Dual Processing Model for Medical Decision-Making: An Extension to Diagnostic TestingReport as inadecuate




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Dual Processing Theories DPT assume that human cognition is governed by two distinct types of processes typically referred to as type 1 intuitive and type 2 deliberative. Based on DPT we have derived a Dual Processing Model DPM to describe and explain therapeutic medical decision-making. The DPM model indicates that doctors decide to treat when treatment benefits outweigh its harms, which occurs when the probability of the disease is greater than the so called -threshold probability- at which treatment benefits are equal to treatment harms. Here we extend our work to include a wider class of decision problems that involve diagnostic testing. We illustrate applicability of the proposed model in a typical clinical scenario considering the management of a patient with prostate cancer. To that end, we calculate and compare two types of decision-thresholds: one that adheres to expected utility theory EUT and the second according to DPM. Our results showed that the decisions to administer a diagnostic test could be better explained using the DPM threshold. This is because such decisions depend on objective evidence of test-treatment benefits and harms as well as type 1 cognition of benefits and harms, which are not considered under EUT. Given that type 1 processes are unique to each decision-maker, this means that the DPM threshold will vary among different individuals. We also showed that when type 1 processes exclusively dominate decisions, ordering a diagnostic test does not affect a decision; the decision is based on the assessment of benefits and harms of treatment. These findings could explain variations in the treatment and diagnostic patterns documented in today’s clinical practice.



Author: Athanasios Tsalatsanis, Iztok Hozo, Ambuj Kumar, Benjamin Djulbegovic

Source: http://plos.srce.hr/



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