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Analysis of consultant decision-making in the management of prostate cancer

Prostate Cancer and Prostatic Diseases volume 11, pages 288–293 (2008)Cite this article

Abstract

The purpose of this study was to assess the consistency of decision-making among consultant urologists in the management of early prostate cancer. Thirty-two UK urology consultants completed a questionnaire containing 70 paper scenarios representing patients with early prostate cancer. Within these were 13 repeat cases to allow assessment of reliability of decision-making. Consultants demonstrated low reliability (on average 56–79%) when formulating decisions. None of the consultants used all of the available patient information when formulating treatment plans. The cue ‘patient choice’ was not used significantly by any of the consultants and the cue ‘patient co-morbidity’ was rarely used despite being crucial components of decision-making. These results are surprising and in general represent poor clinical practice. They also justify the increasing use of the multidisciplinary team and protocol-driven pathways to standardize and thus improve patient care.

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References

  1. Stewart TR . ‘Judgement analysis: procedures’. In: Brehmer B, Joyce CRB (eds). Human Judgement. The SJT View, Chapter 2. North Holland: Elsevier, 1988, pp 41–47.

    Chapter  Google Scholar 

  2. Wigton RS . ‘Application of judgement analysis and cognitive feed back to medicine’. In: Brehmer B, Joyce CRB (eds). Human Judgement. The SJT View, Chapter 7. North Holland: Elsevier, 1988, pp 227–246.

    Chapter  Google Scholar 

  3. Kirwan JR, Chaput De Saintonage D, Joyce C . Clinical judgement in rheumatoid arthritis I. Rheumatologists' opinions and the development of paper patients. Ann Rheum Dis 1983; 42: 644–647.

    Article  CAS  Google Scholar 

  4. Kirwan JR, Currey HL . Clinical judgement in rheumatoid arthritis II. Judging current disease activity in clinical practice. Ann Rheum Dis 1983; 42: 648–651.

    Article  CAS  Google Scholar 

  5. Kirwan JR, Chaput de Saintonge DM, Joyce CR . Clinical judgement in rheumatoid arthritis. III. British rheumatologists' judgement of ‘change in response to therapy’. Ann Rheum Dis 1984; 43: 686–694.

    Article  CAS  Google Scholar 

  6. Kirwan JR, Currey HL . Clinical judgement in rheumatoid arthritis. IV. Rheumatologists's assessments of disease remain stable over long periods. Ann Rheum Dis 1984; 43: 695–697.

    Article  CAS  Google Scholar 

  7. http://www.baus.org.uk.

  8. Cooksey RW . Judgement Analysis: Theory, Methods and Applications. Academic Press: Sydney, 1996.

    Google Scholar 

  9. Miller GA . The magical number seven plus or minus two: some limits on our capacity for processing information. Psychol Rev 1956; 63: 81–97.

    Article  CAS  Google Scholar 

  10. Wilson J, Clarke M, Ewings P, Graham J, MacDonagh R . The assessment of patient life-expectancy: how accurate are urologists and oncologists? BJU Int 2005; 95: 794–798.

    Article  Google Scholar 

  11. Skånér Y, Strender L, Bring J . How do GPs use clinical information in their judgements of heart failure? A clinical judgement analysis study. Scand J Prim Health Care 1998; 16: 95–100.

    Article  Google Scholar 

  12. Anonymous. Guidelines on the management of prostate cancer. A document for local expert groups in the United Kingdom preparing prostate management policy documents. BJU Int 1999; 84: 987–1014.

    Google Scholar 

Download references

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Authors and Affiliations

  1. Department of Urology, Taunton and Somerset Hospital, Taunton, UK

    J Wilson, K Kennedy & R MacDonagh

  2. Research and Development Support Unit, Taunton and Somerset Hospital, Taunton, UK

    P Ewings

Authors
  1. J Wilson
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  2. K Kennedy
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  3. P Ewings
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  4. R MacDonagh
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Correspondence to J Wilson.

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Wilson, J., Kennedy, K., Ewings, P. et al. Analysis of consultant decision-making in the management of prostate cancer. Prostate Cancer Prostatic Dis 11, 288–293 (2008). https://doi.org/10.1038/sj.pcan.4501025

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  • DOI: https://doi.org/10.1038/sj.pcan.4501025

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