Sequential decision tree using the analytic hierarchy process for decision support in rectal cancer

OBJECTIVE The aim of the study is to determine the most appropriate method for construction of a sequential decision tree in the management of rectal cancer, using various patient-specific criteria and treatments such as surgery, chemotherapy, and radiotherapy. METHODS An analytic hierarchy process (AHP) was used to determine the priorities of variables. Relevant criteria used in two decision steps and their relative priorities were established by a panel of five general surgeons. Data were collected via a web-based application and analyzed using the "Expert Choice" software specifically developed for the AHP. Consistency ratios in the AHP method were calculated for each set of judgments, and the priorities of sub-criteria were determined. A sequential decision tree was constructed for the best treatment decision process, using priorities determined by the AHP method. RESULTS Consistency ratios in the AHP method were calculated for each decision step, and the judgments were considered consistent. The tumor-related criterion "presence of perforation" (0.331) and the patient-surgeon-related criterion "surgeon's experience" (0.630) had the highest priority in the first decision step. In the second decision step, the tumor-related criterion "the stage of the disease" (0.230) and the patient-surgeon-related criterion "surgeon's experience" (0.281) were the paramount criteria. The results showed some variation in the ranking of criteria between the decision steps. In the second decision step, for instance, the tumor-related criterion "presence of perforation" was just the fifth. CONCLUSION The consistency of decision support systems largely depends on the quality of the underlying decision tree. When several choices and variables have to be considered in a decision, it is very important to determine priorities. The AHP method seems to be effective for this purpose. The decision algorithm developed by this method is more realistic and will improve the quality of the decision tree.

[1]  C L Soskolne,et al.  Surgeon-related factors and outcome in rectal cancer. , 1998, Annals of surgery.

[2]  E. Buskens,et al.  Decision analysis in the surgical treatment of patients with familial adenomatous polyposis: a Dutch-Scandinavian collaborative study including 659 patients , 2001, Gut.

[3]  R. Hämäläinen,et al.  On the measurement of preferences in the analytic hierarchy process , 1997 .

[4]  Thomas L. Saaty,et al.  Models, Methods, Concepts & Applications of the Analytic Hierarchy Process , 2012 .

[5]  Thomas L. Saaty,et al.  On the relativity of relative measures - accommodating both rank preservation and rank reversals in the AHP , 2000, Eur. J. Oper. Res..

[6]  D J Sargent,et al.  Impact of surgical and pathologic variables in rectal cancer: a United States community and cooperative group report. , 2001, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[7]  F. Lootsma.  SCALE SENSITIVITY IN THE MULTIPLICATIVE AHP AND SMART , 1993 .

[8]  Pablo Aragonés Beltrán,et al.  An AHP-based evaluation procedure for Innovative Educational Projects : A face-to-face vs. computer-mediated case study , 2008 .

[9]  Thomas L. Saaty,et al.  DECISION MAKING WITH THE ANALYTIC HIERARCHY PROCESS , 2008 .

[10]  Mohsen Pirdashti,et al.  An AHP-Delphi Multi-Criteria Usage Cases Model with Application to Citrogypsum Decisions, Case Study: Kimia Gharb Gostar Industries Company , 2009 .

[11]  T. Saaty.  Relative measurement and its generalization in decision making why pairwise comparisons are central in mathematics for the measurement of intangible factors the analytic hierarchy/network process , 2008 .

[12]  Kimbroe J. Carter,et al.  Analysis of Three Decision-making Methods , 1999, Medical decision making : an international journal of the Society for Medical Decision Making.

[13]  L. Marchand,et al.  Combined influence of genetic and dietary factors on colorectal cancer incidence in Japanese Americans. , 1999, Journal of the National Cancer Institute. Monographs.

[14]  V. Fazio,et al.  Management of rectal cancer , 2004, Journal of Gastrointestinal Surgery.

[15]  Yildirim Bayazit,et al.  A novel computer based expert decision making model for prostate cancer disease management. , 2005, The Journal of urology.

[16]  Lars Påhlman,et al.  Neoadjuvant Therapy in Rectal Cancer , 2011, Diseases of the colon and rectum.

[17]  Sanjiv S. Gambhir,et al.  Decision Analysis for the Cost-Effective Management of Recurrent Colorectal Cancer , 2001, Annals of surgery.

[18]  W. Mackillop,et al.  Association between time to initiation of adjuvant chemotherapy and survival in colorectal cancer: a systematic review and meta-analysis. , 2011, JAMA.

[19]  G. A. Miller.  THE PSYCHOLOGICAL REVIEW THE MAGICAL NUMBER SEVEN, PLUS OR MINUS TWO: SOME LIMITS ON OUR CAPACITY FOR PROCESSING INFORMATION 1 , 1956 .

[20]  James G Dolan,et al.  Patient priorities in colorectal cancer screening decisions 1 , 2005, Health expectations : an international journal of public participation in health care and health policy.

[21]  Devinder Kumar,et al.  Current concepts in the non-operative management of rectal cancer after neoadjuvant chemoradiation. , 2011, Anticancer research.

[22]  Martin A. Cheever,et al.  The Prioritization of Cancer Antigens: A National Cancer Institute Pilot Project for the Acceleration of Translational Research , 2009, Clinical Cancer Research.

[23]  J. Terdiman,et al.  Colorectal cancer screening: scientific review. , 2003, JAMA.

[24]  Al Harbi,et al.  APPLICATION OF THE AHP IN PROJECT MANAGEMENT , 2001 .

[25]  Y. Kitamura,et al.  Decision-making process of patients with gynecological cancer regarding their cancer treatment choices using the analytic hierarchy process. , 2010, Japan journal of nursing science : JJNS.

[26]  P. Boyle,et al.  ABC of colorectal cancer: Epidemiology , 2000, BMJ.

[27]  R. Jiang,et al.  Scale transitivity in the AHP , 2003, J. Oper. Res. Soc..

[28]  Elliot B Sloane,et al.  Medical decision support using the Analytic Hierarchy Process. , 2002, Journal of healthcare information management : JHIM.

[29]  Jeanne-Marie Guise,et al.  Subjective risk vs. objective risk can lead to different post-cesarean birth decisions based on multiattribute modeling. , 2011, Journal of clinical epidemiology.

[30]  Sushil Kumar,et al.  Analytic hierarchy process: An overview of applications , 2006, Eur. J. Oper. Res..

[31]  James G. Dolan,et al.  Involving patients in decisions regarding preventive health interventions using the analytic hierarchy process , 2000, Health expectations : an international journal of public participation in health care and health policy.

[32]  C. Mathers,et al.  Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008 , 2010, International journal of cancer.

[33]  Yin-Feng Xu,et al.  A comparative study of the numerical scales and the prioritization methods in AHP , 2008, Eur. J. Oper. Res..

[34]  F Popa,et al.  Present and future tense in operable rectal cancer. , 2011, Chirurgia.

[35]  M Bracale,et al.  Analytic Hierarchy Process (AHP) for Examining Healthcare Professionals’ Assessments of Risk Factors , 2010, Methods of Information in Medicine.

[36]  Thomas L. Saaty,et al.  How to Make a Decision: The Analytic Hierarchy Process , 1990 .

[37]  Gail M. Wilkes.  Pocket guide to colorectal cancer : drugs and treatment , 2009 .

[38]  Kamal M. Al‐Subhi Al‐Harbi,et al.  Application of the AHP in project management , 2001 .

[39]  Perry J Pickhardt,et al.  Value-of-information analysis to guide future research in colorectal cancer screening. , 2009, Radiology.

[40]  Kazuhiko Ohe,et al.  Relationship between risk information on total colonoscopy and patient preferences for colorectal cancer screening options: Analysis using the Analytic Hierarchy Process , 2008, BMC health services research.

[41]  William Ho,et al.  Integrated analytic hierarchy process and its applications - A literature review , 2008, Eur. J. Oper. Res..

[42]  D. Tsiftsis,et al.  Preoperative decision making for rectal cancer. , 2010, American journal of surgery.

[43]  K Kotake,et al.  Overview of colorectal cancer in Japan , 1997, Diseases of the colon and rectum.

[44]  Fatemeh Zahedi,et al.  The Analytic Hierarchy Process—A Survey of the Method and its Applications , 1986 .

[45]  J. Dolan.  Shared decision-making--transferring research into practice: the Analytic Hierarchy Process (AHP). , 2008, Patient education and counseling.

[46]  James G. Dolan,et al.  Randomized Controlled Trial of a Patient Decision Aid for Colorectal Cancer Screening , 2002, Medical decision making : an international journal of the Society for Medical Decision Making.

[47]  Matthew J. Liberatore,et al.  The analytic hierarchy process in medical and health care decision making: A literature review , 2008, Eur. J. Oper. Res..

[48]  Laurence Collette,et al.  Chemotherapy with preoperative radiotherapy in rectal cancer. , 2006, The New England journal of medicine.