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Published in: BMC Medical Informatics and Decision Making 1/2014

Open Access 01-12-2014 | Research article

How do physicians decide to treat: an empirical evaluation of the threshold model

Authors: Benjamin Djulbegovic, Shira Elqayam, Tea Reljic, Iztok Hozo, Branko Miladinovic, Athanasios Tsalatsanis, Ambuj Kumar, Jason Beckstead, Stephanie Taylor, Janice Cannon-Bowers

Published in: BMC Medical Informatics and Decision Making | Issue 1/2014

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Abstract

Background

According to the threshold model, when faced with a decision under diagnostic uncertainty, physicians should administer treatment if the probability of disease is above a specified threshold and withhold treatment otherwise. The objectives of the present study are to a) evaluate if physicians act according to a threshold model, b) examine which of the existing threshold models [expected utility theory model (EUT), regret-based threshold model, or dual-processing theory] explains the physicians’ decision-making best.

Methods

A survey employing realistic clinical treatment vignettes for patients with pulmonary embolism and acute myeloid leukemia was administered to forty-one practicing physicians across different medical specialties. Participants were randomly assigned to the order of presentation of the case vignettes and re-randomized to the order of “high” versus “low” threshold case. The main outcome measure was the proportion of physicians who would or would not prescribe treatment in relation to perceived changes in threshold probability.

Results

Fewer physicians choose to treat as the benefit/harms ratio decreased (i.e. the threshold increased) and more physicians administered treatment as the benefit/harms ratio increased (and the threshold decreased). When compared to the actual treatment recommendations, we found that the regret model was marginally superior to the EUT model [Odds ratio (OR) = 1.49; 95% confidence interval (CI) 1.00 to 2.23; p = 0.056]. The dual-processing model was statistically significantly superior to both EUT model [OR = 1.75, 95% CI 1.67 to 4.08; p < 0.001] and regret model [OR = 2.61, 95% CI 1.11 to 2.77; p = 0.018].

Conclusions

We provide the first empirical evidence that physicians’ decision-making can be explained by the threshold model. Of the threshold models tested, the dual-processing theory of decision-making provides the best explanation for the observed empirical results.
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Metadata
Title
How do physicians decide to treat: an empirical evaluation of the threshold model
Authors
Benjamin Djulbegovic
Shira Elqayam
Tea Reljic
Iztok Hozo
Branko Miladinovic
Athanasios Tsalatsanis
Ambuj Kumar
Jason Beckstead
Stephanie Taylor
Janice Cannon-Bowers
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Medical Informatics and Decision Making / Issue 1/2014
Electronic ISSN: 1472-6947
DOI
https://doi.org/10.1186/1472-6947-14-47

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