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Related Experiment Videos

What's wrong with decision analysis? Can the left brain influence the right?

A S Detsky, D Redelmeier, H B Abrams

    Journal of Chronic Diseases
    |January 1, 1987
    PubMed
    Summary

    Decision analysis in nephrology showed limited impact on clinical practice. Clinicians valued biopsy information beyond outcomes, highlighting challenges in integrating clinical intuition and decision-making models.

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    Area of Science:

    • Nephrology
    • Clinical Decision Analysis
    • Medical Education

    Background:

    • Decision analysis aims to improve clinical practice by providing evidence-based recommendations.
    • The utility of renal biopsy for idiopathic nephrotic syndrome was evaluated using decision analysis.

    Purpose of the Study:

    • To assess the impact of decision analysis on clinical practice.
    • To understand clinicians' perspectives on decision analysis in nephrology.

    Main Methods:

    • A published decision analysis report on renal biopsy utility was presented to nephrologists and residents.
    • Qualitative feedback was gathered from clinicians regarding the analysis and its applicability.

    Main Results:

    • Despite analysis showing no significant difference in outcomes between biopsy and empiric steroids, most clinicians preferred biopsy.

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  • Clinicians cited the "value of information" (e.g., prognosis) from biopsy as crucial, a factor not fully captured by the analysis.
  • Some clinicians expressed discomfort with the simulation due to the absence of real patients and found decision analysis logic did not align with clinical intuition.

    • Conclusions:

    • Decision analysis faces challenges in incorporating the "value of information" and aligning with clinical intuition.
    • Effective engagement with clinicians and demonstrating tangible benefits are crucial for decision analysis adoption.
    • Overcoming these challenges is necessary for decision analysis to move beyond academia and impact clinical practice.