ABSTRACT
Bayesian inference in medical decision making is a concept that has a long history with 3 essential developments: 1) the recognition of the need for data (demonstrable scientific evidence), 2) the development of probability, and 3) the development of inverse probability. Beginning with the demonstrative evidence of the physician's sign, continuing through the development of probability theory based on considerations of games of chance, and ending with the work of Jakob Bernoulli, Laplace, and others, we will examine how Bayesian inference developed.
Subject(s)
Bayes Theorem , Decision Support Techniques , Diagnosis, Differential , Evidence-Based Medicine/history , Probability , England , History, 17th Century , History, 18th Century , History, 19th Century , History, 20th Century , History, 21st Century , HumansSubject(s)
Decision Making , Judgment , Judicial Role , Liability, Legal , Cost-Benefit Analysis , Humans , Logic , Paternalism , Social Justice , United StatesABSTRACT
OBJECTIVE: The goal of this study was to gain understanding about patients' perspectives on decision making in the context of invasive medical interventions and whether patients' decision-making preferences influenced the type of information they desired to be provided by physicians. DESIGN: Questionnaire study of consecutive patients in a university-based general medicine clinic. INTERVENTIONS: Patients were presented with a randomized list of three types of information that physicians could provide (risk, benefit and physician's opinion on whether they should undergo the procedure). Patients were asked whether they preferred patient-based, physician-based, or shared decision making and then were asked to select which one or combination of these three information types was most important to them in their own decision making. Patients were also asked to self-report on how many invasive procedures they had undergone in their own lives. PARTICIPANTS: A total of 202 consecutive patients (mean age = 65.1 years, SD = 12.3, range 28-88; mean education 13.3 years, SD 2.9, range 2-23). MAIN OUTCOME MEASURES: Patient reports. RESULTS: Of the 202 patients, two patients reported no decision-making preference. These two patients were excluded from the analysis. Of the 200 remaining patients, 62.5% (125/200) preferred shared, 22.5%(45/200) preferred physician-based, and 15.5% (31/200) preferred patient-based decision making. More than half of all subjects chose physician opinion as the most important type of information for decision making. Older patients (odds ratio 1.028; confidence interval 1.003-1.053) were more likely to have ranked the doctor's opinion as the most important in their decision making for invasive medical interventions. CONCLUSIONS: Although most patients want to share decision making with their physicians regarding invasive procedures, the majority of these patients report relying on the doctor's opinion on whether to undergo the procedure as the most important information in their own decision making.
