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| Clinical Decision Making and Informatics Links:
Decision Analysis Courses Online
CDM Clinical Decision Making Fellowship lectures at NEMC. BIRT: Boston Informatics Research Training Fellowship lecture series. PubMed medline beta search engine Infoseek search engine LCS Reading Room and here is the Catalog MIT Libraries to go to the main page or Barton, the Online Catalog to search holdings. |
Jack Adams-Webber,
The Construing Person: According to [George] Kelly, anxiety is experienced
whenever one is confronted with events that are outside the range of convenience of one's personal constructus, that is, one has no basis for anticipating
them. In short anxiety is being "caught with one's constructs
down."
Thesis Research ContributionI have developed a representation of patient values and a tailored elicitation procedure which forms the backbone of my thesis research.Utility Assessment on an Individualized BasisThe core of my PhD thesis is a method for the collection of patient values on an individualized basis suitable for use in decision analysis models. The most unique aspect is that the representation of values is in the words of the patient. The elicitation is systematic and reproducible. It is basically a reconstruction of utility assessment using some fundamental utility assessment building blocks with a little systematic psychologic domain methodology for eliciting dimensions of importance to an individual. You can download a 10 page pre-thesis paper in postscript or Word for W95 format from my ftp site or press here. The full thesis is available from the same site or press here. The defense was September 4th, 1998. You may view the web version of a presentation given February 5th, 1997, to my Oral Exam Committee for successful PhD candidate qualification by clicking here.Resume'. You are welcome to read a more detailed description of my Career Goals and Objectives.
Why, you ask, do we need to elicit the values of an individual? I recently completed a pilot study in collaboration with Mark Davis, MD, of the Beth Israel Deaconess Emergency Department in which we wanted to find out whether patients would prefer to avoid severe disability as a consequence of stroke or any increased risk of death. Current trends in the use of clot dissolving drugs like tissue Plasminogen Activating factor present us with a decision regarding just such a tradeoff. Studies suggest that these drugs decrease the rate of long term disability significantly if administered within a few hours of the onset of signs of stroke, but at the cost of slightly increasing the risk that you might die with in a few days. Understanding the preference of an individual in this case could greatly aid decision making in choice of treatment. To noone's surprise, we found a diversity in the values expressed in our structured interveiws. To our surprise, however, we found more answers that were difficult to make sense of than we expected, despite the authors of these answers being very convinced of their preferences. I presented a talk that reviewed our findings and the surprising rate of what is sometimes referred to as "discordant" responses to values elicitation. The talk concludes that we need to find better ways to systematically discover the way these patients think with a few strategies based on the analysis of the data. Moreover, it justifies the pursuit of my thesis research. You can browse an html version of the presentation.
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With my Wife, 
Cheree,
and our two sons |
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This page has been accessed
times since 17 January 1996.
last edited 10/7/98
Send comments to duane@mit.edu
