The development of collective reliability: a study of therapeutic decision-making

Abstract

Therapeutic decisions in oncology are no longer the product of individual expertise but of evidence-based medicine (EBM). The objective of evidence-based medicine is to improve the quality of care and homogenize medical practices. Practitioners have two decision-making aids: the guidelines, which consist of a set of therapeutic rules created by experts of the domain; and the Pluridisciplinary Conciliation Committee, which gathers a set of practitioners of various specialties in order to examine situations that cannot be solved by the sole and strict application of the guidelines. During these meetings, different solutions proposed by the practitioners are confronted and evaluated. This research aims at understanding the implicit effects of such a collective confrontation on knowledge construction, both at the individual and collective levels. A two-step methodology of knowledge elicitation has been carried out. In the first step, 19 practitioners were asked to think aloud, while solving 14 experimental realistic problems. In the second step, practitioners were confronted with the solutions of their colleagues and asked to comment about them (individual allo-confrontations). The results show that the benefits of the collective confrontation go beyond the decision-making aid. It ensures the reliability of decisions in developing a collective frame of reference for adaptation knowledge, while leading to individual knowledge development.

Keywords:

• Evidence-based medicine
• Confrontation method
• Knowledge development
• Therapeutic decision-making
• Reliability