The new tool, described in PLoS Medicine, presents the risks and benefits of these different options in the form of a roulette wheel. The patient spins the wheel, and can then directly visualize the chances of a particular treatment leading to benefit or harm.
The researchers, led by 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.
"Shared decision making has largely been adopted as an ideal way for physicians and patients to join together whenever there are decisions that need to be made about management of health care issues," say the researchers.
But 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, "and this is exacerbated when we try to deal in more extreme probabilities, such as 3 in 10,000."
The researchers believe that the roulette wheel could be an important advance in shared decision making because patients are offered visual--rather than numerical--displays of the probability of benefits and harms.
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All works published in PLoS Medicine are open access. Everything is immediately available without cost to anyone, anywhere--to read, download, redistribute, include in databases, and otherwise use--subject only to the condition that the original authorship is properly attributed. Copyright is retained by the authors. The Public Library of Science uses the Creative Commons Attribution License.
Citation: Hoffman JR, Wilkes MS, Day FC, Bell DS, Higa JK (2006) The roulette wheel: An aid to informed decision making. PLoS Med 3(6): e137.
PLEASE ADD THE LINK TO THE PUBLISHED ARTICLE IN ONLINE VERSIONS OF YOUR REPORT: http://dx.doi.org/10.1371/journal.pmed.0030137
PRESS-ONLY PREVIEW OF THE ARTICLE: http://www.plos.org/press/plme-03-06-hoffman.pdf
Related images for press use: http://www.plos.org/press/plme-03-06-hoffman.jpg
Caption: Roulette wheels of relative risks for an average 65 year-old man, whether or not he opts for PSA screening.
David Geffen School of Medicine
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PLoS Medicine is an open access, freely available international medical journal. It publishes original research that enhances our understanding of human health and disease, together with commentary and analysis of important global health issues. For more information, visit http://www.plosmedicine.org
About the Public Library of Science
The Public Library of Science (PLoS) is a non-profit organization of scientists and physicians committed to making the world's scientific and medical literature a freely available public resource. For more information, visit http://www.plos.org
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