Roulette wheel can aid treatment decisions
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Researchers from the University of California Los Angeles have developed a tool that they hope will help ease the burden of making difficult treatment decisions. It’s a roulette wheel that allows patients to visualize the probable outcomes associated with different treatment options for different diseases.
The roulette wheel can be adapted to represent any current clinical question and is based on “best current evidence,” according to its developers, Dr. Jerome R. Hoffman and colleagues.
For illustration purposes, Hoffman and colleagues describe inn the journal PLoS Medicine how a healthy 65-year-old man might use the roulette wheel to decide whether or not to be screened for prostate cancer with a standard PSA blood test.
By spinning the roulette wheel, the man sees that his chances of developing symptoms of prostate cancer in his lifetime are very small, regardless of whether he has the PSA test or not.
But he also learns that if he undergoes the PSA test and cancer is found, treating the cancer results in a 50-percent reduction in the chances of dying from prostate cancer.
However, the roulette wheel also shows him that he has a 58 percent chance of developing erectile dysfunction or incontinence because of treatment for prostate cancer.
Gone are the days when doctors dispensed advice and recommendations without involving the patient, note Hoffman and colleagues in their report. Shared decision making is now largely how decisions are made.
One of the problems with shared decision-making, however, is that doctors often present the risks and benefits of different treatments in a way that is not easily understood by patients.
“Many of us have trouble understanding numbers, particularly in the context of risk and probability,” write Hoffman and colleagues. “It is hard for anyone to comprehend the difference between a 7 percent chance and an 8 percent chance - is there a meaningful difference? - and this is exacerbated when we try to deal in more extreme probabilities, such as 3 in 10,000.”
Hoffman and colleagues are hopeful that the roulette wheel will help patients, in consultation with their doctor, make difficult treatment choices.
An interactive version of the roulette wheel on prostate cancer can be found at http://edoctoring.ncl.ac.uk/System_Check/psa_detect_html.
SOURCE: PLoS Medicine June 2006.
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