BMC Med Inform Decis Mak - A regret theory approach to decision curve analysis: a novel method for eliciting decision makers' preferences and decision-making.

Tópicos

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Resumo

CKGROUND: Decision curve analysis (DCA) has been proposed as an alternative method for evaluation of diagnostic tests, prediction models, and molecular markers. However, DCA is based on expected utility theory, which has been routinely violated by decision makers. Decision-making is governed by intuition (system 1), and analytical, deliberative process (system 2), thus, rational decision-making should reflect both formal principles of rationality and intuition about good decisions. We use the cognitive emotion of regret to serve as a link between systems 1 and 2 and to reformulate DCA.METHODS: First, we analysed a classic decision tree describing three decision alternatives: treat, do not treat, and treat or no treat based on a predictive model. We then computed the expected regret for each of these alternatives as the difference between the utility of the action taken and the utility of the action that, in retrospect, should have been taken. For any pair of strategies, we measure the difference in net expected regret. Finally, we employ the concept of acceptable regret to identify the circumstances under which a potentially wrong strategy is tolerable to a decision-maker.RESULTS: We developed a novel dual visual analog scale to describe the relationship between regret associated with "omissions" (e.g. failure to treat) vs. "commissions" (e.g. treating unnecessary) and decision maker's preferences as expressed in terms of threshold probability. We then proved that the Net Expected Regret Difference, first presented in this paper, is equivalent to net benefits as described in the original DCA. Based on the concept of acceptable regret we identified the circumstances under which a decision maker tolerates a potentially wrong decision and expressed it in terms of probability of disease.CONCLUSIONS: We present a novel method for eliciting decision maker's preferences and an alternative derivation of DCA based on regret theory. Our approach may be intuitively more appealing to a decision-maker, particularly in those clinical situations when the best management option is the one associated with the least amount of regret (e.g. diagnosis and treatment of advanced cancer, etc).

Resumo Limpo

ckground decis curv analysi dca propos altern method evalu diagnost test predict model molecular marker howev dca base expect util theori routin violat decis maker decisionmak govern intuit system analyt delib process system thus ration decisionmak reflect formal principl ration intuit good decis use cognit emot regret serv link system reformul dcamethod first analys classic decis tree describ three decis altern treat treat treat treat base predict model comput expect regret altern differ util action taken util action retrospect taken pair strategi measur differ net expect regret final employ concept accept regret identifi circumst potenti wrong strategi toler decisionmakerresult develop novel dual visual analog scale describ relationship regret associ omiss eg failur treat vs commiss eg treat unnecessari decis maker prefer express term threshold probabl prove net expect regret differ first present paper equival net benefit describ origin dca base concept accept regret identifi circumst decis maker toler potenti wrong decis express term probabl diseaseconclus present novel method elicit decis maker prefer altern deriv dca base regret theori approach may intuit appeal decisionmak particular clinic situat best manag option one associ least amount regret eg diagnosi treatment advanc cancer etc

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