Insular decision criteria in clinical practice: Analysis of decision-making in oncology

Background:
Medical decision-making is complex and involves a variety of decision criteria, many of which are universally recognised. However, decision-making analyses have demonstrated that certain decision criteria are not used uniformly among clinicians.
Aim:
We describe decision criteria, which for various contexts are only used by a minority of decision makers. For these, we introduce and define the term “insular criteria”.
Methods:
19 studies analysing clinical decision-making based on decision trees were included in our study. All studies were screened for decision-making criteria that were mentioned by less than three local decision makers in studies involving 8–26 participants.
Results:
14 out of the 19 included studies reported insular criteria. We identified 42 individual insular criteria. They could be intuitively allocated to seven major groups, these were: comorbidities, treatment, patients’ characteristics …