Shared decision making of burdensome surveillance tests using personalized schedules and their burden and benefit
Statistics in Medicine, vol. 41, pp. 2115–2131
Abstract
Benchmark surveillance tests for detecting disease progression (eg, biopsies, endoscopies) in early-stage chronic noncommunicable diseases (eg, cancer, lung diseases) are usually burdensome. For detecting progression timely, patients undergo invasive tests planned in a fixed one-size-fits-all manner (eg, annually). We aim to present personalized test schedules based on the risk of disease progression, that optimize the burden (the number of tests) and the benefit (shorter time delay in detecting progression is better) better than fixed schedules, and enable shared decision making. Our motivation comes from the problem of scheduling biopsies in prostate cancer surveillance. Using joint models for time-to-event and longitudinal data, we consolidate patients' longitudinal data (eg, biomarkers) and results of previous tests, into individualized future cumulative-risk of progression. We then create personalized schedules by planning tests on future visits where the predicted cumulative-risk is above a threshold (eg, 5% risk). We update personalized schedules with data gathered over follow-up. To find the optimal risk threshold, we minimize a utility function of the expected number of tests (burden) and expected time delay in detecting progression (shorter is beneficial) for different thresholds. We estimate these two in a patient-specific manner for following any schedule, by utilizing a patient's predicted risk profile. Patients/doctors can employ these quantities to compare personalized and fixed schedules objectively and make a shared decision of a test schedule.
Authors 5
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Anirudh Tomer corresponding
Affiliation as printed
Department of Biostatistics Erasmus University Medical Center Rotterdam Zuid‐Holland The Netherlands
Department of Biostatistics, Erasmus University Medical Center, Rotterdam, Zuid-Holland, The Netherlands
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Affiliation as printed
Department of Public Health Erasmus University Medical Center Rotterdam Zuid‐Holland The Netherlands
Department of Urology Erasmus University Medical Center Rotterdam Zuid‐Holland The Netherlands
Department of Public Health, Erasmus University Medical Center, Rotterdam, Zuid-Holland, The Netherlands
Department of Urology, Erasmus University Medical Center, Rotterdam, Zuid-Holland, The Netherlands
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Affiliation as printed
Department of Urology Erasmus University Medical Center Rotterdam Zuid‐Holland The Netherlands
Department of Urology, Erasmus University Medical Center, Rotterdam, Zuid-Holland, The Netherlands
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Ewout Willem Steyerberg Aachen Department of Biomedical Data Sciences Leiden University Medical Center Leiden Zuid‐Holland The Netherlands Department of Biomedical Data Sciences
Erasmus MC · Leiden University Medical Center
Affiliation as printed
Department of Biomedical Data Sciences Leiden University Medical Center Leiden Zuid‐Holland The Netherlands
Department of Public Health Erasmus University Medical Center Rotterdam Zuid‐Holland The Netherlands
Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
Department of Public Health, Erasmus University Medical Center, Rotterdam, Zuid-Holland, The Netherlands
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Affiliation as printed
Department of Biostatistics Erasmus University Medical Center Rotterdam Zuid‐Holland The Netherlands
Department of Biostatistics, Erasmus University Medical Center, Rotterdam, Zuid-Holland, The Netherlands
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