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5. Finding and assessing treatment effect sweet spots in clinical trial data

Author

Craig, Erin, Redelmeier, Donald A, and Tibshirani, Robert J

Subjects
Statistics - Methodology
Abstract

Identifying heterogeneous treatment effects (HTEs) in randomized controlled trials is an important step toward understanding and acting on trial results. However, HTEs are often small and difficult to identify, and HTE modeling methods which are very general can suffer from low power. We present a method that exploits any existing relationship between illness severity and treatment effect, and identifies the "sweet spot", the contiguous range of illness severity where the estimated treatment benefit is maximized. We further compute a bias-corrected estimate of the conditional average treatment effect (CATE) in the sweet spot, and a $p$-value. Because we identify a single sweet spot and $p$-value, we believe our method to be straightforward to interpret and actionable: results from our method can inform future clinical trials and help clinicians make personalized treatment recommendations., Comment: 14 pages, 14 figures

Published
2020

18. Cognitive Biases and Artificial Intelligence.

Author

Wang, Jonathan and Redelmeier, Donald A.

Subjects
ARTIFICIAL intelligence, GENERATIVE artificial intelligence, COGNITIVE bias, ATTENTIONAL bias, CHRONIC obstructive pulmonary disease, DEATH rate
Abstract

Generative artificial intelligence (AI) models are increasingly utilized for medical applications. We tested whether such models are prone to human-like cognitive biases when offering medical recommendations. We explored the performance of OpenAI generative pretrained transformer (GPT)-4 and Google Gemini-1.0-Pro with clinical cases that involved 10 cognitive biases and system prompts that created synthetic clinician respondents. Medical recommendations from generative AI were compared with strict axioms of rationality and prior results from clinicians. We found that significant discrepancies were apparent for most biases. For example, surgery was recommended more frequently for lung cancer when framed in survival rather than mortality statistics (framing effect: 75% vs. 12%; P<0.001). Similarly, pulmonary embolism was more likely to be listed in the differential diagnoses if the opening sentence mentioned hemoptysis rather than chronic obstructive pulmonary disease (primacy effect: 100% vs. 26%; P<0.001). In addition, the same emergency department treatment was more likely to be rated as inappropriate if the patient subsequently died rather than recovered (hindsight bias: 85% vs. 0%; P<0.001). One exception was base-rate neglect that showed no bias when interpreting a positive viral screening test (correction for false positives: 94% vs. 93%; P=0.431). The extent of these biases varied minimally with the characteristics of synthetic respondents, was generally larger than observed in prior research with practicing clinicians, and differed between generative AI models. We suggest that generative AI models display human-like cognitive biases and that the magnitude of bias can be larger than observed in practicing clinicians. [ABSTRACT FROM AUTHOR]

Published
2024
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27. Changes in Media Reporting Quality and Suicides Following National Media Engagement on Responsible Reporting of Suicide in Canada: Changements de la Qualité des reportages dans les médias sur les suicides suite à l’engagement des médias nationaux à la déclaration responsable du suicide au Canada

Author

Sinyor, Mark, primary, Ekstein, Daniella, additional, Prabaharan, Nivetha, additional, Fiksenbaum, Lisa, additional, Vandermeer, Caroline, additional, Schaffer, Ayal, additional, Pirkis, Jane, additional, Heisel, Marnin J., additional, Goldstein, Benjamin I., additional, Redelmeier, Donald A., additional, Taylor, Paul, additional, and Niederkrotenthaler, Thomas, additional

Published
2024
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40. The association of continuity of care and cancer centre affiliation with outcomes among patients with cancer who require emergency department care

Author

Grewal, Keerat, Sutradhar, Rinku, Krzyzanowska, Monika K., Redelmeier, Donald A., and Atzema, Clare L.

Subjects
Patient outcomes, Care and treatment, Health aspects, Usage, Cancer -- Patient outcomes -- Care and treatment, Cancer patients -- Health aspects, Hospital emergency services -- Usage, Chemotherapy, Cancer treatment, CAT scans, Patient care, Hospital admission and discharge, Tomography, Emergency medicine, Hospitals, Databases, Radiation (Physics), Medical research
Abstract

Cancer is one of the leading causes of mortality worldwide, and patients with cancer frequently use the emergency department. (1-5) Previous studies have shown the importance of continuity of medical [...], BACKGROUND: Patients with cancer have complex care requirements and frequently use the emergency department. The purpose of this study was to determine whether continuity of care, cancer expertise of an institution or both affect outcomes in patients with cancer in the emergency setting. METHODS: We conducted a retrospective cohort study using administrative databases from Ontario, Canada, involving records of patients aged 20 years and older who received chemotherapy or radiation in the 30 days before a cancer-related visit to the emergency department between 2006 and 2011. Patients seen in an emergency department at an alternative hospital (not the site where cancer treatment was given) were matched based on propensity score to patients who visited their original hospital (site where cancer treatment was given). Next, patients seen at an alternative emergency department that was in a general hospital (i.e., not a cancer centre) were matched to patients who visited their original hospital or a cancer centre. Outcomes were admission to hospital at the index visit to the emergency department, 30-day mortality, having imaging with computed tomography and return visits to the emergency department. RESULTS: We found 42820 patients who were eligible for our study. Patients seen in the emergency departments at alternative hospitals were less likely to be admitted to hospital (odds ratio [OR] 0.78, 95% confidence interval [CI] 0.74-0.83) and had higher hazards of return visits to the emergency department than matched patients at original hospitals (hazard ratio [HR] 1.06, 95% CI 1.03-1.11). In comparison, patients at alternative general hospitals also had lower odds of admission to hospital (OR 0.83, 95% CI 0.79-0.88) and higher hazards of return visits to the emergency department (HR 1.07, 95% CI 1.03-1.11) compared with matched counterparts; however, these patients had higher 30-day mortality (OR 1.13, 95% CI 1.05-1.22) and lower odds of having CT imaging (OR 0.74, 95% CI 0.69-0.80). INTERPRETATION: Cancer expertise of an institution rather than continuity of care may be an important predictor of outcomes following emergency treatment of patients with cancer.

Published
2019
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44. The Reply

Author

Redelmeier, Donald A., primary, Wang, Jonathan, additional, and Thiruchelvam, Deva, additional

Published
2023
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45. Association of Different Prescribing Patterns for Oral Corticosteroids With Fracture Preventive Care Among Older Adults in the UK and Ontario

Author

Matthewman, Julian, primary, Tadrous, Mina, additional, Mansfield, Kathryn E., additional, Thiruchelvam, Deva, additional, Redelmeier, Donald A., additional, Cheung, Angela M., additional, Lega, Iliana C., additional, Prieto-Alhambra, Daniel, additional, Cunliffe, Lawrence A., additional, Mulick, Amy, additional, Henderson, Alasdair, additional, Langan, Sinéad M., additional, and Drucker, Aaron M., additional

Published
2023
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