Risk and Decision Making: Modeling and Statistics in Medicine – Case Studies

This chapter illustrates issues of risk and decision-making in connection to health issues by case studies. Fundamental aspects of statistics in medicine are the topics of a separate twin chapter on “Risk and Decision Making: Modeling and Statistics in Medicine – Fundamental Aspects.” The present chapter represents the ideas in the form of case studies. The first case study illustrates how risk communication fails in a public discussion. To improve the situation, it gets essential that the wider public acquires more competencies so that risks can be debated carefully in public health and for individuals who have to decide about measurements to undergo in order to advance their situation. Some methods to increase risk competencies by simpler representations of the used model are illustrated. The second case study focuses on the question of participating in a screening program for breast cancer from the perspective of affected people, which provides a platform for authentic information and how it may be understood and used for the decision of an individual. In this role play, the following actors are involved: the affected woman, her husband, a friend of the family, and the attending physician. It quickly becomes clear that the views between the interest groups are not really congruent. The third case study investigates the benefits of screening programs from the perspective of empirical studies. It summarizes the evaluation of screening programs based on results of long-term meta-studies for breast cancer. Finally, fact boxes are displayed that are intended to be widely understandable; they should support an individual’s decision for or against screening. Overall, the weighted risks show no or only slight benefits for the screening programs. It remains the question whether societal endeavors should focus on alternative measurements rather than promoting screening programs as the small average improvement of system performance is contrasted with high risks of severe harm to a small number of participants. The societal rationale in the background suffers from a clash between stakeholders in the public debate: the role one plays determines to a great extent the judgment of the relative benefits of screening programs.