Decision modeling of disagreements: pediatric hematologists' management of idiopathic thrombocytopenic purpura.

Harold P Lehmann, Nkossi Dambita, James F Casella, James F. Casella, Decision Group of the TMH Pediatric Subcommittee ITP Decision Group of the TMH Pediatric Subcommittee

Research output: Contribution to journalArticle

Abstract

To identify core disagreements between pediatric hematologists who would treat children with idiopathic thrombocytopenic purpura (ITP) on initial presentation ("Treaters") and those who would treat by observation ("Observers"), to determine whether each group's preferred stance was consistent with each individual's detailed perceptions, and to identify key variables in each stance. A decision model was constructed in collaboration with experts, and a detailed questionnaire was presented to a nationally representative committee of 25 pediatric hematologists. A full decision tree was specified for each respondent. Nineteen (76%) experts responded; based on preference for initial treatment, 9 were Treaters and 10 Observers. Of the 30 probability/effectiveness variables, 8--almost all concerning treatment effectiveness--had at least one statistically-significant difference between the 2 groups regarding low, best, or high estimates. To convince Observers that treatment is effective would take a clinical trial with between 39 000 and 87 000 participants; to convince Treaters that treatment is not effective enough, between 97 000 and 114 000 participants. Observers' calculated numbers needed to treat (NNTs) of about 150 000 are more consistent (P = 0.0023) with their elicited maximum NTTs of about 500. Physicians not specifically trained provided enough data to specify complete individual decision models. From the estimates provided, no practical clinical trial could convince hematologists who would treat children on initial presentation with ITP just to simply observe them or could convince those who would just observe to instead treat with available agents. Perceived burdens could be better characterized, perhaps by including parental perceptions and preferences.

Original languageEnglish (US)
Pages (from-to)805-815
Number of pages11
JournalMedical Decision Making
Volume31
Issue number6
StatePublished - Nov 2011

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Idiopathic Thrombocytopenic Purpura
Decision Support Techniques
Pediatrics
Pragmatic Clinical Trials
Numbers Needed To Treat
Decision Trees
Therapeutics
Observation
Clinical Trials
Physicians
Surveys and Questionnaires

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Lehmann, H. P., Dambita, N., Casella, J. F., Casella, J. F., & ITP Decision Group of the TMH Pediatric Subcommittee, D. G. O. T. TMH. P. S. (2011). Decision modeling of disagreements: pediatric hematologists' management of idiopathic thrombocytopenic purpura. Medical Decision Making, 31(6), 805-815.

Decision modeling of disagreements : pediatric hematologists' management of idiopathic thrombocytopenic purpura. / Lehmann, Harold P; Dambita, Nkossi; Casella, James F; Casella, James F.; ITP Decision Group of the TMH Pediatric Subcommittee, Decision Group of the TMH Pediatric Subcommittee.

In: Medical Decision Making, Vol. 31, No. 6, 11.2011, p. 805-815.

Research output: Contribution to journalArticle

Lehmann, HP, Dambita, N, Casella, JF, Casella, JF & ITP Decision Group of the TMH Pediatric Subcommittee, DGOTTMHPS 2011, 'Decision modeling of disagreements: pediatric hematologists' management of idiopathic thrombocytopenic purpura.', Medical Decision Making, vol. 31, no. 6, pp. 805-815.
Lehmann HP, Dambita N, Casella JF, Casella JF, ITP Decision Group of the TMH Pediatric Subcommittee DGOTTMHPS. Decision modeling of disagreements: pediatric hematologists' management of idiopathic thrombocytopenic purpura. Medical Decision Making. 2011 Nov;31(6):805-815.
Lehmann, Harold P ; Dambita, Nkossi ; Casella, James F ; Casella, James F. ; ITP Decision Group of the TMH Pediatric Subcommittee, Decision Group of the TMH Pediatric Subcommittee. / Decision modeling of disagreements : pediatric hematologists' management of idiopathic thrombocytopenic purpura. In: Medical Decision Making. 2011 ; Vol. 31, No. 6. pp. 805-815.
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