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Abstract
The aim of this research was to create and evaluate a decision aid to support a patient's ability to share in decision making, where the options available have uncertain benefits and potential harms. A color-coded matrix was used as the decision aid where randomly placed cells representing benefits, harms, and neutral outcomes in quantities corresponding to their respective likelihoods. An iterative approach generated an indifference point for a set of hypothesized decision scenarios. Forty-eight study participants were asked their preferences across 12 hypothesized cancer screening testing decisions. Plots of each participant's indifference curve and regions for accepting or rejecting a screening test regimen were used to illustrate how the method can be applied, and to illustrate that some participants' decision process was irrational. The decision aid provides a useful mechanism for communicating uncertain medical outcomes to patients. It can use helpful to assist in the implementation of patientcentered medical decision making. It can also identify patients who cannot effectively interpret information in a rational manner.
Keywords: Clinical decision making, shared medical decisions, decision aids
Introduction
It is becoming commonplace for medical office visits to include physician-patient discussions designed to empower health consumers to take ownership of their medical care. In fact, contemporary medical practice recommends a shared decision process, where patient and physicians discuss options (1). As more data become available concerning the benefits and risks of medical procedures, public health organizations have evolved from prescribing certain procedures to recommending that they be undertaken only after consultation with a medical professional. Notable examples include treatment options for chronic diseases (e.g., cancer, diabetes, anemia), some adult vaccines (e.g., pneumococcal disease, shingles), some elective surgeries (e.g., knee replacement, gastric bypass), pharmaceutical drug options (with potential for adverse effects), and cancer screening tests (e.g., prostate, colon, and breast). In these cases, a physician provides up-todate information but the patient makes the "final call."
The aim of this research was to create an intuitive visual aid to support an individual's decision-making where medical decisions involve uncertain benefits and potential harms. It would replace a one-size-fitsall recommendation in favor of an action plan for an individual or a customized recommendation for a homogeneous group. The example used in this article concerns cancer screening, although the decision aid has...