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Primer: using decision analysis to improve clinical decision making in urology

Nature Clinical Practice Urology volume 3, pages 439–448 (2006)Cite this article

Abstract

Many clinical decisions in urology involve uncertainty about the course of disease or the effectiveness of treatment. Many decisions also involve trade-offs; for example, an improvement in patient survival at the cost of an increased risk of treatment-related adverse effects. Decision analysis is a formal, quantitative method for systematically comparing the benefits and harms of alternative clinical strategies under circumstances of uncertainty. The basic steps in performing a decision analysis are to define the clinical scenario or problem, identify the clinical strategies to be considered in the decision, enumerate all of the important sequelae of each strategy and their associated probabilities, define the outcome of interest, and assign a value to each possible outcome. Health outcomes can be defined in a number of ways, including quality-adjusted survival. A key aspect of decision analysis is allowing the values of particular health outcomes to vary from patient to patient, depending on individual preferences. Decision analysis has already been used to assess a variety of prevention, screening and treatment decisions in urology, and there is much potential for its future application. Greater incorporation of decision-analytic techniques into urology research and clinical practice might improve decision making, and thereby improve patient outcomes.

Key Points

  • Decision analysis is a formal, quantitative method for systematically comparing the benefits and harms of alternative clinical strategies under circumstances of uncertainty

  • Decision analysis has been used to evaluate interventions for the prevention, screening, treatment or follow-up of prostate, bladder and testicular cancers, benign prostatic hyperplasia and other urologic conditions

  • Quality-adjusted life-years are a preferred outcome measure in decision analysis because they combine both quantity and quality of life

  • When decision analysis is used to inform individual patient decisions, the values of important health outcomes should reflect a patient's own preferences

  • Greater incorporation of decision-analytic techniques into urology research and clinical practice might improve decision making, and thereby improve patient outcomes

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Figure 1: Decision tree of a new therapy versus a standard therapy for a debilitating infection in elderly patients
Figure 2: Standard gamble
Figure 3: A Markov model of superficial bladder cancer
Figure 4: One-way sensitivity analysis on the probability of cure with a new therapy

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Author information

Authors and Affiliations

  1. Assistant Attending Outcomes Research Scientist,

    Elena B Elkin & Andrew J Vickers

  2. in the Department of Epidemiology and Biostatistics at Memorial Sloan–Kettering Cancer Center, Assistant Attending Research Methodologist, New York, NY

    Elena B Elkin & Andrew J Vickers

  3. Chairman of the Department of Quantitative Health Sciences at the Cleveland Clinic, Cleveland, OH, USA

    Michael W Kattan

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  1. Elena B Elkin
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  2. Andrew J Vickers
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  3. Michael W Kattan
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Correspondence to Elena B Elkin.

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Elkin, E., Vickers, A. & Kattan, M. Primer: using decision analysis to improve clinical decision making in urology. Nat Rev Urol 3, 439–448 (2006). https://doi.org/10.1038/ncpuro0556

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