June 14th, 2006
Playing roulette with your physician
A recent issue of PLoS Medicine describes a visual tool that might help patients to choose between several medical treatments. This aid to informed decision making, developed at UCLA, displays the risks and benefits of different options in the form of a roulette wheel. Once the patient spins the wheel, he can see if a particular treatment will be good or bad for him. The process of shared decision making is not new, but instead of being offered probabilities and numbers, this tool offers a visual help to patients. But read more before playing roulette for a better health.
Here is an introduction from PLoS Medicine.
The researchers, led by [UCLA physician] Jerome Hoffman, show how the roulette wheel could help a healthy 65-year old man decide whether or not to be screened for prostate cancer (the screening test is a blood test called the PSA).
By spinning the roulette wheel, the man sees that if he decides to get a PSA test, he may slightly lower his risk of dying from prostate cancer but he also greatly increases the chances of becoming incontinent and/or impotent from prostate cancer treatment. The roulette wheel shows him that his chances of developing symptoms of prostate cancer are very small, whether or not he gets screened.
And as an image is better than a thousand words, the figure below illustrates what the patient could see in this particular case (Credit: Jerome Hoffman/PLoS Medicine).
This second figure shows the relative risks associated with a hypothetical treatment (Credit: Jerome Hoffman/PLoS Medicine). The roulette gives a clear warning: without treatment, the patient will die. I guess I’ll choose the treatment in this particular case.
But in more ambiguous cases, how this roulette wheel will help patients to take better decisions?
One of the problems with shared decision making, they say, is that physicians have traditionally presented the risks and benefits of different treatments in the form of numbers, which many people have trouble understanding. "It is hard for anyone to comprehend the difference between a 7% chance and an 8% chance," they say.
For more information about this visual tool, the research work has been published in the PLoS Medicine journal under the name "The Roulette Wheel: An Aid to Informed Decision Making" (Volume 3, Issue 6, June 2006).
Here are two links to this paper in text format and in PDF format (6 pages, 603 KB). The above illustrations come from this paper which also warns about some limitations.
It is possible that for some patients magical thinking could be applied even to the roulette wheel, such that they would believe that the outcome they obtain on a sample spin (or series of spins) in a physician’s office would predict what will actually happen to them should they choose to follow such a strategy "in real life." It is also possible that other patients will object to using the roulette wheel because of religious (or other) objections to "gambling." For both these reasons, it will be important for physicians to emphasize that the tool is designed only to demonstrate the likely potential hazards of alternate strategies.
Finally, if you want to discover more, you can try an online version of this roulette wheel.
Sources: PLoS Medicine news release, via EurekAlert!, June 12, 2006; and various web sites
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