Multi-criteria decision-making
Given such challenges, other options to enhance clinical decision-making have been proposed. One option is multi-criteria decision-making (MCDM) analysis,13-15 which could potentially be used to improve consistency, reliability, and the efficiency of clinical decision-making in an evidence-based method.
MCDM analysis can be a means to quantify clinical subjective information and formalise decision-making. When clinically interpreting multiple pieces of subjective information, this information can become more explicit and transparent if structured into an ordered form using decision-making tools. MCDM analysis has the additional benefit of using mathematical modelling with ranking and scoring, to refine and provide decision-making structure. Having structure and ranking of important clinical information supports the clinician with decision-making which is a step up from (potentially flawed) clinical intuition.16
The design of a model is beyond the scope of this report. However, we can briefly consider the steps using the example of a clinical provider undertaking decision-making from a musculoskeletal assessment. When mathematical modelling is added to this scenario, as in MCDM analysis, multiple subjective pieces of clinical information can be developed into a set of decision-making factors called criteria, which in turn have levels of choices. The levels of choices have a point value, that can represent their relative importance,13 and there is available software that can be used to attribute point values to the refined clinical information.17 The point values give a clear representation of the relative importance of each piece of clinical information to allow alternatives to be compared.18 This allows transparency, reliability, and credibility for the decision-making process. While there are many different MCDM models, they all aim is to improve decision-making.19 Although, to date, MCDM is not being used for shoulder injury pathway decision-making, there are many areas in healthcare where MCDM has been used successfully, such as prioritising antibiotics, recommending hip tests and classifying disease.20-22
When considering the basic MCDM, and what makes this a possible solution, it is helpful to have some history. MCDM has been developing for over 40 years23 and for health care, the use of MCDM analysis is steadily growing.15 It is important to recognise that in health care, algorithms and point systems have long been used as a source of assisting decision-making and there is increasing support for algorithms for more complex decisions, such as prioritising for elective surgery13 With an increasing prevalence of musculoskeletal conditions as the population ages, this is an area where MCDM tools can be useful to guide decision-making.24 MCDM tools are used online, and the process of using internet-based software for health decision-making has been found acceptable for both health care providers and patients.13 Furthermore, online MCDM software is a step forward from the earlier mentioned points-based systems.