Intuitive weights of harm for therapeutic decision making in smear-negative pulmonary Tuberculosis

An interview study of physicians in India, Pakistan and Bangladesh

Chandrashekhar T. Sreeramareddy, Mahbubur Rahman, H. N. Harsha Kumar, Mohsin Shah, Ahmed Manadir Hossain, Md Abu Sayem, Juan M. Moreira, Jef Van Den Ende

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background: To estimate the amount of regret and weights of harm by omission and commission during therapeutic decisions for smear-negative pulmonary Tuberculosis. Methods. An interviewer-administered survey was done among young physicians in India, Pakistan and Bangladesh with a previously used questionnaire. The physicians were asked to estimate probabilities of morbidity and mortality related with disease and treatment and intuitive weights of omission and commission for treatment of suspected pulmonary Tuberculosis. A comparison with weights based on literature data was made. Results: A total of 242 physicians completed the interview. Their mean age was 28 years, 158 (65.3%) were males. Median probability (%) of mortality and morbidity of disease was estimated at 65% (inter quartile range [IQR] 50-75) and 20% (IQR 8-30) respectively. Median probability of morbidity and mortality in case of occurrence of side effects was 15% (IQR 10-30) and 8% (IQR 5-20) respectively. Probability of absolute treatment mortality was 0.7% which was nearly eight times higher than 0.09% reported in the literature data. The omission vs. commission harm ratios based on intuitive weights, weights calculated with literature data, weights calculated with intuitive estimates of determinants adjusted without and with regret were 3.0 (1.4-5.0), 16 (11-26), 33 (11-98) and 48 (11-132) respectively. Thresholds based on pure regret and hybrid model (clinicians' intuitive estimates and regret) were 25 (16.7-41.7), and 2(0.75-7.5) respectively but utility-based thresholds for clinicians' estimates and literature data were 2.9 (1-8.3) and 5.9 (3.7-7.7) respectively. Conclusion: Intuitive weight of harm related to false-negatives was estimated higher than that to false-positives. The mortality related to treatment was eightfold overestimated. Adjusting expected utility thresholds for subjective regret had little effect.

Original languageEnglish
Article number67
JournalBMC Medical Informatics and Decision Making
Volume14
Issue number1
DOIs
Publication statusPublished - 08-08-2014
Externally publishedYes

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Bangladesh
Pakistan
Pulmonary Tuberculosis
India
Decision Making
Interviews
Physicians
Weights and Measures
Emotions
Mortality
Morbidity
Therapeutics

All Science Journal Classification (ASJC) codes

  • Health Policy
  • Health Informatics

Cite this

Sreeramareddy, Chandrashekhar T. ; Rahman, Mahbubur ; Harsha Kumar, H. N. ; Shah, Mohsin ; Hossain, Ahmed Manadir ; Sayem, Md Abu ; Moreira, Juan M. ; Van Den Ende, Jef. / Intuitive weights of harm for therapeutic decision making in smear-negative pulmonary Tuberculosis : An interview study of physicians in India, Pakistan and Bangladesh. In: BMC Medical Informatics and Decision Making. 2014 ; Vol. 14, No. 1.
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Intuitive weights of harm for therapeutic decision making in smear-negative pulmonary Tuberculosis : An interview study of physicians in India, Pakistan and Bangladesh. / Sreeramareddy, Chandrashekhar T.; Rahman, Mahbubur; Harsha Kumar, H. N.; Shah, Mohsin; Hossain, Ahmed Manadir; Sayem, Md Abu; Moreira, Juan M.; Van Den Ende, Jef.

In: BMC Medical Informatics and Decision Making, Vol. 14, No. 1, 67, 08.08.2014.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Intuitive weights of harm for therapeutic decision making in smear-negative pulmonary Tuberculosis

T2 - An interview study of physicians in India, Pakistan and Bangladesh

AU - Sreeramareddy, Chandrashekhar T.

AU - Rahman, Mahbubur

AU - Harsha Kumar, H. N.

AU - Shah, Mohsin

AU - Hossain, Ahmed Manadir

AU - Sayem, Md Abu

AU - Moreira, Juan M.

AU - Van Den Ende, Jef

PY - 2014/8/8

Y1 - 2014/8/8

N2 - Background: To estimate the amount of regret and weights of harm by omission and commission during therapeutic decisions for smear-negative pulmonary Tuberculosis. Methods. An interviewer-administered survey was done among young physicians in India, Pakistan and Bangladesh with a previously used questionnaire. The physicians were asked to estimate probabilities of morbidity and mortality related with disease and treatment and intuitive weights of omission and commission for treatment of suspected pulmonary Tuberculosis. A comparison with weights based on literature data was made. Results: A total of 242 physicians completed the interview. Their mean age was 28 years, 158 (65.3%) were males. Median probability (%) of mortality and morbidity of disease was estimated at 65% (inter quartile range [IQR] 50-75) and 20% (IQR 8-30) respectively. Median probability of morbidity and mortality in case of occurrence of side effects was 15% (IQR 10-30) and 8% (IQR 5-20) respectively. Probability of absolute treatment mortality was 0.7% which was nearly eight times higher than 0.09% reported in the literature data. The omission vs. commission harm ratios based on intuitive weights, weights calculated with literature data, weights calculated with intuitive estimates of determinants adjusted without and with regret were 3.0 (1.4-5.0), 16 (11-26), 33 (11-98) and 48 (11-132) respectively. Thresholds based on pure regret and hybrid model (clinicians' intuitive estimates and regret) were 25 (16.7-41.7), and 2(0.75-7.5) respectively but utility-based thresholds for clinicians' estimates and literature data were 2.9 (1-8.3) and 5.9 (3.7-7.7) respectively. Conclusion: Intuitive weight of harm related to false-negatives was estimated higher than that to false-positives. The mortality related to treatment was eightfold overestimated. Adjusting expected utility thresholds for subjective regret had little effect.

AB - Background: To estimate the amount of regret and weights of harm by omission and commission during therapeutic decisions for smear-negative pulmonary Tuberculosis. Methods. An interviewer-administered survey was done among young physicians in India, Pakistan and Bangladesh with a previously used questionnaire. The physicians were asked to estimate probabilities of morbidity and mortality related with disease and treatment and intuitive weights of omission and commission for treatment of suspected pulmonary Tuberculosis. A comparison with weights based on literature data was made. Results: A total of 242 physicians completed the interview. Their mean age was 28 years, 158 (65.3%) were males. Median probability (%) of mortality and morbidity of disease was estimated at 65% (inter quartile range [IQR] 50-75) and 20% (IQR 8-30) respectively. Median probability of morbidity and mortality in case of occurrence of side effects was 15% (IQR 10-30) and 8% (IQR 5-20) respectively. Probability of absolute treatment mortality was 0.7% which was nearly eight times higher than 0.09% reported in the literature data. The omission vs. commission harm ratios based on intuitive weights, weights calculated with literature data, weights calculated with intuitive estimates of determinants adjusted without and with regret were 3.0 (1.4-5.0), 16 (11-26), 33 (11-98) and 48 (11-132) respectively. Thresholds based on pure regret and hybrid model (clinicians' intuitive estimates and regret) were 25 (16.7-41.7), and 2(0.75-7.5) respectively but utility-based thresholds for clinicians' estimates and literature data were 2.9 (1-8.3) and 5.9 (3.7-7.7) respectively. Conclusion: Intuitive weight of harm related to false-negatives was estimated higher than that to false-positives. The mortality related to treatment was eightfold overestimated. Adjusting expected utility thresholds for subjective regret had little effect.

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