Decision analysis based medical decision making in Neuroendocrine tumours Adil Ahmed Research Registrar, Gastroenterology Dept, North Hampshire Hospital NHS trust, Basingstoke & Honorary Registrar Kings College Hospital	PDF File
The winner of the Catherine Pouget Award in 2006 was Dr. Adil Ahmed. The following report is on the current status of the project :

Background

Shared decision making, in which patients and health professionals join in both the process of decision making and ownership of the decision made, is attracting considerable interest. Many patients want to play a more active role. Increased patient involvement is an important part of quality improvement since it has been associated with improved health outcome. Patients cannot express informed preferences unless they are given sufficient and appropriate information, including detailed explanations about their condition and the likely outcomes with and without treatment. Yet many report considerable difficulties in obtaining relevant information. Neuroendocrine tumors (NET’s) constitute a heterogeneous group of neoplasm’s, which share certain characteristic biological features. They originate from neuroendocrine cells, have secretory characteristics and may frequently present with hypersecretory syndromes. NET’s are rare tumors with rates approaching 3 per 100000 per year. NET’s are slow growing & even malignant neuroendocrine tumors are associated with prolonged survival and the prevalence is relatively high. Management of NET’s involves a complex algorithm with several possible pathways. The main aim of treatment is improvement of quality of life (QoL). Due to the choice available the best mode of management for an individual patient remains a dilemma. Decision aids do a better job than usual care in improving patient’s knowledge about options and create more realistic expectations. They enhance active participation in decision making; lower decisional conflict; decrease the proportion of people remaining undecided, and improve agreement between values and choice without increasing patient’s anxiety. A number of studies have found that, despite serious initiatives on the part of national organisations to develop and disseminate guidelines, practitioners may still ignore them. For these reasons there is growing interest in new ways of disseminating medical knowledge more effectively, notably by translating content of guideline from textual form into a logical form that can be executed by providing patient specific prompts, reminders and other forms of advice on individual’s care. Decision analysis is a process that offers an explicit and systematic approach to decision making based on a premise of rationality. It is founded on the work of von Neumann and Morganstern who described a model for human decision making know as the theory of expected utility.