Decision-making in oncology
Decision-making in medicine is influenced by several factors including the patient’s condition, resource availability, patient preferences, and clinician preferences. In the past 2 decades, there has been significant research on cognitions related to decision-making. A best-selling book by Nobel Laureate psychologist Daniel Kahneman titled “Thinking, Fast and Slow” is an excellent place to start learning about cognitive factors related to decision-making.
Our research began by exploring the factors leading to the variability of ECOG (Eastern Clinical Oncology Group) rating score by cancer clinicians for hypothetical patients based on case vignettes. We felt this would be a good place to start as ECOG scores are used in various decision-making processes, such as deciding between palliative and curative treatment for a particular patient, enrollment of patients to cancer clinical trials, and also in cancer treatment guidelines. The publication below will let you have a glimpse of the complexity and variability of a simple scale such as ECOG.
Datta SS, Ghosal, Daruvala R et al (2019) How do clinicians rate patient’s performance status using ECOG performance scale? A mixed methods exploration of variability in decision making in oncology. Ecancermedicalscience 13: 913. DOI: 10.3332/ecancer.2019.913
Moving on from treatment, we wanted to explore the perception of the meaningful benefit of endpoints, price, and value of different cancer treatments. This is the first-ever study reporting the value of cancer treatment from LMICs as perceived by oncologists in LMICs. These perceptions are likely to influence in decision of opting for a particular treatment for cancer patients.
Datta, S. S., V. Sharma, A. Mukherjee, S. Agrawal, B. Sirohi, and B. Gyawali. 2024. What Constitutes Meaningful Benefit of Cancer Drugs in the Context of LMICs? A Mixed-Methods Study of Oncologists’ Perceptions on Endpoints, Benefit, Price, and Value of Cancer Drugs. ESMO Open 9 (11): 103976. (Access here).
Decision-making in infection control practices and antibiotic stewardship
We also explored decision-making in infection control and antibiotic stewardship in several small studies and you may find these interesting if you are planning change management in a hospital setting as part of an anti-biotic stewardship program or leading an infection control program. All these changes involve human beings adapting to these changes.
Agarwal N, Agarwal SK, Bhattacharya S, Datta SS, Chatterjee S, Ahmed R. (2018) Antibiotic Prophylaxis for Breast Oncosurgery in a Setting With a High Prevalence of Multidrug-Resistant Bacteria: Common Sense Infection Control Measures Are MoreImportant Than Prolonged Antibiotics. Infect Control Hosp Epidemiol. 2018 Apr;39(4):498-500. DOI: 10.1017/ice.2017.313
Ravi N, Laha A, Hmar L, Chatterjee S, Goswami J, Goel G, Dhar K, Ghosh T, Chatterjee S, Datta SS, Bhattacharya S. (2017) Exploring the prescribing behaviours and the mind of antibiotic prescribers is critical for a successful antibiotic stewardship programme: Results of a survey from Eastern India. Indian J Med Microbiol. 2017 Apr-Jun;35(2):299-301.
Dalen, Rv., Gombert, K., Bhattacharya, S., Datta, S.S. (2013) Mind the mind: Results of a hand-hygiene research in a state-of-the-art cancer hospital. Indian J Med Microbiol. 2013 Jul-Sep;31(3):280-2. DOI: 10.4103/0255-0857.115639