, Volume 24, Issue 5, pp 642-648,
Open Access This content is freely available online to anyone, anywhere at any time.
Date: 27 Feb 2009

Tips for Teachers of Evidence-based Medicine: Making Sense of Decision Analysis Using a Decision Tree

Abstract

Decision analysis is a tool that clinicians can use to choose an option that maximizes the overall net benefit to a patient. It is an explicit, quantitative, and systematic approach to decision making under conditions of uncertainty. In this article, we present two teaching tips aimed at helping clinical learners understand the use and relevance of decision analysis. The first tip demonstrates the structure of a decision tree. With this tree, a clinician may identify the optimal choice among complicated options by calculating probabilities of events and incorporating patient valuations of possible outcomes. The second tip demonstrates how to address uncertainty regarding the estimates used in a decision tree. We field tested the tips twice with interns and senior residents. Teacher preparatory time was approximately 90 minutes. The field test utilized a board and a calculator. Two handouts were prepared. Learners identified the importance of incorporating values into the decision-making process as well as the role of uncertainty. The educational objectives appeared to be reached. These teaching tips introduce clinical learners to decision analysis in a fashion aimed to illustrate principles of clinical reasoning and how patient values can be actively incorporated into complex decision making.

Members of the Evidence-Based Medicine Teaching Tips Working Group: Peter C. Wyer (project director), College of Physicians and Surgeons, Columbia University, New York, NY; Deborah Cook, Gordon Guyatt (general editor), Ted Haines, Roman Jaeschke, McMaster University, Hamilton, ON.; Rose Hatala, University of British Columbia, Vancouver, BC; Robert Hayward (editor, online version), Bruce Fisher, University of Alberta, Edmonton, AL.; Sheri Keitz (field test coordinator), University of Miami Miller School of Medicine, Miami, FL; Alexandra Barratt, University of Sydney, Sydney, Australia; Antonio L. Dans, University of the Philippines College of Medicine, Manila, The Philippines; Cassie Kennedy and Victor M Montori, Mayo Clinic College of Medicine, Rochester, MN; Jennifer Kleinbart, Emory University School of Medicine, Atlanta, GA; Anna Lee, Anthony Ho and Gavin M Joynt, The Chinese University of Hong Kong; Rosanne Leipzig, Thomas McGinn, Mount Sinai Medical Center, New York, NY; Virginia Moyer, Baylor College of Medicine, Houston, TX; Thomas B. Newman, University of California, San Francisco, San Francisco, CA; Kameshwar Prasad, All India Institute of Medical Sciences, New Delhi, India; W. Scott Richardson, Wright State University, Dayton, OH; Mark C. Wilson, University of Iowa, Iowa City, IA.