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Dealing with treatment uncertainty in elderly AML patients
A
Figure 1. Behavioral tasks.
B
(A) Physician’s individual risk aversion evaluation. The clos- er the scroll bar is to 500 euros, the more risk-seeking the behavior; the lower the score bar, the greater the aversion to risk. E.g. if the scroll bar is at 200 euros, the person prefers a 50% chance of winning 500 euros to a 100% chance of winning 190 euros. If the scroll bar is at 300 Euros, the person prefers a 50% chance of winning 500 euros to a 100% chance of winning 290 euros. The latter is riskier since you are giving up more certain money (290 vs. 190) for a chance to win the same amount (500 euros). (B) Physician’s individ- ual uncertainty aversion eval- uation. The same line of rea- soning applies to the uncer- tainty aversion evaluation except that for option A, the
C
D
were attending physicians or professors (70%), 166 worked in an academic center (72%), 197 were special- ized in hematology (86%), and the mean patient volume per physician was 20.7 (SD±17.1).
Medical decision-making among clinical vignettes
The physicians’ decisions about the 6 clinical vignettes assessing front-line therapy for older AML patient are summarized in Figure 2. The most controversial case was Vignette #4 for which 50.8% of respondents recommend-
gain is
probability of
unknown. The closer the scroll bar is to 500 euros the more uncertainty-seeking the behavior; the lower the scroll bar, the greater the aversion to uncertainty. (C) Classic binary choices from Kahneman and Tversky. Choice patterns AC and BD conform to the expected utility theory. Choice patterns AD and BC do not conform to expected utility theory (for fur- ther details see Online Supplementary Appendix, Section 2). (D) Self-evaluation of the willingness to take risk in four different domains.
ed IC versus 49.2% opting for a non-intensive approach. Increasing the age of this patient in Vignette #5 resulted in a marked decrease (from 50.8% to 6.9%) in the propor- tion of respondents choosing IC. Alternatively, increasing the WBC in Vignette #6 increased the proportion of physi- cians who recommended an IC from 50.8% to 64.7%. These practice variations induced by modifying classical AML prognosis factors were expected, and they thus pro- vide internal quality control of non-random responses to the online survey (internal coherence criteria).
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