Helping Patients and Physicians Reach Individualized Medical Decisions: Theory and Application to Prenatal Diagnostic Testing Edi Karni, Moshe Leshno, and Sivan Rapaport Edi Karni, Moshe Leshno, and Sivan Rapaport (Institute) Helping Patients and Physicians Reach Individualized Medical Decisions: Theory and Applic 1 / 18
The Problem A patient must choose among alternative courses of action, including Edi Karni, Moshe Leshno, and Sivan Rapaport (Institute) Helping Patients and Physicians Reach Individualized Medical Decisions: Theory and Applic 2 / 18
The Problem A patient must choose among alternative courses of action, including a treatment, Edi Karni, Moshe Leshno, and Sivan Rapaport (Institute) Helping Patients and Physicians Reach Individualized Medical Decisions: Theory and Applic 2 / 18
The Problem A patient must choose among alternative courses of action, including a treatment, a physician to administer it, Edi Karni, Moshe Leshno, and Sivan Rapaport (Institute) Helping Patients and Physicians Reach Individualized Medical Decisions: Theory and Applic 2 / 18
The Problem A patient must choose among alternative courses of action, including a treatment, a physician to administer it, a medical facility in which the treatment is to be administered. Edi Karni, Moshe Leshno, and Sivan Rapaport (Institute) Helping Patients and Physicians Reach Individualized Medical Decisions: Theory and Applic 2 / 18
The Considerations The alternatives might be complex, involving assessment of: Edi Karni, Moshe Leshno, and Sivan Rapaport (Institute) Helping Patients and Physicians Reach Individualized Medical Decisions: Theory and Applic 3 / 18
The Considerations The alternatives might be complex, involving assessment of: risks and values Edi Karni, Moshe Leshno, and Sivan Rapaport (Institute) Helping Patients and Physicians Reach Individualized Medical Decisions: Theory and Applic 3 / 18
The Considerations The alternatives might be complex, involving assessment of: risks and values …nancial consequences Edi Karni, Moshe Leshno, and Sivan Rapaport (Institute) Helping Patients and Physicians Reach Individualized Medical Decisions: Theory and Applic 3 / 18
The Considerations The alternatives might be complex, involving assessment of: risks and values …nancial consequences lifestyle and family considerations Edi Karni, Moshe Leshno, and Sivan Rapaport (Institute) Helping Patients and Physicians Reach Individualized Medical Decisions: Theory and Applic 3 / 18
The Considerations The alternatives might be complex, involving assessment of: risks and values …nancial consequences lifestyle and family considerations These are di¢cult to assess as wholes. Instead Edi Karni, Moshe Leshno, and Sivan Rapaport (Institute) Helping Patients and Physicians Reach Individualized Medical Decisions: Theory and Applic 3 / 18
The Considerations The alternatives might be complex, involving assessment of: risks and values …nancial consequences lifestyle and family considerations These are di¢cult to assess as wholes. Instead Identify the di¤erent components Edi Karni, Moshe Leshno, and Sivan Rapaport (Institute) Helping Patients and Physicians Reach Individualized Medical Decisions: Theory and Applic 3 / 18
The Considerations The alternatives might be complex, involving assessment of: risks and values …nancial consequences lifestyle and family considerations These are di¢cult to assess as wholes. Instead Identify the di¤erent components Evaluate the separately Edi Karni, Moshe Leshno, and Sivan Rapaport (Institute) Helping Patients and Physicians Reach Individualized Medical Decisions: Theory and Applic 3 / 18
The Considerations The alternatives might be complex, involving assessment of: risks and values …nancial consequences lifestyle and family considerations These are di¢cult to assess as wholes. Instead Identify the di¤erent components Evaluate the separately Aggregate these evaluations to generate a decision criterion. Edi Karni, Moshe Leshno, and Sivan Rapaport (Institute) Helping Patients and Physicians Reach Individualized Medical Decisions: Theory and Applic 3 / 18
The Inputs The doctor’s input Edi Karni, Moshe Leshno, and Sivan Rapaport (Institute) Helping Patients and Physicians Reach Individualized Medical Decisions: Theory and Applic 4 / 18
The Inputs The doctor’s input specifying the alternative treatments Edi Karni, Moshe Leshno, and Sivan Rapaport (Institute) Helping Patients and Physicians Reach Individualized Medical Decisions: Theory and Applic 4 / 18
The Inputs The doctor’s input specifying the alternative treatments describing the possible medical outcomes Edi Karni, Moshe Leshno, and Sivan Rapaport (Institute) Helping Patients and Physicians Reach Individualized Medical Decisions: Theory and Applic 4 / 18
The Inputs The doctor’s input specifying the alternative treatments describing the possible medical outcomes providing an assessment of the risks associated with each treatment, facility and physician. Edi Karni, Moshe Leshno, and Sivan Rapaport (Institute) Helping Patients and Physicians Reach Individualized Medical Decisions: Theory and Applic 4 / 18
The Inputs The doctor’s input specifying the alternative treatments describing the possible medical outcomes providing an assessment of the risks associated with each treatment, facility and physician. The patient’s input Edi Karni, Moshe Leshno, and Sivan Rapaport (Institute) Helping Patients and Physicians Reach Individualized Medical Decisions: Theory and Applic 4 / 18
The Inputs The doctor’s input specifying the alternative treatments describing the possible medical outcomes providing an assessment of the risks associated with each treatment, facility and physician. The patient’s input His personal valuation of the potential medical outcomes Edi Karni, Moshe Leshno, and Sivan Rapaport (Institute) Helping Patients and Physicians Reach Individualized Medical Decisions: Theory and Applic 4 / 18
The Inputs The doctor’s input specifying the alternative treatments describing the possible medical outcomes providing an assessment of the risks associated with each treatment, facility and physician. The patient’s input His personal valuation of the potential medical outcomes His …nancial and other concerns, such as it impact on his lifestyle and family. Edi Karni, Moshe Leshno, and Sivan Rapaport (Institute) Helping Patients and Physicians Reach Individualized Medical Decisions: Theory and Applic 4 / 18
The Approach Normative but not paternalistic Edi Karni, Moshe Leshno, and Sivan Rapaport (Institute) Helping Patients and Physicians Reach Individualized Medical Decisions: Theory and Applic 5 / 18
The Approach Normative but not paternalistic Normative - The presumption is that the patient would like his decision to be governed by the principles (axioms) of expected utility theory, which we take as normatively compelling. Edi Karni, Moshe Leshno, and Sivan Rapaport (Institute) Helping Patients and Physicians Reach Individualized Medical Decisions: Theory and Applic 5 / 18
The Approach Normative but not paternalistic Normative - The presumption is that the patient would like his decision to be governed by the principles (axioms) of expected utility theory, which we take as normatively compelling. Non-paternalistic - the recommended course of action maximizes the patient’s expected utility, but is silent on what this utility should be. The patient is the ultimate arbiter of his own well-being. Edi Karni, Moshe Leshno, and Sivan Rapaport (Institute) Helping Patients and Physicians Reach Individualized Medical Decisions: Theory and Applic 5 / 18
The Model c - a vector of the patient’s characteristics (medical history, age, gender, race, etc.) Edi Karni, Moshe Leshno, and Sivan Rapaport (Institute) Helping Patients and Physicians Reach Individualized Medical Decisions: Theory and Applic 6 / 18
The Model c - a vector of the patient’s characteristics (medical history, age, gender, race, etc.) a - action (treatment, doctor, medical facility) Edi Karni, Moshe Leshno, and Sivan Rapaport (Institute) Helping Patients and Physicians Reach Individualized Medical Decisions: Theory and Applic 6 / 18
The Model c - a vector of the patient’s characteristics (medical history, age, gender, race, etc.) a - action (treatment, doctor, medical facility) < � preference relation on the set of actions is represented by ( a , c ) 7! λ ( a ) ∑ U ( f ( ω ; a , c ) , ω ) p ( ω j a , c ) + v ( a ) . ω 2 Ω Edi Karni, Moshe Leshno, and Sivan Rapaport (Institute) Helping Patients and Physicians Reach Individualized Medical Decisions: Theory and Applic 6 / 18
The Model c - a vector of the patient’s characteristics (medical history, age, gender, race, etc.) a - action (treatment, doctor, medical facility) < � preference relation on the set of actions is represented by ( a , c ) 7! λ ( a ) ∑ U ( f ( ω ; a , c ) , ω ) p ( ω j a , c ) + v ( a ) . ω 2 Ω U - utility function; Edi Karni, Moshe Leshno, and Sivan Rapaport (Institute) Helping Patients and Physicians Reach Individualized Medical Decisions: Theory and Applic 6 / 18
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