Patient selection for operation: the complex balance between information and intuition

Treatment strategy and decision-making for elderly surgical candidates with early lung cancer

Among elderly cancer patients of the same chronological age, there is a wide range of heterogeneity in their ability to tolerate surgery. When an elderly patient comes to a thoracic surgeon, the surgeon first considers how healthy the patient is. If the patient looks healthy or in fit condition, the surgeon offers lobectomy plus mediastinal lymph node dissection. On the other hand, if the patient looks frail, the surgeon may offer, instead of a standard treatment, lobectomy without lymph node dissection, sublobar resection, or radiotherapy or may not offer any kind of treatment. This review was conducted to obtain an overview of these options and compare the treatment outcomes reported in the literature for the purpose of making a good decision for elderly surgical candidates with early lung cancer.

Conscious versus unconscious thinking in the medical domain: the deliberation-without-attention effect examined

Previous studies have shown that with important decisions, unconscious thought has surprisingly led to better choices than conscious thought. The present study challenges this so-called 'deliberation-without-attention effect' in the medical domain. In a computerized study, physicians and medical students were asked, after either conscious or unconscious thought, to estimate the 5-year survival probabilities of four fictitious patients with varying medical characteristics. We assumed that experienced physicians would outperform students as a result of their superior knowledge. The central question was whether unconscious thought in this task would lead to better performance in experts or novices, in line with the deliberation-without-attention effect. We created four fictitious male 60-year-old patients, each of whom with signs and symptoms related to likely prognosis, from 12 (Complex) or 4 (Simple) categories. This manipulation resulted in objectively different life expectancies for these patients. Participants (86 experienced physicians and 57 medical students) were randomly allocated to the Simple or Complex condition. Statements were randomly presented for 8 s. Next, each participant assessed the life expectancies after either conscious or unconscious thought. As expected, experienced physicians were better in assessing life expectancies than medical students. No significant differences were found in performance between conscious and unconscious thought, nor did we detect a significant interaction between expertise level and mode of thought. In a medical decision task, unconscious thought did not lead to better performance of experienced physicians or medical students than conscious thought. Our findings do not support the deliberation-without-attention effect.