Plastic Surgeon Expertise in Predicting Breast Reconstruction Outcomes for Patient Decision Analysis.
Plastic Surgeon Expertise in Predicting Breast Reconstruction Outcomes for Patient Decision Analysis.
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DOI：
10.1097/gox.0000000000000010
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发表时间：
2013-11-01
期刊：
影响因子：
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通讯作者：
Markey MK
中科院分区：
文献类型：
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作者：
Sun CS;Reece GP;Crosby MA;Fingeret MC;Skoracki RJ;Villa MT;Hanasono MM;Baumann DP;Chang DW;Cantor SB;Markey MK
决策分析提供了一个框架，可以帮助乳腺癌患者做出良好的乳房重建决策。这类分析的一个要求是以概率的形式提供有关结果发生的可能性的信息。本研究的目的是确定当数据有限时，整形外科医生是否是概率信息的良好来源，无论是个人还是作为一个群体。为7名整形外科医生提供了相关的医疗信息和患者的术前照片，并要求他们使用为研究设计的问卷来分配预测翻修次数、并发症和最终美学结果的概率。对数严格适当评分用于评估外科医生预测乳房再造结果的能力。分析外科医生的回答，以确定其答案的准确性和可信度。作为个体，外科医生预测结果的能力存在差异。对于每个预测类别，不同的外科医生更准确。作为一个群体，外科医生拥有未来事件的知识，尽管他们的概率评估没有得到很好的校准。该群体的预测准确度比最佳个体高出6倍。不鼓励使用个别整形外科医生引出的概率信息，除非个人的预测技能已经过评估。在缺乏这些信息的情况下，最好是就结果的概率达成群体共识。在没有大量证据基础来计算概率的情况下，从一组整形外科医生评估的估计值对于乳房重建决策分析来说可能是可以接受的。
Decision analysis offers a framework that may help breast cancer patients make good breast reconstruction decisions. A requirement for this type of analysis is information about the possibility of outcomes occurring in the form of probabilities. The purpose of this study was to determine if plastic surgeons are good sources of probability information, both individually and as a group, when data are limited. Seven plastic surgeons were provided with pertinent medical information and preoperative photographs of patients and were asked to assign probabilities to predict number of revisions, complications, and final aesthetic outcome using a questionnaire designed for the study. Logarithmic strictly proper scoring was used to evaluate the surgeons’ abilities to predict breast reconstruction outcomes. Surgeons’ responses were analyzed for calibration and confidence in their answers. As individuals, there was variation in surgeons’ ability to predict outcomes. For each prediction category, a different surgeon was more accurate. As a group, surgeons possessed knowledge of future events despite not being well calibrated in their probability assessments. Prediction accuracy for the group was up to 6-fold greater than that of the best individual. The use of individual plastic surgeon–elicited probability information is not encouraged unless the individual’s prediction skill has been evaluated. In the absence of this information, a group consensus on the probability of outcomes is preferred. Without a large evidence base for calculating probabilities, estimates assessed from a group of plastic surgeons may be acceptable for purposes of breast reconstruction decision analysis.