了解预防性干预的决策:未破裂的内动脉瘤例子
Jean Raymond1, François Zhu1, Tim E Darsaut2
1Department of Radiology, Service of Neuroradiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada.
Neuro-Chirurgie
|April 5, 2025
概括
在无症状患者中进行医疗干预的决策不确定. 目前使用观测数据的模型依赖于不切实际的假设,这表明需要实用性试验以获得更好的临床指导.
科学领域:
- 医疗决策的制定 医疗决策的制定
- 临床不确定性 临床不确定性
- 预防性干预 预防性干预
背景情况:
- 无症状患者在预防性干预方面面临不确定的决定,例如治疗偶然的内动脉瘤.
- 过度治疗的风险是管理无症状疾病的一个重要问题.
- 经质量调整的寿命生存率被提出作为传统风险效益分析的替代方案.
研究的目的:
- 审查临床决策中过度诊断和过度治疗的挑战.
- 为了比较基于观察数据的基于风险和基于结果的方法.
- 提出一种更务实的临床决策方法.
主要方法:
- 对预后研究的审查,以解决临床不确定性.
- 检查基于结果和基于风险的方法中的数学转换.
- 基于不同决策模式的假设的比较.
主要成果:
- 基于风险和基于结果的模型都需要强有力的假设:治疗分配的忽视性和时间到事件数据的支配性.
- 基于结果的方法还假设在糟糕的结果后死亡率.
- 这些理论假设在现实世界的临床实践中很少得到满足.
结论:
- 基于观察数据的临床决定往往依赖于不切实际的假设.
- 建议实用临床试验以有效指导临床实践.
- 通过试验转向基于证据的决策至关重要.
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