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Use of Influence Diagrams to Structure Medical Decisions

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  • Robert F. Nease JR
  • Douglas K. Owens

Abstract

Influence diagrams are compact representations of decision problems that are mathematically equivalent to decision trees. The authors present five important principles for structuring a decision as an influence diagram: 1) start at the value node and work back to the decision nodes; 2) draw the arcs in the direction that makes the probabilities easiest to assess; 3) use informational arcs to specify which events will have been observed at the time each decision is made; 4) ensure that missing arcs reflect intentional assertions about conditional independence and the timing of observations; and 5) ensure that there are no cycles in the influence diagram. They then build an influence diagram for the problem of staging non-small-cell lung cancer as an illustration. Influence diagrams offer several strengths for structuring medical decisions. They represent graphically and compactly the probabilistic relationships between parameters in the model. Influence diagrams also allow the model to be structured in a fashion that eases the necessary probability assessments, regardless of whether the assessments are based on available evidence or on expert judgment. Influence diagrams provide an important complement to decision trees, especially for representing probabilistic relationships among variables in a decision model. Key words : decision analysis; influence diagrams; decision tree; decision techniques; cost-effectiveness analysis. (Med Decis Making 1997;17:263-275)

Suggested Citation

  • Robert F. Nease JR & Douglas K. Owens, 1997. "Use of Influence Diagrams to Structure Medical Decisions," Medical Decision Making, , vol. 17(3), pages 263-275, July.
    • Handle: RePEc:sae:medema:v:17:y:1997:i:3:p:263-275
    DOI: 10.1177/0272989X9701700302
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    References listed on IDEAS

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    1. David J. Malenka & Gene L. Colice & Charles Jacobs & J. Robert Beck, 1989. "Mediastinal Staging in Non-small-cell Lung Cancer," Medical Decision Making, , vol. 9(4), pages 231-242, December.
    2. Ross D. Shachter, 1986. "Evaluating Influence Diagrams," Operations Research, INFORMS, vol. 34(6), pages 871-882, December.
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    1. Bielza, Concha & Gómez, Manuel & Shenoy, Prakash P., 2011. "A review of representation issues and modeling challenges with influence diagrams," Omega, Elsevier, vol. 39(3), pages 227-241, June.
    2. Stephen G. Pauker & John B. Wong, 2005. "The Influence of Influence Diagrams in Medicine," Decision Analysis, INFORMS, vol. 2(4), pages 238-244, December.
    3. Dy, Sydney Morss & Rubin, Haya R. & Lehmann, Harold P., 2005. "Why do patients and families request transfers to tertiary care? a qualitative study," Social Science & Medicine, Elsevier, vol. 61(8), pages 1846-1853, October.
    4. Mark Helfand & Stephen G. Pauker, 1997. "Influence Diagrams:," Medical Decision Making, , vol. 17(3), pages 351-352, July.
    5. Douglas K. Owens, 2002. "Analytic Tools for Public Health Decision Making," Medical Decision Making, , vol. 22(1_suppl), pages 3-10, September.

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