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Objective consensus from decision trees.

Paul Martin Putora1, Cedric M Panje2, Alexandros Papachristofilou3

  • 1Department of Radiation Oncology, Kantonsspital St. Gallen, Rorschacherstr. 95, 9007, St. Gallen, Switzerland. paul.putora@kssg.ch.

Radiation Oncology (London, England)
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Summary

Objective consensus can be achieved using decision trees from multiple sources, even with limited evidence. This method identifies common treatment recommendations for prostate cancer radiotherapy without direct negotiation.

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Area of Science:

  • Decision analysis
  • Medical informatics

Background:

  • Consensus-based approaches offer alternatives to evidence-based decision-making when high-level evidence is scarce.
  • Novel objective consensus methods can be derived from decision tree recommendations.

Purpose of the Study:

  • To demonstrate a novel method for establishing objective consensus using decision tree recommendations from multiple sources.
  • To apply this method to clinical practice, specifically for prostate cancer radiotherapy.

Main Methods:

  • Analysis of nine sample decision tree recommendations to determine mode recommendations for each parameter permutation.
  • Application of this method to clinical data from 16 radiation oncology centers for prostate cancer radiotherapy.
  • Conversion of clinical recommendations into decision tree format for objective consensus determination.

Main Results:

  • Treatment recommendations can be systematically assessed for all parameter combinations using multi-source decision trees.
  • Objective consensus was determined via mode recommendations, bypassing direct negotiation.
  • In prostate cancer radiotherapy, despite variations, a mode recommendation was identified for specific parameter combinations (Gleason score, PSA, T-stage).

Conclusions:

  • Decision trees representing recommendations provide a foundation for objective consensus among diverse parties.
  • This approach facilitates consensus in complex clinical scenarios with varied expert opinions.