Advertisement

Journal of General Internal Medicine

, Volume 1, Issue 3, pp 177–182 | Cite as

To test or not to test — To treat or not to treat

The decision-threshold approach to patient management
  • Stephen A. Eraker
  • Louis R. Eeckhoudt
  • Roland J. M. Vanbutsele
  • Thérèse C. Lebrun
  • Jean-Claude L. Sailly
Perspectives

Abstract

The inability to consider explicitly factors that should enter into clinical judgment compromises physician efforts to make cost-effective decisions regarding diagnostic testing and treatment. The authors describe the decision-threshold approach, a decision-analysis strategy that helps physicians identify an optimal test-treatment decision based upon the prior probability of disease, the characteristics of the test (sensitivity, specificity, risk), and the benefits/costs of treatment. They also present a microcomputer graphics program that makes the decision-threshold approach readily available to physicians.

Key words

decision-threshold analysis diagnostic testing treatment decisions 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Griner PF, Mayewski RJ, Mushlin AI, Greenland P. Selection and interpretation of diagnostic tests and procedures. Ann Intern Med 1981;94:553–600Google Scholar
  2. 2.
    Griner PF, Glaser RJ. Misuse of laboratory tests and diagnostic procedures. N Engl J Med 1982;307:1336–9CrossRefPubMedGoogle Scholar
  3. 3.
    Pauker SG, Kassirer JP. Therapeutic decision making: a cost-benefit analysis. N Engl J Med 1975;293:229–34CrossRefPubMedGoogle Scholar
  4. 4.
    Pauker SG, Kassirer JP. The threshold approach to clinical decision making. N Engl J Med 1980;302:1109–17CrossRefPubMedGoogle Scholar
  5. 5.
    Doubilet P. A mathematical approach to interpretation and selection of diagnostic tests. Med Decis Making 1983;3:177–95CrossRefPubMedGoogle Scholar
  6. 6.
    Eeckhout LR, Lebrun TC. Sailly JCL. The informative content of diagnostic tests: an economic analysis. Social Sci Med 1984;18:873–80CrossRefGoogle Scholar
  7. 7.
    Eraker SA, Sasse L. The serum digoxin test and digoxin toxicity: a bayesian approach to decision making. Circulation 1981;64:409–20CrossRefPubMedGoogle Scholar
  8. 8.
    Weinstein MC, Fineberg HV, Elstein AS, et al. Clinical decision analysis. Philadelphia: W. B. Saunders Company. 1980Google Scholar
  9. 9.
    Keeney RL, Raiffa H. Decisions with multiple objectives: preferences and value tradeoffs. New York: John Wiley & Sons, 1976.Google Scholar
  10. 10.
    Eraker SA. Politser P. How decisions are reached: physician and patient. Ann Intern Med 1982;97:262–8CrossRefPubMedGoogle Scholar
  11. 11.
    Beller GA, Smith TW, Abelmann WH, Haber E, Hood WB Jr. Digitalis intoxication: a prospective clinical study with serum level correlations. N Engl J Med 1971;284:989–97CrossRefPubMedGoogle Scholar
  12. 12.
    Greenes RA, Cain KC, Begg CB. Patient-oriented performance measures of diagnostic tests. Met Decis Making 1984;4:7–15CrossRefGoogle Scholar

Copyright information

© Society for Research and Education in Primary Care Internal Medicine 1986

Authors and Affiliations

  • Stephen A. Eraker
    • 1
  • Louis R. Eeckhoudt
  • Roland J. M. Vanbutsele
  • Thérèse C. Lebrun
  • Jean-Claude L. Sailly
  1. 1.Department of Internal MedicineVA Medical CenterSalt Lake City

Personalised recommendations