Decision analysis techniques can help surgeons and patients make better choices about breast reconstruction, according to an article in the October issue of Plastic and Reconstructive Surgery®.
Decision analysis is “an exhaustive, iterative process that involves identifying alternatives, obtaining information about the uncertainty of outcomes, and clarifying preferences and values.” Routinely used in business, decision analysis is increasingly applied to complex medical decisions as well.
In the new paper, Mia K. Markey, PhD, and colleagues of The University of Texas at Austin and The University of Texas MD Anderson Cancer Center, Houston, outline a process that plastic surgeons can follow in guiding patients through decision analysis. The surgeon provides information about the available alternatives and the probability of different outcomes—for example, the need for repeated surgeries, possible complications, and aesthetic results. Based on the patient’s preferences, her values are assigned to possible outcomes.
This information is used to create a “decision tree,” incorporating the options, the likelihood of various outcomes, and the values assigned to each outcome.
A step called sensitivity analysis weighs the impact of changing different variables that might affect the decision—for example, different assumptions regarding the risk of complications or out-of-pocket costs. If the decision remains the same, it is considered robust, the researchers write.
A thoughtful decision analysis can help the patient reach a “good decision”—defined as “one that takes into account her preferences and the uncertainties inherent in reconstructive surgery.” The authors add, “By making good decisions, patient outcomes may be improved.” They are careful to point out that decisions are not outcomes, and outcomes are not decisions. Instead, outcomes result from decisions.
Although it can be “computationally intensive,” Dr Markey and coauthors believe decision analysis has important benefits for women facing decisions about breast reconstruction. They write, “Ideally, its application will attenuate worry, safeguard against regret, transmute uncertainty into certainty, and grant some measure of peace in what may ultimately be a very difficult decision.”
The special topic paper appears as ASPS prepares to observe National Breast Reconstruction Awareness Day on October 15, 2014.