Optimizing Small, Low-Risk, Unruptured Intracranial Aneurysm Treatment Using Game Theory.

Area of Science:

• Neurosurgery
• Medical Decision Making
• Game Theory

Background:

• Incidental diagnosis of unruptured intracranial aneurysms (UIAs) is increasing.
• Small, low-risk UIAs present clinical equipoise regarding treatment vs. conservative management.
• Patient-physician communication challenges arise from this uncertainty.

Purpose of the Study:

• To apply game theory to model physician-patient interactions in managing small, low-risk UIAs.
• To determine how conflict and cooperation influence management decisions.
• To provide a framework for optimal decision-making under clinical equipoise.

Main Methods:

• Developed a game theory model simulating interactions between physicians and patients.
• Assumed rational decision-making for both parties.
• Incorporated physician's ex ante probability of patient preferences.

Main Results:

• Physician's expectations of patient preferences are crucial for guiding initial management recommendations.
• Rational physicians should base their initial offer (treatment vs. conservative) on the probability of patient preferences.
• This approach optimizes decision-making when clinical equipoise exists.

Conclusions:

• Physician expectations of patient preferences should guide the initial management strategy for small, asymptomatic, low-risk UIAs.
• Game theory offers insights into navigating shared decision-making in neurosurgical management.
• This model aids in addressing uncertainty and improving patient-physician alignment.