Roulette wheel can aid treatment decisions

NEW YORK (Reuters Health) – Researchers from the University
of California Los Angeles have developed a tool that they hope
will help ease the burden of making difficult treatment
decisions. It’s a roulette wheel that allows patients to
visualize the probable outcomes associated with different
treatment options for different diseases.

The roulette wheel can be adapted to represent any current
clinical question and is based on “best current evidence,”
according to its developers, Dr. Jerome R. Hoffman and
colleagues.

For illustration purposes, Hoffman and colleagues describe
inn the journal PLoS Medicine how a healthy 65-year-old man
might use the roulette wheel to decide whether or not to be
screened for prostate cancer with a standard PSA blood test.

By spinning the roulette wheel, the man sees that his
chances of developing symptoms of prostate cancer in his
lifetime are very small, regardless of whether he has the PSA
test or not.

But he also learns that if he undergoes the PSA test and
cancer is found, treating the cancer results in a 50-percent
reduction in the chances of dying from prostate cancer.

However, the roulette wheel also shows him that he has a 58
percent chance of developing erectile dysfunction or
incontinence because of treatment for prostate cancer.

Gone are the days when doctors dispensed advice and
recommendations without involving the patient, note Hoffman and
colleagues in their report. Shared decision making is now
largely how decisions are made.

One of the problems with shared decision-making, however,
is that doctors often present the risks and benefits of
different treatments in a way that is not easily understood by
patients.

“Many of us have trouble understanding numbers,
particularly in the context of risk and probability,” write
Hoffman and colleagues. “It is hard for anyone to comprehend
the difference between a 7 percent chance and an 8 percent
chance – is there a meaningful difference? – and this is
exacerbated when we try to deal in more extreme probabilities,
such as 3 in 10,000.”

Hoffman and colleagues are hopeful that the roulette wheel
will help patients, in consultation with their doctor, make
difficult treatment choices.

An interactive version of the roulette wheel on prostate
cancer can be found at
http://edoctoring.ncl.ac.uk/System_Check/psa_detect_html.

SOURCE: PLoS Medicine June 2006.