Abstract
For many medical domains uncertainty and patient preferences are important components of decision making. Decision theory is useful as a representation for such medical models in computer decision aids, but the methodology has typically had poor performance in the areas of explanation and user interface. The additional representation of probabilities and utilities as random variables serves to provide a framework for graphical and text insight into complicated decision models. The approach allows for efficient customization of a generic model that describes the general patient population of interest to a patient- specific model. Monte Carlo simulation is used to calculate the expected value of information and sensitivity for each model variable, thus providing a metric for deciding what to emphasize in the graphics and text summary. The computer-generated explanation includes variables that are sensitive with respect to the decision or that deviate significantly from what is typically observed. These techniques serve to keep the assessment and explanation of the patient's decision model concise, allowing the user to focus on the most important aspects for that patient.
Keywords: Clinical Decision Support Systems, Knowledge Representation, Patient-Specific Models, Computer-Generated Explanation, Uncertainty
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Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Clarke J. R. A comparison of decision analysis and second opinions for surgical decisions. Arch Surg. 1985 Jul;120(7):844–847. doi: 10.1001/archsurg.1985.01390310080018. [DOI] [PubMed] [Google Scholar]
- Critchfield G. C., Willard K. E. Probabilistic analysis of decision trees using Monte Carlo simulation. Med Decis Making. 1986 Apr-Jun;6(2):85–92. doi: 10.1177/0272989X8600600205. [DOI] [PubMed] [Google Scholar]
- Pauker S. G., Kassirer J. P. Clinical decision analysis by personal computer. Arch Intern Med. 1981 Dec;141(13):1831–1837. doi: 10.1001/archinte.141.13.1831. [DOI] [PubMed] [Google Scholar]
- Rutkow I. M. Surgical decision making. The reproducibility of clinical judgement. Arch Surg. 1982 Mar;117(3):337–340. doi: 10.1001/archsurg.1982.01380270055012. [DOI] [PubMed] [Google Scholar]
- Sox H. C., Jr Probability theory in the use of diagnostic tests. An introduction to critical study of the literature. Ann Intern Med. 1986 Jan;104(1):60–66. doi: 10.7326/0003-4819-104-1-60. [DOI] [PubMed] [Google Scholar]
