Weighing Harm in Therapeutic Decisions of Smear-Negative Pulmonary Tuberculosis

Juan Moreira, Bettina Bisig, Petronille Muwawenimana, Paulin Basinga, Zeno Bisoffi, Frank Haegeman, Panduru Kishore and Jef Van den Ende
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Juan Moreira: Centro de Epidemiología Comunitaria y Medicina Tropical, Esmeraldas, Ecuador, Institute of Tropical Medicine, Clinical Sciences, Antwerp, Belgium, jmoreira@itg.be
Bettina Bisig: Institute of Tropical Medicine, Clinical Sciences, Antwerp, Belgium
Petronille Muwawenimana: Centre Hospitalier Universitaire, Kigali, Rwanda
Paulin Basinga: Université Nationale de Rwanda, Ecole de Santé Publique, Kigali, Rwanda
Zeno Bisoffi: Ospedale Sacrocuore, Centro per le malattie tropicale, Negrar, Italy
Frank Haegeman: Support to Health Sector Reform Project, Belgian Technical Cooperation, Vientiane, Lao PDR
Panduru Kishore: Manipal Teaching Hospital, Pokhara, Nepal
Jef Van den Ende: Institute of Tropical Medicine, Clinical Sciences, Antwerp, Belgium

Medical Decision Making, 2009, vol. 29, issue 3, 380-390

Abstract: Purpose. To relate the intuitive weight of harm by commission and harm by omission in therapeutic decisions for pulmonary tuberculosis, and to compare it with a weight based on probabilities. Methods. Clinicians were asked for an estimation of probabilities related with the outcome of treated and nontreated pulmonary tuberculosis and for the toll of wrong decisions. Three ratios of the weight of forgoing a treatment in false-negative patients against the weight of treating false-positives were calculated. The first was based on intuitive estimations, whereas the second and third were based on calculated, either through intuitive estimations of probabilities or through literature data. The association between experience and the difference between the intuitive and the calculated ratios was assessed. Results. Eighty-one participants from Ecuador, Laos, Nepal, and Rwanda responded. The ratio of intuitive weights was 2.0 (interquartile range [IQR], 1.0—4.0) and the ratio of calculated weights based on intuitive probabilities was 64 (IQR, 25.0—169.6; P

Keywords: omission bias; pulmonary tuberculosis; therapeutic decisions; decision threshold; decision theory (search for similar items in EconPapers)
Date: 2009
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Persistent link: https://EconPapers.repec.org/RePEc:sae:medema:v:29:y:2009:i:3:p:380-390

DOI: 10.1177/0272989X08327330

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