Risk and Decision Making: Modeling and Statistics in Medicine – Fundamental Aspects

This chapter develops fundamental aspects of risk and decision making in connection to health issues and highlights the character of statistical concepts used to describe the decision situation. The ideas and concepts are illustrated by examples from the context of medicine. Case studies that deal with the problem of risk judgment and the communication of risk related to medical contexts are the topics of a separate twin Chap. 59, “Risk and Decision Making: Modeling and Statistics in Medicine – Case Studies” In the first section, a framework for decisions is developed that helps to structure the kind of decisions in health issues. Criteria for decisions and constituents of risky situations are part of the discussion. Rationality may be rationally diverging if different stakeholders meet. Decisions in medicine and health issues usually bring several stakeholders together who have different criteria for their decisions and distinct interests in the decision and its consequences. That makes it so difficult but interesting to analyze the background. The second section deals with risk managementRisk management in health issues. The general difficulty to arrive at a consensus about risks is illustrated by the fact that one often is faced with hazards. This means that between the exposition to a hazardous factor and the first symptoms of a negative impact, there is a long time span that makes it difficult to recognize a causal connection between exposition and disease. This delay between hazard and disease makes it hard to provide evidence, and if evidence is available, it is least convincing for many people. The third section illustrates the constituents of diagnosing procedures, the errors, which can be made, and how variables can be used for diagnosis. Procedures that are used in medical statistics are aligned with statistical methods by an analogy between these two disciplines. Furthermore, issues are investigated about the required sample size of empirical studies so that they deliver the information, which is needed to judge the adequacy of a medical measurement. TheStakeholders of decision wider the circle of stakeholders involved in the decision, the further away in the sense of personal involvement and time, the harder it is to attain a reasonable compromise about the inherent values and to make a widely agreed decision.