6 Ekim 2020 Dergi makalesi Açık Erişim

Karanfil, Ozge; Sterman, John

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    <subfield code="a">&lt;p&gt;Tests to screen for certain diseases&amp;mdash;for example, thyroid cancer screening, screening mammography,&lt;br&gt;
and screening of high blood pressure for hypertension&amp;mdash;are increasingly common in&lt;br&gt;
medical practice. However, guidelines for routine screening are contentious for many disorders&lt;br&gt;
and often fluctuate over time. Some tests are over- or underused compared to available evidence&lt;br&gt;
that justifies their use, with clinical practice persistently deviating from evidence-based guidelines.&lt;br&gt;
Here we develop an integrated, broad boundary feedback theory and formal model to&lt;br&gt;
explain the dynamics of routine population screening including fluctuations in policy-decision&lt;br&gt;
thresholds and the expansion of selection criteria which may lead to inappropriate use. We present&lt;br&gt;
a behaviorally realistic, boundedly rational model of detection and selection for medical&lt;br&gt;
screening that explains the potential of endogenous oscillations in practice guidelines as&lt;br&gt;
decision-makers&amp;mdash;including epidemiologists, clinicians, and patients, or policymakers from&lt;br&gt;
guideline issuing organizations, perceive harms and benefits from potential outcomes and make&lt;br&gt;
trade-offs between sensitivity and specificity by altering the existing guidelines and actual practice.&lt;br&gt;
The model endogenously generates fluctuations in screening indications, test thresholds,&lt;br&gt;
test efficiency, and the target screening population, leading to long periods during which practice&lt;br&gt;
guidelines are suboptimal even if the underlying evidence base is constant. We use cancer&lt;br&gt;
screening as a motivating example, but the model is generic with a wide range of potential applications&lt;br&gt;
for important managerial problems in medical contexts, such as screening for hypertension,&lt;br&gt;
hypercholesterolemia, autism spectrum disorder, Alzheimer&amp;rsquo;s disease, and related&lt;br&gt;
dementia. It also applies to other managerial problems in nonmedical contexts, such as airport&lt;br&gt;
screening, background checks, tax audits, automotive emission tests, contentious jurisdiction, or&lt;br&gt;
to consumers of other kinds of information who need to make a decision&amp;mdash;on behalf of an individual,&lt;br&gt;
or for the whole population.&lt;/p&gt;</subfield>
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    <subfield code="a">"Saving lives or harming the healthy?" Overuse and fluctuations in routine medical screening</subfield>
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    <subfield code="a">Sterman, John</subfield>
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    <subfield code="c">2020-10-06</subfield>
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