Are Patients Capable of Using the Analytic Hierarchy Process and Willing to Use It to Help Make Clinical Decisions?

Abstract

The analytic hierarchy process (AHP) is a user-friendly technique that enables a decision maker to elicit subjective values and combine them with more objective data in an explicit, unbiased manner. To determine whether patients are capable of using and willing to use the AHP to help make clinical decisions, the author asked 20 volunteers to perform an AHP analysis of the choice among five screening regimens for colon cancer. The patients were categorized as capable if they completed the analysis in ≤ 45 minutes and as willing if they indicated that they would prefer to go through this type of analysis before making a clinical decision. Eighteen (90%) were capable and willing. The difference between this result and 25%, the predefined null hypothesis, is significant: p = 1.6 × 10^-9. These results indicate that AHP-based decision-making aids are likely to be acceptable to and within the capabilities of many patients. If so, they could serve as practical tools for improving the clinical decision- making process. Key words: decision making; analytic hierarchy process; physician-patient relationship; informed consent. (Med Decis Making 1995;15:76-80)

Get full access to this article

View all access options for this article.

References

Jonsen AR , Siegler M. , Winslade WJ Clinical Ethics. 2nd ed. New York: Macmillan, 1986:61-2.

President's Commission for the Study of Ethical Problems in Medicine and Biomedical Research. Making Health Care Decisions: The Ethical and Legal Implications of Informed Consent in the Patient-Practitioner Relationship. Vol 1. Washington, DC: U.S. Government Printing Office, 1982:2.

Kassirer JP Adding insult to injury. Usurping patients' prerogatives. N Engl J Med. 1983;308:898-901.

Forrow L. , Wartman SA , Brock DW Science, ethics and the making of clinical decisions. Implications for risk factor intervention. JAMA. 1988;259:3161-7.

Greenfield S. , Kaplan S. , Ware JE Jr. Expanding patient involvement in care. Effects on patient outcomes. Ann Intern Med. 1985;102:520-8.

Greenfield S. , Kaplan SH , Ware JE Jr, et al. Patients' participation in medical care: effects on blood sugar control and quality of life in diabetes. J Gen Intern Med. 1988;3:448-57.

Brody DS The patient's role in clinical decision making. Ann Intern Med. 1980;93:718-22.

Lidz CW , Appelbaum PS , Meisel A. Two models of implementing informed consent. Arch Intern Med. 1988;148:1385-9.

Dolan JG , Bordley DR , Miller H. Diagnostic strategies in the management of acute upper gastrointestinal bleeding: patient and physician preferences. J Gen Intern Med. 1993;8:525-9.

10.

Eddy DM Comparing benefits and harms: the balance sheet. JAMA. 1990;263:2493-2505.

11.

Expert Choice Version 8.0. Expert Choice, Inc., Pittsburgh, PA.

12.

Saaty TL Multicriteria Decision Making. The Analytic Hierarchy Process. Pittsburgh: RWS Publications, 1988 .

13.

Dolan JG , Isselhardt BJ , Cappuccio JD The analytic hierarchy process in medical decision making: a tutorial. Med Decis Making. 1989;9:40-50.

14.

Dolan JG , Bordley DR Involving patients in complex decisions about their care: an approach using the analytic hierarchy process. J Gen Intern Med. 1993;8:204-9.

15.

Daniel WW Biostatistics: A Foundation for Analysis in the Health Sciences. 2nd ed. New York: John Wiley and Sons, 1978:64-70.

16.

Zahedi F. The analytic hierarchy process—a survey of the method and its applications . Interfaces, 1986;16:96-108.

17.

Golden BL , Wasil EA , Harker PT , eds. The Analytic Hierarchy Process. Applications and Studies. Berlin-Heidelberg, Germany: Springer-Verlag, 1989.

18.

Hämäläinen RP Computer assisted energy policy analysis in the parliament of Finland. Interfaces. 1988 ;18:12-23.

19.

Liberatore MJ , Nydick RL , Sanchez PM The evaluation of research papers (or how to get an academic committee to agree on something). Interfaces. 1992;22:92-100.

20.

Liberatore MJ , Stylianou AC The development manager's advisory system: a knowledge-based DSS tool for project assessment. Decis Sci. 1993;24:953-76.

21.

Dyer JS Remarks on the analytic hierarchy process. Manage Sci. 1990;36:249-58.

22.

Saaty TL An exposition of the AHP in reply to the paper "Remarks on the analytic hierarchy process." Manage Sci. 1990;36:259-68.

23.

Harker PT , Vargas LG Reply to "Remarks on the analytic hierarchy process" by J. S. Dyer. Manage Sci. 1990;36:269-73.

24.

Dyer JS A clarification of "Remarks on the analytic hierarchy process." Manage Sci. 1990;36:274-5.

25.

Expert Choice I. Expert Choice, Version 8.0, User Manual. Pittsburgh, PA: Expert Choice Inc., 1992:85-91.

26.

Forman E. Multicriteria prioritization in open and closed systems. Unpublished manuscript, 1993.

27.

Eckman MH A counterpoint to the analytic hierarchy process. Med Decis Making. 1989;9:57-8.

28.

Dolan JG Can decision analysis adequately represent clinical problems? J Clin Epidemiol. 1990;43:277-84.

29.

Dolan JG , Bordley DR Involving patients in complex decisions about their care: an approach using the analytic hierarchy process. J Gen Intern Med. 1993;8:204-9.