The Use of Confidence Intervals for Individual Utilities:

Roest, F. H. J.; Eijkemans, Marinus J.C.; Donk, J. van der; Levendag, Peter C.; Meeuwis, Cees A.; Schmitz, Paul; Habbema, J. Dik F.

doi:10.1177/0272989x9701700304

Cited by 7 publications

(4 citation statements)

References 14 publications

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“…20 A mathematical decision analysis model utilizing confidence intervals for utility measurements in deciding between primary radiation and laryngectomy was unsuccessful due to the significant variability and uncertainty concerning specific oncologic and functional outcomes. 21 Another study created a software system designed to utilize a provider’s prior clinical decisions for laryngeal cancer patients to make future decisions. 22 This was limited by the need to explicitly define successful outcomes and by the inherent bias of the model.…”

Section: Discussionmentioning

confidence: 99%

Patient Reflections on Decision Making for Laryngeal Cancer Treatment

Shuman

Larkin

Thomas

et al. 2017

Otolaryngol.--head neck surg.

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Objective To describe the reflections of patients treated for laryngeal cancer with regard to treatment-related decision making. Study Design Cross-sectional survey-based pilot study. Setting Single-institution tertiary care cancer center. Subjects/Methods Adults with laryngeal carcinoma were eligible to participate (N = 57; 46% treated surgically, 54% non-surgically). Validated surveys measuring decisional conflict and regret explored patients’ reflections on their preferences and priorities regarding treatment-related decision making for laryngeal cancer and how patient-reported functional outcomes, professional referral patterns, and desired provider input influenced these reflections. Results When considering the level of involvement of surgeons, radiation oncologists, and medical oncologists in their care, patients were more likely to believe that the specialist whom they saw first was the most important factor in deciding how to treat their cancer (Fisher’s exact, ~χ2 = 16.2, df = 6, P = .02). Patients who were treated for laryngeal cancer who reported worse voice-related quality of life recalled more decisional conflict (P = .01) and experienced more decisional regret (P <.001). Of the patients for whom speech was a top priority prior to treatment, better voice-related quality of life overall scores were correlated with less decision regret about treatment decisions (P <.02). Of the patients for whom eating and drinking were top priorities prior to treatment, better MD Anderson Dysphagia Inventory global scores were correlated with less decision regret about treatment decisions (P <.002). Conclusion Patient priorities and attitudes, coupled with functional outcomes and professional referral patterns, influence how patients reflect on their choices regarding management of laryngeal cancer. Better understanding of these variables may assist in ensuring that patients’ voices are integrated into individualized laryngeal cancer treatment planning.

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Section: Discussionmentioning

confidence: 99%

Patient Reflections on Decision Making for Laryngeal Cancer Treatment

Shuman

Larkin

Thomas

et al. 2017

Otolaryngol.--head neck surg.

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“…Initial branches of the tree include the three possible management options for severe RA wrist disease: non-operative management, TWA, and TWF (Fig. 1) [17]. A model in which the same procedure is associated with the largest expected gain in QALYs regardless of changes in model parameters is considered to be robust.…”

Section: Discussionmentioning

confidence: 99%

“…Similarly, a person with 12 remaining years of life would have a different expected gain in QALYs after a procedure than a person with 20 remaining years of life. Sensitivity analysis is therefore necessary to evaluate the robustness of a decision model [17]. A model in which the same procedure is associated with the largest expected gain in QALYs regardless of changes in model parameters is considered to be robust.…”

Section: Discussionmentioning

confidence: 99%

Reconstructing the Rheumatoid Wrist: A Utility Analysis Comparing Total Wrist Fusion and Total Wrist Arthroplasty from the Perspectives of Rheumatologists and Hand Surgeons

Cavaliere

Oppenheimer

Chung

2009

Hand (New York, N,Y.)

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Rheumatologists and hand surgeons have historically demonstrated strikingly divergent attitudes toward the benefits of surgical intervention, either total wrist fusion or total wrist arthroplasty, for the rheumatoid wrist. A utility analysis was conducted to compare a national random sample of hand surgeons and rheumatologists regarding their opinions about surgical management of severe rheumatoid wrist disease. A web-based trade-off utility survey was developed, and participants were presented with survey scenarios comparing well-controlled rheumatoid arthritis with operative and non-operative management. Utility values were calculated for each scenario, and a decision analytic model was constructed. Utility values for rheumatologists and hand surgeons did not differ significantly for any scenario. Total wrist arthroplasty was associated with the highest expected gain in quality-adjusted life-years for each subgroup. This decision analytic model demonstrates similar opinions between two subspecialties that have historically demonstrated divergent attitudes towards rheumatoid hand surgery.

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“…Sensitivity analysis is necessary to determine the robustness of the model. 21 We varied the remaining healthy years to assess how well our model holds up to large changes of this variable.…”

Section: Methodsmentioning

confidence: 99%

A Decision Analysis of Amputation Versus Reconstruction for Severe Open Tibial Fracture from the Physician and Patient Perspectives

Chung¹,

Shauver²,

Saddawi-Konefka³

et al. 2011

Annals of Plastic Surgery

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Although reconstruction is often the primary choice of surgeons following an open tibial fracture, there is no evidence to support the long-term effectiveness of flap reconstruction over below-knee amputation. The aim of this study is to perform a decision analysis to evaluate treatment preferences for type IIIB and IIIC tibial fractures. Reconstructive microsurgeons, physical medicine physicians and patients with lower extremity trauma completed a web-based standard gamble utility survey to generate quality-adjusted life years (QALYs). Physicians assigned quite high utility values, and there was a slight preference for reconstruction over amputation, with a gain of only 0.55 QALY. Patients assigned significantly lower utility values and also favored reconstruction over amputation, but with a larger gain of 5.54 QALYs. The disparate utilities assigned by physicians and patients highlight the necessity of realistic discussion of outcomes, regardless of management methods.

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The Use of Confidence Intervals for Individual Utilities:

Cited by 7 publications

References 14 publications

Patient Reflections on Decision Making for Laryngeal Cancer Treatment

Patient Reflections on Decision Making for Laryngeal Cancer Treatment

Reconstructing the Rheumatoid Wrist: A Utility Analysis Comparing Total Wrist Fusion and Total Wrist Arthroplasty from the Perspectives of Rheumatologists and Hand Surgeons

A Decision Analysis of Amputation Versus Reconstruction for Severe Open Tibial Fracture from the Physician and Patient Perspectives

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