Evaluating the Influence of a Risk Calculator on Physician Risk Perception and Decision-Making in IPMN Surveillance:...

Area of Science:

• Gastroenterology
• Clinical Decision Support
• Oncology

Background:

• Pancreatic intraductal papillary mucinous neoplasms (IPMNs) require surveillance to detect progression.
• Risk calculators (RCs) aim to aid clinicians in discontinuing surveillance for low-risk IPMNs.
• The impact of RCs on clinical judgment for IPMN management is not fully understood.

Purpose of the Study:

• To evaluate the effect of a risk calculator on clinicians' assessment of IPMN progression risk.
• To determine if RCs influence decisions to continue surveillance for low-risk IPMNs.
• To identify the cancer risk threshold at which clinicians would alter their management recommendations.

Main Methods:

• Clinicians reviewed vignettes of low-risk IPMNs, assessing progression likelihood and surveillance recommendations.
• Participants were randomized to receive only vignettes or vignettes supplemented with data from the DART-1 Risk Calculator (RC).
• Judgments, decisions, and individual risk thresholds were compared between groups.

Main Results:

• The RC did not significantly change clinicians' perceived likelihood of IPMN progression across vignettes.
• No significant difference was observed in recommendations to continue surveillance between groups.
• Clinicians exhibited a wide range in their reported cancer risk thresholds for altering management.

Conclusions:

• The studied RC did not significantly impact clinicians' risk perception or surveillance decisions for IPMNs.
• The study was limited by a small sample size, warranting cautious interpretation.
• Significant variability exists in clinicians' risk thresholds, and further research is needed to understand why RCs may not influence decision-making.