Deciding the fast & frugal way on the application of pharmacodiagnostic tests in cancer care? [Elektronische Ressource] : a comparative study of oncologists', pathologists', and cancer patients' decision making in Germany / von: Odette Wegwarth

Odette Wegwarth

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Deciding the Fast & Frugal Way on the Application of Pharmacodiagnostic Tests in Cancer Care? A Comparative Study of Oncologists’, Pathologists’, and Cancer Patients’ Decision Making in Germany and the USA Dissertation zur Erlangung des akademischen Grades doctor rerum naturalium (Dr. rer. nat.) im Fach Psychologie Eingereicht an der Mathematisch-Naturwissenschaftlichen Fakultät II Humboldt-Universität zu Berlin Von: Dipl.-Psych. Odette Wegwarth 11.06.1973, Salzwedel 1Präsident der Humboldt-Universität zu Berlin Prof. Dr. Christoph Markschies Dekan der Mathematisch-Naturwissenschaftlichen Fakultät II Prof. Dr. Wolfgang Coy Gutachter: 1. Prof. Gerd Gigerenzer 2. Prof. Wolfgang Scholl 3. Prof. Ulrich Hoffrage Tag der Verteidigung: 20.04.2007 2 3µµµµµ Acknowledgement For the outstanding scientific contributions, excellent discussions, exceptional advising, great inspirations, substantial work and generous support, heavy programming, nice designing, helpful comments on earlier drafts of this work, important proofreading, patience, friendship, trust, and love I would like to thank: Gerd Gigerenzer – Steffi Kurzenhäuser – Wolfgang Scholl – Ulrich Hoffrage – Robert W.

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• Gesundheit

Informations

• Publié par: humboldt-universitat_zu_berlin
• Publié le: 01 janvier 2007
• Nombre de lectures: 16
• Langue: English
• Poids de l'ouvrage: 1 Mo

Extrait

Deciding the Fast & Frugal Way on the Application of
Pharmacodiagnostic Tests in Cancer Care?
A Comparative Study of Oncologists’, Pathologists’, and Cancer
Patients’ Decision Making in Germany and the USA


Dissertation
zur Erlangung des akademischen Grades doctor rerum naturalium (Dr. rer. nat.)
im Fach Psychologie





Eingereicht an der
Mathematisch-Naturwissenschaftlichen Fakultät II
Humboldt-Universität zu Berlin


Von:
Dipl.-Psych. Odette Wegwarth
11.06.1973, Salzwedel


1Präsident der Humboldt-Universität zu Berlin
Prof. Dr. Christoph Markschies


Dekan der Mathematisch-Naturwissenschaftlichen Fakultät II
Prof. Dr. Wolfgang Coy




Gutachter:
1. Prof. Gerd Gigerenzer
2. Prof. Wolfgang Scholl
3. Prof. Ulrich Hoffrage



Tag der Verteidigung: 20.04.2007
2 3
Acknowledgement

For the outstanding scientific contributions, excellent discussions, exceptional advising, great
inspirations, substantial work and generous support, heavy programming, nice designing,
helpful comments on earlier drafts of this work, important proofreading, patience, friendship,
trust, and love I would like to thank:

Gerd Gigerenzer – Steffi Kurzenhäuser – Wolfgang Scholl – Ulrich Hoffrage – Robert W.
Day – Gregor Lämmel – Juliet Conlin – Henrik Olsson – Jörg Rieskamp – Wolfgang
Gaissmaier – Ulrich Klocke – Anita Todd – Christel Fraser – The ABC Group – The HU
Colloquium

Epigenomics AG – Torsten Horns – Patricia Jaecklin – Fabian Model – Dennis Bieling –
Robert Sander – Carolina Haefliger – Sabine Maier – Achim Plum

699 mainly unknown participants of the studies

Prof. K. Possinger – Dr. Th. Decker – Dr. R. Pauli – Dr. Sabine von Österreich – Dr. F.
Strohbach – Prof. A. Tannapfel
Deutsche Krebsgesellschaft eV – Gilda’s Club Worldwide – Komen Breast Cancer
Foundation & C.J. – Mamazone – Pink – Inka
Städtische Klinikum Magdeburg – Online Zeitung „Krebs & Mensch“ – Krebs-Kompass –
Deutsche Gesellschaft für Pathologie – Berufsverband Deutscher Pathologen
Arbeitsgemeinschaft Deutscher Tumorzentren – Nord-Ostdeutsche Gesellschaft für
Gynäkologische Onkologie – Deutsches Netzwerk Evidenzbasierter Medizin

Anne – Claudia – Hanene – Tine – Anja – Arne

Daniel and my parents

This thesis could not have been accomplished without you.
4
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1 An Introduction _______________________________________________________ 15
1.1 Cancer___________________________________________________________ 15
1.2 Cancer Treatments ________________________________________________ 16
1.3 Pharmacodiagnostic Testing_________________________________________ 18
1.4 The Goal of the Thesis______________________________________________ 21
2 When Physicians Have to Decide: A Case of Complexity? _____________________ 23
2.1 Some Words About Certain Uncertainty in Medicine____________________ 24
2.2 Condition of Medical Decision-Making Tasks __________________________ 25
2.2.1 Decisions on Tests: A case of Task Complexity or the Bite of Bayes ______ 25
2.2.2 Do Pharmacodiagnostic Tests Have the Potential to Smart Task Complexity
and Uncertainty? _______________________________________________________ 29
2.2.3 Time Pressure _________________________________________________ 30
2.2.4 Quality of Information___________________________________________ 30
2.2.5 Outcome Feedback _____________________________________________ 31
2.2.6 Cost of Health Care 31
2.2.7 Medical Guidelines 32
2.2.8 Last But Not Least: Patients’ Meddling In ___________________________ 33
2.2.9 Unbounded Bounded? 34
2.2.10 Clearing Up the Sky by Offering Bounds ____________________________ 36
2.2.11 Heuristic = Bias? _______________________________________________ 36
2.2.12 Do It Fast, Do It Frugal! _________________________________________ 38
3 Study 1: Discovering Oncologists’ Test Decision Making ______________________ 41
3.1 Pilot Study _______________________________________________________ 41
3.1.1 Design 41
3.1.2 Procedure_____________________________________________________ 41
3.2 Sample characteristics_________________________________________________ 43
3.2.1 Participants ___________________________________________________ 43
53.2.2 Analytical Procedure ____________________________________________ 44
3.2.3 Results _______________________________________________________ 44
3.3 Implications for the Main Study: Do Oncologists Have a Utility Function in
Their Minds? ___________________________________________________________ 50
3.4 Dive Into the Bliss of Researching Human Judgment and Decision Making _52
3.5 Main Study 54
3.5.1 Introduction ___________________________________________________ 54
3.5.2 Design _______________________________________________________ 55
3.5.3 Procedure_____________________________________________________ 59
3.5.4 Participants 61
3.5.5 Analysis Considerations _________________________________________ 63
3.5.6 Results 70
3.6 Summary & Discussion_____________________________________________ 88
4 Study 2: What Role Do The Pathologists Play? ______________________________ 95
4.1 Pilot Study _______________________________________________________ 95
4.1.1 Design 95
4.1.2 Procedure_____________________________________________________ 95
4.1.3 Participants ___________________________________________________ 97
4.1.4 Analytical Procedure ____________________________________________ 97
4.2 Sample characteristic _________________________________________________ 98
4.2.1 Results 98
4.3 Implications for the Main Study – Do Pathologists Juggle With Cues Weights
They Only Feel?________________________________________________________ 102
4.4 Main study ______________________________________________________ 104
4.4.1 Design 105
4.4.2 Procedure____________________________________________________ 108
4.4.3 Participants __________________________________________________ 110
4.4.4 Analysis Considerations ________________________________________ 112
4.4.5 Results 116
64.5 Summary & Discussion____________________________________________ 134
5 The Idea of Shared Decision Making—Or: Does It Always Need Two to Tango? __ 140
5.1 Is to Tango Desired in the Field of Cancer? ___________________________ 142
5.2 Pilot Study ______________________________________________________ 145
5.2.1 Design 145
5.2.2 Procedure____________________________________________________ 147
5.2.3 Participants __________________________________________________ 147
5.2.4 Analytical Procedure ___________________________________________ 149
5.2.5 Results 149
5.3 Implication for the Main Study: Is There Anything to Tango Regarding Tests?
153
5.4 Main Study______________________________________________________ 155
5.4.1 Introduction __________________________________________________ 155
5.4.2 Design 156
5.4.3 Procedure____________________________________________________ 160
5.4.4 Participants 162
5.4.5 Analysis Considerations ________________________________________ 166
5.4.6 Results 168
5.5 Summary & Discussion____________________________________________ 185
6 What Have We Learned (So Far)?: Final Discussion and Conclusion Remarks ___ 190
6.1 Model Concerns or the Data’s New Clothes ___________________________ 190
6.2 Implications for Research in Medical Decision Making _________________ 192
6.3 The Issue With Hypothetical “Paper” Cases and Some Other Methodological
Concerns______________________________________________________________ 195
6.3.1 Some Words on the Matching Heuristic ____________________________ 197
6.4 Implications for the Health System __________________________________ 198
References_______________________________________________________________ 200

7
List of Figures
Figure 3.1: Example of a flowchart of Matching Heuristic searching through a maximum
of two cues (K = 2 model). ___________________________________________________ 68
Figure 3.2: Proportion of yes-choices per country for all oncologists (All_oncologists) as
well as separated between oncologists coming from university clinics (Uni_oncologists),
hospitals (Hospital_oncologists), and private practices (Practice_oncologists). _________ 71
Figure. 3.3: Disagreement over all 18 cases (9 per version) of the German oncologist sample
(mean: 95% CI) for all oncologists (All_oncologists) as well as separated between
oncologists coming from university clinics (Uni_oncologists), hospitals
(Hospital_oncologists), and private practices (Practice_oncologists) _________________ 72
Figure 3.4: Disagreement over all 18 cases (9 per version) of the US oncologist sample
(mean: 95%
(Hospital_oncologists), and private practices (Practice_oncologists). _________________ 73
Figure 3.5: Proportion of the Best Fitting Model for a Participant’s overall Choice
Behavior provided by either Franklin’s rule, Dawes’ rule, Matching Heuristic, or by two or
all Models for the German and the US oncologists. _______________________