Block 3 & 4 Flashcards
Describe three theories of decision making
- normative: what should you be doing, according to social or professional norms?
- descriptive: what are you doing?
- prescriptive: how can we improve what you are doing?
Describe the hypothetic-dedctive model (Elstein 1978)
- seeking evidence to disprove your hypothesis
- cue acquisition > hypothesis formation > cue interpretation > hypothesis evaluation
What did Norman (2005) suggest about diagnostic reasoning?
- hypothetic-deductive model is more commonly used when the clinician has less experience, generally or in that area
- experienced clinicians are more likely to use pattern matching
- experts encountering a less common problem are more likely to use deliberative reasoning
Describe the prospect theory of decision making (Tversky and Kahneman, 1988)
Two phases:
- framing and editing : the preliminary analysis of the decision problem
- phase of evaluation : framed prospects are evaluated and the prospect with the highest value is selected
What three factors can influence the decision making process?
- Framing: how the problem is framed (role of bias)
- Values: a persons values and associated beliefs about the benefits and harms of different options and their outcomes
Evaluation: a persons ability to evaluate the information they have used
Outline the hierarchy of quantitative evidence (best to worst quality)
- Systematic reviews and meta-analyses
- Randomised controlled double blind trials
- Cohort studies
- Case control studies
- Case series
- Case reports
- Ideas, Editorials, Opinions
- Animal research
- In vitro research
Describe how the hierarchy of evidence works and it’s limitations
“better quality” research is higher in the pyramid, it has less potential for bias and so has more predictive power
HOWEVER
- different study designs are suited to different questions
- there are good and bad studies of all types
- the pyramid doesn’t include qualitative research
- it must be used critically
Describe levels of organisation of evidence (5S) and how they fit together
- each stage is condensed into the next
- studies (e.g. original journal articles) > syntheses (e.g. systematic reviews) > synopses (e.g. evidence based journal abstract) > summaries (e.g. evidence based text books) > systems (e.g. computerised decision support)
How can evidence be used in diagnosis?
- to identify the most likely hypothesis
- to evaluate likelihood of hypothesis being correct
- to assess the accuracy of diagnostic tests
How can evidence be used in prognosis?
- to evaluate what happened to other patients with the same condition
How can evidence be used in treatment decisions?
- to evaluate the likelihood of different options having an effect
- to evaluate the likelihood of adverse events happening to the patient
- to assess the likely acceptability of the treatment to the patient
Define consent (MPS)
The properly informed decision of a competent patient, freely given
How can consent be given?
- orally
- written
- expressed
- implied
When is consent required?
- before examination, treatment or care
- for disclosure of confidential information
- when involving a patient in teaching
- research
To be valid, consent must be…
- informed
- voluntary
- given by a patient who has capacity
Why is consent needed?
- ethical requirement (respect autonomy, avoid harm, promote trust)
- professional requirement
- legal requirement (avoid battery, avoid negligence
When is consent not needed?
- emergencies when it is not possible to find out the patients wishes
- if being treated under the mental health act 1983
- if a patient lacks capacity and the treatment is deemed in the patients best interest (mental capacity act 2005)
- if the public health (control of disease) act 1984 applies (allows detention of patient in hospital if they present an infectious disease risk to the public)
- to disclose confidential information in some circumstances (e.g. some one else is at risk of harm)
