal of providing an improved basis for informed consent. The example of Hodgkin''s lymphoma staging and treatment selection is used. Individual patient utilities can be expressed and incorporated into a formal decision analysis for those who face the option of selecting MOPP [mechlorethamine, vincristine, prednisone, procarbazine] chemotherapy or of pursuing the staging process to obtain a chance of being treated appropriately with irradiation. Equal survival probabilities for the 2 options are assumed; thus, the short- and long-term toxicities (quality of life) are the determinants of the decision. Patient-derived utilities can be developed for the 15 categories of anticipated toxicity. This, together with probabilistic inputs regarding toxicity severity and duration, will yield expected utilities for each of the decision options. Three physicians were studied and evaluated in the role of a patient. The physicians'' toxicity preferences were diferent; because of this the management option of choice was different for each. This methodology allows explicit patient preferences to be incorporated into medical decisions without the requirement for detailed patient understanding of testing and/or treatment morbidity frequency and severity.

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