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Related Experiment Videos

Process utility in breast biopsy.

J Shannon Swan1, William F Lawrence, Jessica Roy

  • 1Indiana University, Department of Radiology Education and Research Institute, Indianapolis, USA. shannon@mgh-ita.org

Medical Decision Making : an International Journal of the Society for Medical Decision Making
|July 21, 2006
PubMed
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The waiting trade-off (WTO) effectively distinguishes patient preferences between breast core-needle biopsy (CNB) and excisional surgical biopsy (EXB). This method is feasible even in acute situations with high anxiety levels.

Area of Science:

  • Health Economics
  • Decision Science
  • Medical Psychology

Background:

  • Patient preferences are crucial in medical decision-making, especially for procedures with varying invasiveness.
  • Anxiety can significantly impact patient choices in acute medical scenarios.
  • Understanding short-term health state preferences is vital for ethical and effective patient care.

Purpose of the Study:

  • To assess the feasibility of the waiting trade-off (WTO) method for differentiating patient preferences between breast core-needle biopsy (CNB) and excisional surgical biopsy (EXB).
  • To evaluate if WTO can discriminate preferences in an acute setting characterized by high anxiety.
  • To explore the utility of WTO in understanding short-term health state valuations.

Main Methods:

  • Telephone-based waiting trade-off (WTO) assessments were conducted with 75 women who had prior experience with CNB, excisional surgical biopsy (EXB), or both.

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  • Time trade-off (TTO) was used to measure baseline and test-related anxiety, which then scaled the WTO.
  • Rating scales (RS) were employed to assess convergent validity with WTO and TTO.

    • Main Results:

    • Data from 75 women (38 paired, 37 unpaired) indicated a significant patient preference to wait longer to avoid EXB compared to CNB (P = 0.0003, P = 0.0002).
    • The quality-adjusted life years (QALY) toll for EXB was approximately 1.5 days, nearing a critical threshold in established models.
    • A significant correlation was observed between WTO and RS scores, supporting the validity of the WTO method.

    Conclusions:

    • The waiting trade-off (WTO) is a feasible and practical tool for differentiating patient preferences for short-term health states.
    • WTO can effectively discriminate between procedural preferences, even in acute medical situations where anxiety is a prominent factor.
    • The findings suggest WTO can provide valuable insights into patient values for minimally invasive versus more invasive procedures.