Decision Making Criteria in Oncology.

Decision making is one of the most complex skills required of an oncologist and is affected by a broad range of parameters. For example, the wide variety of treatment options, with various outcomes, side-effects and costs present challenges in selecting the most appropriate treatment. Many treatment choices are affected by limited scientific evidence, availability of therapies or patient-specific factors. In the decision making process, standardized approaches can be useful, but a multitude of criteria are relevant to this process. Thus, the aim of this review is to summarize common types of decision criteria used in oncology by focusing on 3 main categories: criteria associated with the decision maker (both patient and doctor), decision specific criteria, and the often-overlooked contextual factors. Our review aims to highlight the broad range of decision criteria in use, as well as variations in their interpretation.

Insular Decision Criteria in Clinical Practice: Analysis of Decision-Making in Oncology.

BACKGROUND: Medical decision-making is complex and involves a variety of decision criteria, many of which are universally recognised. However, decision-making analyses have demonstrated that certain decision criteria are not used uniformly among clinicians. AIM: We describe decision criteria, which for various contexts are only used by a minority of decision makers. For these, we introduce and define the term "insular criteria". METHODS: 19 studies analysing clinical decision-making based on decision trees were included in our study. All studies were screened for decision-making criteria that were mentioned by less than three local decision makers in studies involving 8-26 participants. RESULTS: 14 out of the 19 included studies reported insular criteria. We identified 42 individual insular criteria. They could be intuitively allocated to seven major groups, these were: comorbidities, treatment, patients' characteristics/preferences, caretaker, scores, laboratory and tumour properties/staging. CONCLUSION: Insular criteria are commonly used in clinical decision-making, yet, the individual decision makers may not be aware of them. With this analysis, we demonstrate the existence of insular criteria and their variety. In daily practice and clinical studies, awareness of insular criteria is important.

Expertise Diversity, Informal Leadership Hierarchy, and Team Knowledge Creation: A study of pharmaceutical research collaborations.

Knowledge creation increasingly requires experts from diverse domains to collaborate in teams, yet the effect of expertise diversity on team knowledge creation is inconclusive. We focus on task uncertainty and informal leadership hierarchies - the disparity in team members' engagement in leadership activities (task- and relationship-oriented) - to answer the questions when and why expertise diversity may hinder team knowledge creation. We develop a model in which informal leadership hierarchy mediates the conditional indirect effect of the team's expertise diversity on its knowledge creation under different levels of task uncertainty. We test this moderated mediation model using multi-source data from self-managing project teams comprising collaborators from a pharmaceutical company and its research partners. We find that when task uncertainty is low, the indirect effect of expertise diversity on team knowledge creation is positive, whereas when task uncertainty is high, it is negative. This conditional indirect effect occurs via task-oriented but not relationship-oriented leadership hierarchy. Our findings provide insights into the mechanisms and boundary conditions for expertise diversity to hinder, rather than facilitate, knowledge creation in collaborations.

Treatment Options in Oncology.

Multiple treatment strategies exist for many oncologic problems. In this review, we provide a summary of various reasons for the existence of multiple treatment options in oncology, including factors that concern the treating physician (eg, treatment preferences), environmental factors (eg, financial, regulatory, and scientific aspects), and individual patient-specific factors (eg, medical condition, preferences). We demonstrate the vital role of available treatment options and their origins for clinical decision making and patient communication. These aspects are particularly helpful in the process of shared decision making, which is increasingly favored in situations where there are multiple medically reasonable options.