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J Biomed Inform. 2009 Apr;42(2):272-86. doi: 10.1016/j.jbi.2008.09.004. Epub 2008 Oct 10.

A distributed system for support and explanation of shared decision-making in the prenatal testing domain.

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  • 1Ben Gurion University, Information Systems, Pinkas 26, 62661 Tel Aviv, Israel. itay_se@zahav.net.il

Abstract

Medical domains involve numerous tests and treatments, the sheer variety of which confounds both care providers and patients. Many of the decisions depend on the patient's preferences. Shared decision-making, which explicitly involves the patients and their preferences, is therefore imperative, but requires also a sufficient explanatory infrastructure. We introduce a distributed application, PANDEX, that, by using decision-analytic methods, assists patients and care providers to reach optimal decisions. Based on a generic architecture, the PANDEX prototype, which focuses on the domain of genetic prenatal consultation, is designed to calculate the optimal treatment strategy based on the patient's clinical data and preferences. A major focus of our study was on developing several types of in-depth sensitivity and importance analysis methods and on the implementation of the respective graphical tools embedded in the system, to help the patient fully understand the recommended strategy. A preliminary assessment of PANDEX by six genetic consultants demonstrated a relative unwillingness to work with PANDEX (mean=2.16+/-0.98 (SD), on a scale of 1-5), but a tendency to agree with its recommended strategies (mean=3.48+/-1.4) and with its capability to provide insights into the recommended strategies (3.28+/-1.23). PANDEX was considered by the consultants to be a potentially useful tool for patients.

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