Author

Poonam Sharma

Date

June 2007

Document Type

Thesis

Degree Name

M.S.

Department

Dept. of Medical Informatics and Clinical Epidemiology

Institution

Oregon Health & Science University

Abstract

This thesis presents three decision models for a child-birth after cesarean decision. The first decision model used an AHP approach, the second used a decision tree approach, and the third model used a hybrid AHP-decision tree approach. The AHP model assessed medical risk subjectively while the decision tree and hybrid models assessed medical risk objectively. Decision criteria included both maternal and neonatal outcomes. Maternal outcomes included hysterectomy, numbness/pain near incision, incontinence, and placental abnormalities causing a risk to future pregnancies. Neonatal outcomes included disability and death. Data on 96 women with a prior cesarean were used from a partnering studying that used the AHP decision aid tool. Utilities for the decision tree were derived from a normalization method of AHP criteria weights. Various sensitivity analyses revealed the decision tree was sensitive to all probabilities of maternal outcomes except for hysterectomy. The decision models revealed that the mode of risk assessment plays a big role in determining the decision. Multiple decision models using subjective and objective risk assessments can play an important role in the clinician-patient shared decision making process.

Identifier

doi:10.6083/M40V89TZ

School

School of Medicine

Share

COinS
 
 

To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.