Choosing the surgical mortality threshold for high risk patients with stage Ia non-small cell lung cancer: insights from decision analysis


Dowie, J; Wildman, M; (2002) Choosing the surgical mortality threshold for high risk patients with stage Ia non-small cell lung cancer: insights from decision analysis. Thorax, 57 (1). pp. 7-10. ISSN 0040-6376 DOI: https://doi.org/10.1136/thorax.57.1.7

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Abstract

The recent British Thoracic Society guidelines recommend that surgical mortality should not be greater than 8% for pneumonectomy and 4% for lobectomy. These cut offs are advanced as guidelines to inform decision making as to whether or not patients with operable lung cancer should be offered surgery. They have been developed from a notion of what acceptable surgical mortality should be. The planning of care for patients with lung cancer involves making choices between different treatments with different outcomes. While it is accepted that the probability of these outcomes is likely to differ among patients, individual patient preferences for them are also likely to vary. Fixed cut offs for surgical mortality mean ignoring this variation. Decision analysis can be used to assist in the complex task of integrating clinical characteristics and varying patient preferences. By considering high risk patients with potentially curable stage Ia non-small cell lung cancer, it is shown that decision analysis has the potential to illuminate decision making and guideline development within the field of cancer care.

Item Type: Article
Keywords: Carcinoma, Non-Small-Cell Lung/physiopathology/psychology/*surgery, Choice Behavior, *Decision Support Techniques, Decision Trees, Dyspnea/physiopathology/psychology/surgery, Human, Informed Consent, Lung Neoplasms/physiopathology/psychology/*surgery, Patient Participation, Patient Satisfaction, Pneumonectomy/methods/*mortality, Quality of Life, Risk Factors, Support, Non-U.S. Gov't, Survival Analysis, Carcinoma, Non-Small-Cell Lung, physiopathology, psychology, surgery, Choice Behavior, Decision Support Techniques, Decision Trees, Dyspnea, physiopathology, psychology, surgery, Human, Informed Consent, Lung Neoplasms, physiopathology, psychology, surgery, Patient Participation, Patient Satisfaction, Pneumonectomy, methods, mortality, Quality of Life, Risk Factors, Support, Non-U.S. Gov't, Survival Analysis
Faculty and Department: Faculty of Public Health and Policy > Dept of Health Services Research and Policy
Faculty of Public Health and Policy > Dept of Social and Environmental Health Research
PubMed ID: 11809982
Web of Science ID: 173288100005
URI: http://researchonline.lshtm.ac.uk/id/eprint/17483

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