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Oehrlein EM, Schoch S, Majercak K, Gressler LE, Costantino RC, Love TR, Perfetto EM. Development and Testing of a Chronic-Disease Patient Experience Mapping Toolbox. THE PATIENT 2024; 17:263-274. [PMID: 38172406 DOI: 10.1007/s40271-023-00658-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/25/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Stakeholders increasingly expect research and care delivery to be guided by and to optimize patient experiences. However, standardized tools to engage patients to gather high-quality data about their experiences, priorities, and desired outcomes are not publicly available. The objective of this study was to develop and test a Toolbox with a disease-agnostic interview guide template and accompanying resources to assist researchers in engaging patients living with chronic disease in a dialogue about their experiences. METHODS Guided by a multidisciplinary workgroup, a targeted literature review (PubMed) was conducted, followed by group discussions to identify/thematically organize patient experience concepts, development of a conceptual model, and drafting of an interview guide template and patient-facing visual. Materials were tested/refined via cognitive (n = 5) and pilot (n = 30) interviews conducted virtually with US patients diagnosed with chronic/potentially disabling conditions from December 2020 to April 2021. Patient-facing tools were reviewed by health literacy experts for applicability/accessibility. English-speaking adults who self-reported receiving a chronic condition diagnosis at least 6 months prior participated in a 60-90 min interview. RESULTS Patient experience concepts were organized thematically under three domains: (1) life before a diagnosis, (2) experiences getting a diagnosis, and (3) experiences living with a diagnosis. A plain language consent sheet template, interview guide template, and patient experience conceptual model were developed and revised based on input from interviewees, interviewers, and the workgroup. CONCLUSIONS A disease-agnostic patient-engagement Toolbox was developed and tested to capture patient experience data. These materials can be customized based on study objectives and leveraged by various stakeholders to identify opportunities to enhance the patient centricity of healthcare delivery and research.
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Affiliation(s)
- Elisabeth M Oehrlein
- National Health Council, 1730 M St. NW Suite 650, Washington, DC, 20036, USA.
- Applied Patient Experience, LLC, 2201 Wisconsin Ave NW, Suite 200, Washington, DC, 20007, USA.
| | - Silke Schoch
- National Health Council, 1730 M St. NW Suite 650, Washington, DC, 20036, USA
| | - Kelsie Majercak
- National Health Council, 1730 M St. NW Suite 650, Washington, DC, 20036, USA
| | - Laura Elisabeth Gressler
- Division of Pharmaceutical Evaluation and Policy, College of Pharmacy, University of Arkansas for Medical Sciences, 4301 W Markham St, Little Rock, AR, 72205, USA
| | - Ryan C Costantino
- National Health Council, 1730 M St. NW Suite 650, Washington, DC, 20036, USA
- School of Pharmacy, University of Maryland, 20 N. Pine St, Baltimore, MD, 21201, USA
| | - T Rosie Love
- School of Pharmacy, University of Maryland, 20 N. Pine St, Baltimore, MD, 21201, USA
- Enterprise Intelligence and Data Solutions Program Management Office, Program Executive Office, Defense Healthcare Management Systems, 1700 North Moore Street, Suite 2300, Arlington, VA, 22209, USA
| | - Eleanor M Perfetto
- National Health Council, 1730 M St. NW Suite 650, Washington, DC, 20036, USA
- School of Pharmacy, University of Maryland, 20 N. Pine St, Baltimore, MD, 21201, USA
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Myers RE, Hallman MH, Shimada A, DiCarlo MA, Davis KV, Leach WT, Chambers CV. Primary care patient interests in joining a planned multi-cancer early detection clinical trial. Cancer Med 2024; 13:e7312. [PMID: 38785202 PMCID: PMC11117448 DOI: 10.1002/cam4.7312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 05/07/2024] [Accepted: 05/08/2024] [Indexed: 05/25/2024] Open
Abstract
INTRODUCTION Clinical trials are being conducted and are being planned to assess the safety and efficacy of multi-cancer early detection (MCED) tests for use in cancer screening. This study aimed to determine the feasibility of primary care patient outreach in recruiting participants to a planned MCED clinical trial, assess patient interest in trial participation, and measure decisional conflict related to participation. METHODS The research team used the electronic medical record of a large, urban health care system to identify primary care patients 50-80 years of age who were potentially eligible for a planned MCED trial. We mailed information about the planned MCED trial to identified patients and then contacted the patients by telephone to obtain consent and administer a baseline survey. Subsequently, we contacted consented patients to complete an interview to review the mailed information and elicit perceptions about trial participation. Finally, a research coordinator administered an endpoint telephone survey to assess patient interest in and decisional conflict related to joining the trial. RESULTS We randomly identified 1000 eligible patients and were able to make contact with 690 (69%) by telephone. Of the patients contacted, 217 (31%) completed the decision counseling session and 219 (32%) completed the endpoint survey. Among endpoint survey respondents, 177 (81%) expressed interest in joining the MCED trial and 162 (74%) reported low decisional conflict. CONCLUSIONS Most patients were contacted and about a quarter of those contacted expressed interest in and low decisional conflict about joining the planned MCED trial. Research is needed to determine how to optimize patient outreach and engage patients in shared decision-making about MCED trial participation.
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Affiliation(s)
- Ronald E. Myers
- Division of Population Science, Department of Medical OncologyThomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
| | - Mie H. Hallman
- Division of Population Science, Department of Medical OncologyThomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
| | - Ayako Shimada
- Division of Biostatistics, Department of Pharmacology and Experimental TherapeuticsThomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
| | - Melissa A. DiCarlo
- Division of Population Science, Department of Medical OncologyThomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
| | - Kaitlyn V. Davis
- Department of Family and Community MedicineThomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
| | - William T. Leach
- Department of Family and Community MedicineThomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
| | - Christopher V. Chambers
- Department of Family and Community MedicineThomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
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Kötting L, Anand-Kumar V, Keller FM, Henschel NT, Lippke S. Effective Communication Supported by an App for Pregnant Women: Quantitative Longitudinal Study. JMIR Hum Factors 2024; 11:e48218. [PMID: 38669073 PMCID: PMC11087862 DOI: 10.2196/48218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 01/31/2024] [Accepted: 02/20/2024] [Indexed: 04/30/2024] Open
Abstract
BACKGROUND In the medical field of obstetrics, communication plays a crucial role, and pregnant women, in particular, can benefit from interventions improving their self-reported communication behavior. Effective communication behavior can be understood as the correct transmission of information without misunderstanding, confusion, or losses. Although effective communication can be trained by patient education, there is limited research testing this systematically with an app-based digital intervention. Thus, little is known about the success of such a digital intervention in the form of a web-app, potential behavioral barriers for engagement, as well as the processes by which such a web-app might improve self-reported communication behavior. OBJECTIVE This study fills this research gap by applying a web-app aiming at improving pregnant women's communication behavior in clinical care. The goals of this study were to (1) uncover the potential risk factors for early dropout from the web-app and (2) investigate the social-cognitive factors that predict self-reported communication behavior after having used the web-app. METHODS In this study, 1187 pregnant women were recruited. They all started to use a theory-based web-app focusing on intention, planning, self-efficacy, and outcome expectancy to improve communication behavior. Mechanisms of behavior change as a result of exposure to the web-app were explored using stepwise regression and path analysis. Moreover, determinants of dropout were tested using logistic regression. RESULTS We found that dropout was associated with younger age (P=.014). Mechanisms of behavior change were consistent with the predictions of the health action process approach. The stepwise regression analysis revealed that action planning was the best predictor for successful behavioral change over the course of the app-based digital intervention (β=.331; P<.001). The path analyses proved that self-efficacy beliefs affected the intention to communicate effectively, which in turn, elicited action planning and thereby improved communication behavior (β=.017; comparative fit index=0.994; Tucker-Lewis index=0.971; root mean square error of approximation=0.055). CONCLUSIONS Our findings can guide the development and improvement of apps addressing communication behavior in the following ways in obstetric care. First, such tools would enable action planning to improve communication behavior, as action planning is the key predictor of behavior change. Second, younger women need more attention to keep them from dropping out. However, future research should build upon the gained insights by conducting similar internet interventions in related fields of clinical care. The focus should be on processes of behavior change and strategies to minimize dropout rates, as well as replicating the findings with patient safety measures. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03855735; https://classic.clinicaltrials.gov/ct2/show/NCT03855735.
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Affiliation(s)
- Lukas Kötting
- Psychology and Methods, School of Business, Social & Decision Sciences, Constructor University Bremen gGmbH, Bremen, Germany
| | - Vinayak Anand-Kumar
- Psychology and Methods, School of Business, Social & Decision Sciences, Constructor University Bremen gGmbH, Bremen, Germany
| | | | - Nils Tobias Henschel
- Psychology and Methods, School of Business, Social & Decision Sciences, Constructor University Bremen gGmbH, Bremen, Germany
| | - Sonia Lippke
- Psychology and Methods, School of Business, Social & Decision Sciences, Constructor University Bremen gGmbH, Bremen, Germany
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Sánchez-Martínez FI, Abellán-Perpiñán JM, Martínez-Pérez JE, Gómez-Torres JL. Design of a multiple criteria decision analysis framework for prioritizing high-impact health technologies in a regional health service. Int J Technol Assess Health Care 2024; 40:e21. [PMID: 38576122 DOI: 10.1017/s0266462324000205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
OBJECTIVES This study aims to develop a framework for establishing priorities in the regional health service of Murcia, Spain, to facilitate the creation of a comprehensive multiple criteria decision analysis (MCDA) framework. This framework will aid in decision-making processes related to the assessment, reimbursement, and utilization of high-impact health technologies. METHOD Based on the results of a review of existing frameworks for MCDA of health technologies, a set of criteria was proposed to be used in the context of evaluating high-impact health technologies. Key stakeholders within regional healthcare services, including clinical leaders and management personnel, participated in a focus group (n = 11) to discuss the proposed criteria and select the final fifteen. To elicit the weights of the criteria, two surveys were administered, one to a small sample of healthcare professionals (n = 35) and another to a larger representative sample of the general population (n = 494). RESULTS The responses obtained from health professionals in the weighting procedure exhibited greater consistency compared to those provided by the general public. The criteria more highly weighted were "Need for intervention" and "Intervention outcomes." The weights finally assigned to each item in the multicriteria framework were derived as the equal-weighted sum of the mean weights from the two samples. CONCLUSIONS A multi-attribute function capable of generating a composite measure (multicriteria) to assess the value of high-impact health interventions has been developed. Furthermore, it is recommended to pilot this procedure in a specific decision context to evaluate the efficacy, feasibility, usefulness, and reliability of the proposed tool.
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Affiliation(s)
| | | | | | - Jorge-Luis Gómez-Torres
- International Doctorate School, PhD programme in Economics, DEcIDE, University of Murcia, Murcia, Spain
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Schemmel N, Ulrich L, Lauberger J, Steckelberg A, Lühnen J. Exploring the information needs of patients with osteoarthritis of the knee: a content analysis of Facebook group posts. BMC Musculoskelet Disord 2024; 25:120. [PMID: 38336736 PMCID: PMC10854127 DOI: 10.1186/s12891-024-07240-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 01/29/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND End-stage osteoarthritis of the knee (OAK) is often treated by total knee arthroplasty (TKA). This intervention can significantly improve quality of life. However, many patients are dissatisfied with the outcome of surgery. One of the factors related to dissatisfaction is the of lack integration of patients' preferences, habits and values that are not addressed by physicians. To develop realistic expectations, affected patients need evidence-based information. Our aim was to explore the information needs of patients with OAK to support the development of decision aids and consent forms to promote informed decision-making. Additionally, we investigated whether the information needs during the Covid-19 pandemic differ from those before the pandemic. METHODS The qualitative research design included a social media analysis of Facebook groups. Facebook groups were selected according to the following criteria: Thematic relevance, English or German language, at least one new post per week, from period before and after the start of the Covid-19 pandemic in March 2020. Thematically relevant group posts were analysed according to the content-structuring content analysis of Kuckartz using MaxQDA. RESULTS Out of 448 identified Facebook groups, we screened seven for relevant posts and a total of 77 posts out of 6 groups were selected. The following eight categories were derived during the coding process: access to health care, disease information, TKA indication and contraindication, TKA outcome and quality of life, information needs regarding conservative therapy, strain, attitude towards TKA and attitude towards conservative therapy. The analysis showed that patients with OAK need information about the benefits and risks of TKA and conservative therapies. CONCLUSION This study provides information on the information needs of patients with OAK in order to decide between TKA or conservative therapy. Patients need information about treatment options in due consideration of their immediate living situation to be reliably able to assess potential outcomes. Such Information about TKA should enable patients to assess the individual prognosis with comprehensible and relevant outcome measures. Also, they should be formulated with the living environment of the patients in mind and be linked to possible fears and negative previous experiences with treatments.
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Affiliation(s)
- Nicole Schemmel
- Institute for Health and Nursing Science, Martin Luther University Halle-Wittenberg, Magdeburger Straße 8, D-06112, Halle (Saale), Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt, Institute of Clinical Nursing Science, Universität zu Berlin, Berlin, Germany
| | - Lydia Ulrich
- Institute for Health and Nursing Science, Martin Luther University Halle-Wittenberg, Magdeburger Straße 8, D-06112, Halle (Saale), Germany
| | - Julia Lauberger
- Institute for Health and Nursing Science, Martin Luther University Halle-Wittenberg, Magdeburger Straße 8, D-06112, Halle (Saale), Germany
| | - Anke Steckelberg
- Institute for Health and Nursing Science, Martin Luther University Halle-Wittenberg, Magdeburger Straße 8, D-06112, Halle (Saale), Germany.
| | - Julia Lühnen
- Institute for Health and Nursing Science, Martin Luther University Halle-Wittenberg, Magdeburger Straße 8, D-06112, Halle (Saale), Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt, Institute of Clinical Nursing Science, Universität zu Berlin, Berlin, Germany
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Yi M, Jia Y, Zhao B, Chen O. The Barriers to Shared Decision-making in Exercise Prescription for Children With Asthma: A Qualitative Study From Parents' Perspective. J Pediatr Health Care 2024:S0891-5245(24)00001-4. [PMID: 38310492 DOI: 10.1016/j.pedhc.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 01/13/2024] [Accepted: 01/13/2024] [Indexed: 02/05/2024]
Abstract
INTRODUCTION The knowledge of barriers from the parental perspective is essential for facilitating shared decision-making in the field of pediatric asthma. METHOD Participants who were parents of children with a diagnosis of asthma were recruited, and in-depth, semistructured interviews were conducted. The interview transcripts were analyzed thematically using framework methods. RESULTS Seventeen participants undertook interviews. Three themes and nine subthemes emerged: (1) decision-making need level-limited understanding of decision-making knowledge, ambiguity regarding self-empowerment roles, and lack of family member support; (2) decision-making support level-insufficient ability to evaluate information, inefficient communication with health care professionals, and excessive use of professional terminology; and (3) decision-making outcome level-doubts about the final decision-making choices, time constraints on decision-making, and absence of mechanisms to track decisions made. DISCUSSION The findings would serve as crucial foundations for the development of decision-aid programs within the context of pediatric asthma.
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van Til JA, Pearce A, Ozdemir S, Hollin IL, Peay HL, Wu AW, Ostermann J, Deal K, Craig BM. Role Preferences in Medical Decision Making: Relevance and Implications for Health Preference Research. THE PATIENT 2024; 17:3-12. [PMID: 37874464 PMCID: PMC10769916 DOI: 10.1007/s40271-023-00649-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/27/2023] [Indexed: 10/25/2023]
Abstract
Health preference research (HPR) is being increasingly conducted to better understand patient preferences for medical decisions. However, patients vary in their desire to play an active role in medical decisions. Until now, few studies have considered patients' preferred roles in decision making. In this opinion paper, we advocate for HPR researchers to assess and account for role preferences in their studies, to increase the relevance of their work for medical and shared decision making. We provide recommendations on how role preferences can be elicited and integrated with health preferences: (1) in formative research prior to a health preference study that aims to inform medical decisions or decision makers, (2a) in the development of health preference instruments, for instance by incorporating a role preference instrument and (2b) by clarifying the respondent's role in the decision prior to the preference elicitation task or by including role preferences as an attribute in the task itself, and (3) in statistical analysis by including random parameters or latent classes to raise awareness of heterogeneity in role preferences and how it relates to health preferences. Finally, we suggest redefining the decision process as a model that integrates the role and health preferences of the different parties that are involved. We believe that the field of HPR would benefit from learning more about the extent to which role preferences relate to health preferences, within the context of medical and shared decision making.
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Affiliation(s)
- Janine A van Til
- Department of Health Technology and Services Research, Technical Medical Center, Faculty of Behavioural, Management and Social Sciences (BMS), University of Twente, Technohal, Room 3304, P.O. Box 217, 7500 AE, Enschede, The Netherlands.
| | - Alison Pearce
- The Daffodil Centre, The University of Sydney, a Joint Venture with Cancer Council NSW, Sydney, Australia
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Semra Ozdemir
- Department of Population Health Sciences, Duke University, Durham, NC, USA
| | - Ilene L Hollin
- Department of Health Services Administration and Policy, College of Public Health, Temple University, Philadelphia, PA, USA
| | - Holly L Peay
- Genomics and Translational Research Center, RTI International, Research Triangle Park, NC, USA
| | - Albert W Wu
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jan Ostermann
- Department of Health Services, Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Ken Deal
- DeGroote School of Business, McMaster University, Hamilton, ON, Canada
| | - Benjamin M Craig
- Department of Economics, University of South Florida, Tampa, FL, USA
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Liu X, Kim MK, Du D, Zhou X, Wang L, Jiang X. Patient Education with New Media Integration Self-Management Support Model Improves Therapeutic Outcomes of Rosacea Patients. Patient Prefer Adherence 2023; 17:2395-2400. [PMID: 37790861 PMCID: PMC10544126 DOI: 10.2147/ppa.s431955] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 09/22/2023] [Indexed: 10/05/2023] Open
Abstract
Objective To retrospectively analyze the factors influencing the treatment of rosacea patients with regular follow-up by self-management support in the new media chronic disease management model, to explore the effect of self-management support and to provide an objective basis for clinical application. Methods Female patients with rosacea who were regularly followed up for more than 6 months at the rosacea follow-up clinic of the Department of Dermatology, West China Hospital, Sichuan University, from March 2022 to June 2023, with erythema and capillary dilation as the main clinical phenotype, met the rosacea diagnostic criteria of the American Rosacea Expert Committee 2017 edition, and received medications recommended by the Chinese Rosacea Treatment Guidelines (2021 edition). A total of 125 patients were treated with combined photobiomodulation therapy (PBMT), and the patients were divided into a standardized group (CEA<1, IGA<1) and a non-standardized group (CEA≥1, IGA≥1) based on significant rosacea efficacy (CEA<1, IGA<1) within 6 months. The age, gender, education level, duration of rosacea, treatment regimen, education intensity, CEA, and IGA baseline data were compared between the two groups, and logistic regression analysis was performed to analyze the factors influencing the significant efficacy of rosacea. Results There was a significant difference in the mean length of education between the two groups (P<0.05), and the differences between the rest of the baseline information of the two groups were not statistically significant (P>0.05). Logistic regression analysis showed that the variable that significantly influenced the efficacy of treatment was the mean length of education (≥130.5 min/month), and the intensity of education was significantly associated with the efficacy of treatment. Conclusion Self-management support in the new media chronic disease management model has a positive impact on the treatment of rosacea patients.
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Affiliation(s)
- Xu Liu
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
- Laboratory of Dermatology, Clinical Institute of Inflammation and Immunology, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Min-Kyu Kim
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
- Laboratory of Dermatology, Clinical Institute of Inflammation and Immunology, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Dan Du
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
- Laboratory of Dermatology, Clinical Institute of Inflammation and Immunology, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Xinyu Zhou
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
- Laboratory of Dermatology, Clinical Institute of Inflammation and Immunology, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Lian Wang
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
- Laboratory of Dermatology, Clinical Institute of Inflammation and Immunology, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Xian Jiang
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
- Laboratory of Dermatology, Clinical Institute of Inflammation and Immunology, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
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Socal MP, Estus E, Long J, Crane MA, Pegany V, Anderson GF. Developing Prioritization Criteria to Identify Target Drugs for CalRx, the California Generic Drugs Initiative. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:634-638. [PMID: 36379412 DOI: 10.1016/j.jval.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 10/21/2022] [Accepted: 11/04/2022] [Indexed: 05/03/2023]
Abstract
OBJECTIVES This study aimed to establish criteria to identify priority drugs for CalRx, a California-sponsored initiative to support the manufacture and distribution of affordable generic drugs. METHODS A web-based ranking exercise was implemented with key stakeholders in August 2020, using pricing, spending, and public health criteria identified through a review of academic literature and public health agency reports. A total of 39 of 40 invited stakeholders in 4 different categories-patient advocates, healthcare providers, health insurers, and health policy and economic experts-participated in this study (98% response rate). RESULTS Drugs that treat large populations, drugs that represent high cost to payors, and drugs that represent high cost to consumers were ranked a priority, receiving > 10% of ranking weights. Drugs that treat conditions with high morbidity or mortality, drugs without therapeutic alternatives, and drugs treating vulnerable populations represented criteria of further interest (9%-10% of weights). Shortage risk and curative effect (8%-9% of the weights), high price increases, communicable disease treatments, and high unit prices (< 8% of the weights) represented the bottom of the priority distribution. CONCLUSIONS This study suggests that drugs that treat large populations, drugs that represent large costs to payors, and drugs that represent large costs to consumers should be the priority for California's CalRx generic drug initiative. A prioritizing algorithm will assist California in determining top drugs to target from a public health and spending perspective as it plans the rollout of the CalRx initiative and negotiates with drug manufacturers.
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Affiliation(s)
- Mariana P Socal
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Emily Estus
- California Health and Human Services Agency, Sacramento, CA, USA
| | - Jingmiao Long
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Matthew A Crane
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Vishaal Pegany
- California Health and Human Services Agency, Sacramento, CA, USA
| | - Gerard F Anderson
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Nasir Ahmad NSB, Mustafa FB, Muhammad Yusoff SY. Spatial prediction of soil erosion risk using knowledge-driven method in Malaysia's Steepland Agriculture Forested Valley. ENVIRONMENT, DEVELOPMENT AND SUSTAINABILITY 2023:1-27. [PMID: 37362990 PMCID: PMC10119017 DOI: 10.1007/s10668-023-03251-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 04/11/2023] [Indexed: 06/28/2023]
Abstract
Soil is a fundamental resource with its value vital to the world's ecosystem. Due to the fact that soil is one of the bases of all terrestrial life, humans cannot survive without it. However, soil erosion has jeopardized soil sustainability and affected the environmental quality, leaving a bad impact if these issues were not tackled at an earlier phase. Many research has been done to predict soil erosion susceptibility areas using different methods. This research aims to classify the contributing factors of soil erosion according to the risk and generate a soil erosion risk prediction map in Cameron Highlands. Thus, this research focuses on a knowledge-driven method that uses Analytical Hierarchy Process (AHP) technique to achieve the objectives. This technique consists of weighing the factors adopted by comparing pairs of factors that control erosion in this area through experts' opinions. 15 factors have been chosen to build the prediction map. Result shows that rainfall erosivity is the main factor contributing to soil erosion in Cameron Highlands which is 0.110, followed by land use (0.095), slope steepness (0.089), soil texture (0.079), NDVI (0.079), TWI (0.072), slope length (0.065), slope aspect (0.064), slope altitude (0.062), SPI (0.061), lithology (0.060), slope curvature (0.054), drainage density (0.049), distance to road (0.029) and distance to stream (0.025). The west part of the study area was exposed to a high risk of soil erosion. This research will give the decision-makers, policymakers and planners insight into minimizing the soil erosion problem and suggest better precautions and solutions to overcome this severe environmental problem in the more advanced phase.
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Affiliation(s)
| | - Firuza Begham Mustafa
- Department of Geography, Faculty of Arts and Social Sciences, University of Malaya, 50603 Kuala Lumpur, Malaysia
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Ding Q. A system for preventing internal fistula needle dislodgement: Delphi study and pilot evaluation. Jpn J Nurs Sci 2023:e12530. [PMID: 36869423 DOI: 10.1111/jjns.12530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 01/18/2023] [Accepted: 02/02/2023] [Indexed: 03/05/2023]
Abstract
AIM To establish a scoring system for risk assessment (SSRA) for internal fistula needle dislodgement (IND) in hemodialysis (HD) patients. METHODS The SSRA was constructed based on literature search, medical history review, expert consultations, expert meeting (Delphi study), and analytic hierarchy process. Then, a pilot test was conducted at our hospital between August 1, 2020, and July 30, 2021. Consecutive patients requiring HD were included and randomly assigned to experimental and control groups (1:1 ratio). Control group was treated with the routine procedures, while the experimental group was treated with strengthened nursing measures based on the individual risk assessed by SSRA. Finally, the incidence of IND was compared between the two groups. RESULTS For the Delphi study, 16 experts in dialysis nursing in Zhejiang, Shanghai, Guangzhou, and Qinghai were included. The final draft of the SSRA included three first-level indices, 11 second-level indices, and 26 third-level indices. A total of 218 HD patients were included. The IND rate in the experimental group was significantly lower than that in the control group (p < .01). CONCLUSION We established a scientific, reliable, and feasible SSRA for timely identification of HD patients with high risk of IND and the corresponding nursing procedures to prevent IND.
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Affiliation(s)
- Qing Ding
- Yiwu Central Hospital, Yiwu, Zhejiang Province, China
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12
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Stein D. Location Factors Impact the Career Choice of German Dental Practitioners - An Empirical Analytical Approach to Multi-Criteria Decision-Making. Health Serv Res Manag Epidemiol 2023; 10:23333928231186215. [PMID: 37464989 PMCID: PMC10350783 DOI: 10.1177/23333928231186215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Abstract
Objectives In light of the increasing number of employed dentists and the decreasing rate of self-employed dentists, the factors that impact the decision to set up a dental office in Germany were investigated. Central to this approach is the provision of comprehensive dental care. Methods Using a pairwise comparison technique, the analytic hierarchy process (AHP), location factors identified as relevant in a systematic literature review and then prioritized by the professionals were weighted and ranked. Results According to this, five factors generally dominate the decision to open a dental office. These are, in descending order: environment for the family, quality of life in the private environment, real income, perception of location, and good infrastructure. The strongest impact on the rank order of the influencing factors is the socio-demographic characteristic of gender. For female dentists, the family environment is in the first place (p = .3196/C.R. = 0.1502). For male colleagues, this influence ranks third (p = .1550/C.R. = 0.1468) and real income receives the first place (p = .244/C.R. = 0.1468). For female dentists, the influence of income ranks fifth (p = .076/C.R. = 0.1502). Female and male dentists who grew up in rural areas were less likely to prefer employment (13.6%) than subjects of urban origin (40.2%). Conclusion The method of AHP is a way to map a priority list of all relevant factors. It can successfully show variations related to specific personal attributes. Obviously, there are factors that are of greater importance for the decision-making process to set up a dental office.
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Affiliation(s)
- David Stein
- Faculty of Business Management and Economics, Mendel University, Brno, Czech Republic
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13
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Mohr W, Rädke A, Afi A, Mühlichen F, Platen M, Scharf A, Michalowsky B, Hoffmann W. Development of a Quantitative Preference Instrument for Person-Centered Dementia Care—Stage 2: Insights from a Formative Qualitative Study to Design and Pretest a Dementia-Friendly Analytic Hierarchy Process Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148554. [PMID: 35886406 PMCID: PMC9321359 DOI: 10.3390/ijerph19148554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 07/04/2022] [Accepted: 07/11/2022] [Indexed: 02/05/2023]
Abstract
Person-centered care (PCC) requires knowledge about patient preferences. An analytic hierarchy process (AHP) is one approach to quantify, weigh and rank patient preferences suitable for People living with Dementia (PlwD), due to simple pairwise comparisons of individual criteria from a complex decision problem. The objective of the present study was to design and pretest a dementia-friendly AHP survey. Methods: Two expert panels consisting of n = 4 Dementia Care Managers and n = 4 physicians to ensure content-validity, and “thinking-aloud” interviews with n = 11 PlwD and n = 3 family caregivers to ensure the face validity of the AHP survey. Following a semi-structured interview guide, PlwD were asked to assess appropriateness and comprehensibility. Data, field notes and partial interview transcripts were analyzed with a constant comparative approach, and feedback was incorporated continuously until PlwD had no further comments or struggles with survey completion. Consistency ratios (CRs) were calculated with Microsoft® Excel and ExpertChoice Comparion®. Results: Three main categories with sub-categories emerged: (1) Content: clear task introduction, (sub)criteria description, criteria homogeneity, (sub)criteria appropriateness, retest questions and sociodemography for heterogeneity; (2) Format: survey structure, pairwise comparison sequence, survey length, graphical design (incl. AHP scale), survey procedure explanation, survey assistance and response perspective; and (3) Layout: easy wording, short sentences and visual aids. Individual CRs ranged from 0.08 to 0.859, and the consolidated CR was 0.37 (0.038). Conclusions: Our formative qualitative study provides initial data for the design of a dementia-friendly AHP survey. Consideration of our findings may contribute to face and content validity in future quantitative preference research in dementia.
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Affiliation(s)
- Wiebke Mohr
- German Center for Neurodegenerative Diseases e.V. (DZNE), Site Rostock/Greifswald, Ellernholzstrasse 1-2, D-17487 Greifswald, Germany; (A.R.); (A.A.); (F.M.); (M.P.); (A.S.); (B.M.); (W.H.)
- Correspondence: ; Tel.: +49-3834-8685-37
| | - Anika Rädke
- German Center for Neurodegenerative Diseases e.V. (DZNE), Site Rostock/Greifswald, Ellernholzstrasse 1-2, D-17487 Greifswald, Germany; (A.R.); (A.A.); (F.M.); (M.P.); (A.S.); (B.M.); (W.H.)
| | - Adel Afi
- German Center for Neurodegenerative Diseases e.V. (DZNE), Site Rostock/Greifswald, Ellernholzstrasse 1-2, D-17487 Greifswald, Germany; (A.R.); (A.A.); (F.M.); (M.P.); (A.S.); (B.M.); (W.H.)
| | - Franka Mühlichen
- German Center for Neurodegenerative Diseases e.V. (DZNE), Site Rostock/Greifswald, Ellernholzstrasse 1-2, D-17487 Greifswald, Germany; (A.R.); (A.A.); (F.M.); (M.P.); (A.S.); (B.M.); (W.H.)
| | - Moritz Platen
- German Center for Neurodegenerative Diseases e.V. (DZNE), Site Rostock/Greifswald, Ellernholzstrasse 1-2, D-17487 Greifswald, Germany; (A.R.); (A.A.); (F.M.); (M.P.); (A.S.); (B.M.); (W.H.)
| | - Annelie Scharf
- German Center for Neurodegenerative Diseases e.V. (DZNE), Site Rostock/Greifswald, Ellernholzstrasse 1-2, D-17487 Greifswald, Germany; (A.R.); (A.A.); (F.M.); (M.P.); (A.S.); (B.M.); (W.H.)
| | - Bernhard Michalowsky
- German Center for Neurodegenerative Diseases e.V. (DZNE), Site Rostock/Greifswald, Ellernholzstrasse 1-2, D-17487 Greifswald, Germany; (A.R.); (A.A.); (F.M.); (M.P.); (A.S.); (B.M.); (W.H.)
| | - Wolfgang Hoffmann
- German Center for Neurodegenerative Diseases e.V. (DZNE), Site Rostock/Greifswald, Ellernholzstrasse 1-2, D-17487 Greifswald, Germany; (A.R.); (A.A.); (F.M.); (M.P.); (A.S.); (B.M.); (W.H.)
- Institute for Community Medicine, Section Epidemiology of Health Care and Community Health, University Medicine Greifswald, Ellernholzstrasse 1-2, D-17487 Greifswald, Germany
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14
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Chuang YC, Zhu Z, Jin Y, Chien CW, Tung TH. Using hybrid consistent fuzzy preference relations-importance-performance analysis model to improve shared decision-making quality based on orthopaedic nurses' perceptions. J Clin Nurs 2022. [PMID: 35775418 DOI: 10.1111/jocn.16427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 04/22/2022] [Accepted: 06/10/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE To understand key factors for shared decision-making (SDM) and the quality improvement of nursing decisions in the orthopaedic clinical environment. METHOD This study applied the consistent consistent fuzzy preference relations (CFPRs) and importance-performance analysis (IPA) methods to explore the attribute weights and SDM performance, respectively. The dataset was collected from 16 orthopaedic clinical nurses' experiences in a third-grade and first-level general hospital in Taizhou, China. This study was performed according to the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) guidelines. RESULTS The results showed that "I made clear to my patient or patient's family that a nursing care decision needs to be made", "I explained the advantages and disadvantages of the nursing care options to my patient or patient's family" and "I told my patient or patient's family that there are different nursing care options for caring his/her medical condition" were key factors for affecting SDM. The statistical significance confidence and difference error of weight results were 98.321% and 1.679%, respectively. In addition, "I asked my patient or patient's family which nursing care option he/she prefers" was the key factor for improving orthopaedic clinical nursing in the case hospital. CONCLUSION The hybrid CFPRs-IPA model can help hospital managers effectively understand the key factors of SDM quality and improve the orthopaedic clinical nursing performance from nurses' perspectives. RELEVANCE TO CLINICAL PRACTICE A quantitative decision-making model can help nurses understand the key factors affecting the quality of SDM in nursing decision-making and promote nursing decision-making and patient-centred nursing service quality. A series of corresponding SDM training courses (i.e. concepts, knowledge and skills) can be provided for hospital and nursing department managers to maximise the potentially available resources. PATIENT OR PUBLIC CONTRIBUTION The clinical care process should be committed to involving patients in their care decisions and also provide an opportunity for patients to gain a comprehensive understanding of the care decision-making process in order to inform future patient contributions to care decisions.
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Affiliation(s)
- Yen-Ching Chuang
- Institute of Public Health and Emergency Management, Taizhou University, Taizhou, Zhejiang, China.,Business College, Taizhou University, Taizhou, Zhejiang, China
| | - Zhong Zhu
- Department of Orthopaedics, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China
| | - Yanjun Jin
- Nursing Department, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China
| | - Ching-Wen Chien
- Institute for Hospital Management, Tsing Hua University, Shenzhen Campus, Shenzhen, China
| | - Tao-Hsin Tung
- Evidence-Based Medicine Center, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang, China
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15
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Cahill PT, Reitzel M, Anaby DR, Camden C, Phoenix M, Romoff S, Campbell WN. Supporting rehabilitation stakeholders in making service delivery decisions: a rapid review of multi-criteria decision analysis methods. Disabil Rehabil 2022:1-14. [PMID: 35649688 DOI: 10.1080/09638288.2022.2080285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE This review aimed to synthesize knowledge about multi-criteria decision analysis methods for supporting rehabilitation service design and delivery decisions, including: (1) describing the use of these methods within rehabilitation, (2) identifying decision types that can be supported by these methods, (3) describing client and family involvement, and (4) identifying implementation considerations. METHODS We conducted a rapid review in collaboration with a knowledge partner, searching four databases for peer-reviewed articles reporting primary research. We extracted relevant data from included studies and synthesized it descriptively and with conventional content analysis. RESULTS We identified 717 records, of which 54 met inclusion criteria. Multi-criteria decision analysis methods were primarily used to understand the strength of clients' and clinicians' preferences (n = 44), and five focused on supporting decision making. Shared decision making with stakeholders was evident in only two studies. Clients and families were mostly engaged in data collection and sometimes in selecting the relevant criteria. Good practices for supporting external validity were inconsistently reported. Implementation considerations included managing cognitive complexity and offering authentic choices. CONCLUSIONS Multi-criteria decision analysis methods are promising for better understanding client and family preferences and priorities across rehabilitation professions, contexts, and caseloads. Further work is required to use these methods in shared decision making, for which increased use of qualitative methods and stakeholder engagement is recommended. IMPLICATIONS FOR REHABILITATIONMulti-criteria decision analysis methods are promising for evidence-based, shared decision making for rehabilitation.However, most studies to date have focused on estimating stakeholder preferences, not supporting shared decision making.Cognitive complexity and modelling authentic and realistic decision choices are major barriers to implementation.Stakeholder-engagement and qualitative methods are recommended to address these barriers.
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Affiliation(s)
- Peter T Cahill
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
| | - Meaghan Reitzel
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
| | - Dana R Anaby
- School of Physical and Occupational Therapy, McGill University, Montréal, Canada.,CanChild Centre for Child Disability Research, Hamilton, Canada
| | - Chantal Camden
- CanChild Centre for Child Disability Research, Hamilton, Canada.,School of Rehabilitation, University of Sherbrooke, Sherbrooke, Canada
| | - Michelle Phoenix
- School of Rehabilitation Science, McMaster University, Hamilton, Canada.,CanChild Centre for Child Disability Research, Hamilton, Canada
| | - Shelley Romoff
- Empowered Kids Ontario-Enfants Avenir Ontario, Toronto, Canada
| | - Wenonah N Campbell
- School of Rehabilitation Science, McMaster University, Hamilton, Canada.,CanChild Centre for Child Disability Research, Hamilton, Canada
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16
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Manhas KP, Olson K, Churchill K, Miller J, Teare S, Vohra S, Wasylak T. Exploring patient centredness, communication and shared decision-making under a new model of care: Community rehabilitation in canada. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:1051-1063. [PMID: 33825236 DOI: 10.1111/hsc.13304] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 12/16/2020] [Accepted: 01/05/2021] [Indexed: 05/27/2023]
Abstract
Patient-centred care and patient engagement in healthcare and health research are widely mandated by funders, health systems and institutions. Increasingly, shared decision-making (SDM) is recognised as promoting patient-centred care. We explore this relationship by studying SDM in the context of integrating novel patient-centred policies in community rehabilitation. There is little research on SDM in rehabilitation, and less so in the critical community context. Patient co-investigators led study co-design. We aimed to describe how patients and providers experience SDM at community rehabilitation sites that adopted a novel, patient-centred Rehabilitation Model of Care (RMoC). Guided by focused ethnography, we conducted focus groups and interviews. Patient and professional participants were recruited from 10 RMoC early-adopter community rehabilitation sites. Sites varied in geography, patient population and provider disciplines. Patient and community engagement researchers used a set-collect-reflect method to document patient perspectives. Researchers captured provider perspectives using a semi-structured question guide. We completed 11 focus groups and 18 interviews (n = 45 providers, n = 17 patients). We found that most early-adopter providers spoke in a shared, patient-first language that focused on patient readiness, barriers and active listening. Congruent patient perceptions reflected inclusion in decision-making, goal setting and positive relationships. Many patients queried how care would become and remain accessible before and after community rehabilitation care respectively. Remaining connected while in the community was described as important to patients. Providers identified barriers like time, team dynamics and lack of clarity on the RMoC aims, which challenged the initiative's long-term sustainability. Policy innovations can promote SDM and communication through multiple strategies and training to facilitate candid, encouraging conversations. Sustainability of SDM gains is paramount. Most providers moved beyond tokenistic engagement, but competing responsibilities and team member resistance could thwart continuity. Further research is needed to empirically assess respectful and compassionate communication and SDM in community rehabilitation long term.
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Affiliation(s)
- Kiran Pohar Manhas
- Alberta Health Services, Calgary, Canada
- Integrative Health Institute, University of Alberta, Edmonton, Canada
| | - Karin Olson
- Integrative Health Institute, University of Alberta, Edmonton, Canada
- Faculty of Nursing, University of Alberta, Edmonton, Canada
| | - Katie Churchill
- Alberta Health Services, Calgary, Canada
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Occupational Therapy, University of Alberta, Edmonton, Canada
| | - Jean Miller
- Patient and Community Engagement Research Program, O'Brien Institute for Public Health, University of Calgary, Calgary, Canada
| | - Sylvia Teare
- Patient and Community Engagement Research Program, O'Brien Institute for Public Health, University of Calgary, Calgary, Canada
| | - Sunita Vohra
- Integrative Health Institute, University of Alberta, Edmonton, Canada
- Departments of Pediatrics and Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | - Tracy Wasylak
- Alberta Health Services, Calgary, Canada
- Faculty of Nursing, University of Calgary, Calgary, Canada
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17
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Jin Y, Hong H, Liu C, Chien CW, Chuang YC, Tung TH. Exploring the Key Factors of Shared Decision-Making Through an Influential Network Relation Map: The Orthopedic Nurse's Perspective. Front Med (Lausanne) 2022; 8:762890. [PMID: 35127743 PMCID: PMC8811211 DOI: 10.3389/fmed.2021.762890] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 12/13/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Few studies have used quantitative methods to explore the key factors affecting shared decision-making (SDM) in nursing decision-making from the perspective of orthopedic nurses. PURPOSE To understand the intercorrelations among shared decision-making questionnaire-nurse (SDM-Q-NUR) factors and identify key factors for clinical nursing care decisions in orthopedics. METHODS In May 2021, this study investigated the interdependence of the SDM-Q-NUR scale and developed an influential network-relation map (INRM) from the clinical experience of 13 trained orthopedic nurses using the Decision-making Trial and Evaluation Laboratory method. RESULTS The INRM results showed that the nine criteria corresponded to three stages: preparation, discussion, and decision. "I helped my patient or patient's family understand all the information" (C 5) and "I wanted to know from my patient or patient's family how they want to be involved in making the nursing care decision" (C 2) are the main key factors for the beginning of nursing decision. In the discussion and decision stages, the corresponding key factors are "I made it clear to my patient or patient's family that a nursing care decision needs to be made" (C 1) and "I asked my patient or patient's family which nursing care option they prefer" (C 6). The result's statistical significance confidence and gap error were 98.106% and 1.894%, respectively. CONCLUSIONS When making nursing decisions with patients, orthopedic nurses need to have detailed information about how patients are involved in SDM and all relevant information. Nurses should also inform patients and their families regarding the purpose of the discussion, namely, to help one understand the content, advantages, and disadvantages of the nursing care options, and finally, make a decision.
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Affiliation(s)
- Yanjun Jin
- Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China
| | - Haiyan Hong
- Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China
| | - Chao Liu
- Institute for Hospital Management, Tsing Hua University, Shenzhen Campus, Shenzhen, China
| | - Ching-Wen Chien
- Institute for Hospital Management, Tsing Hua University, Shenzhen Campus, Shenzhen, China
| | - Yen-Ching Chuang
- Institute of Public Health & Emergency Management, Taizhou University, Taizhou, China
- Business College, Taizhou University, Taizhou, China
| | - Tao-Hsin Tung
- Evidence-Based Medicine Center, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, China
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18
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Liu WY, Tung TH, Chuang YC, Chien CW. Using DEMATEL Technique to Identify the Key Success Factors of Shared Decision-Making Based on Influential Network Relationship Perspective. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:1-10. [DOI: 10.1155/2021/6618818] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/19/2024]
Abstract
In the field of medicine, shared decision-making (SDM) is an important issue primarily aimed at resolving the problem of information asymmetry between clinicians and patients in the selection of treatment options and follow-up nursing plans. Most previous studies on this topic have focused on key elements and the development and implementation of SDM scales. This study used the decision-making trial and evaluation laboratory (DEMATEL) method to establish a network of influence relationships among factors that are keys to the success of the SDM process. Survey data were obtained from a well-known brain hospital in China. The key factors of success included tailor information, flexibility approach, check understanding patient, document (discussion about) decision, present evidence, make or explicitly defer decision, and patient values and preferences. We determined that clinicians should provide a series of treatment options and follow-up care plans based on a patientʼs conditions and preferences. Clinicians should also actively communicate with patients and their families to ensure a thorough understanding of the entire treatment and nursing process. This study also highlights the academic value of the cross-disciplinary integration of medical decision issues and multiple attribute decision-making methodologies.
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Affiliation(s)
- Wen-Yi Liu
- Department of Health Policy Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Institute for Hospital Management, Tsing Hua University, Shenzhen Campus, Shenzhen, China
- Shanghai Bluecross Medical Science Institute, Shanghai, China
| | - Tao-Hsin Tung
- Evidence-Based Medicine Center, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai 317000, China
| | - Yen-Ching Chuang
- Institute of Public Health & Emergency Management, Taizhou University, Taizhou, China
| | - Ching-Wen Chien
- Institute for Hospital Management, Tsing Hua University, Shenzhen Campus, Shenzhen, China
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19
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Factorial validity and internal consistency of a practitioners' checklist for therapists in rehabilitation. JBI Evid Implement 2021; 19:387-393. [PMID: 34810408 DOI: 10.1097/xeb.0000000000000279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIMS The current study aimed to assess the validity and internal consistency of a 20-item checklist to help provide rehabilitation based on effective and clear goal setting. METHODS A questionnaire survey was conducted regarding rehabilitation practices followed by physical, occupational, and speech-language therapists over the past month. The questionnaire was based on a checklist covering the following four areas, each comprising five items: goal setting based on patient and family intent and therapist perspective including long-term and short-term goals; therapist's specialized analysis and focalization of problems using the International Classification of Functioning, Disability and Health to clarify work processes and behaviors that hinder high-priority activities; proposal of plans considering the evidence and environment, which clarifies options for resolution methods (plans) and evidence; and formulation and implementation of plans including patient and family intent, which determines plan frequency and implementation period. The checklist was prepared based on medical records and previous studies by two occupational therapists who had experience in providing hospital and home-visit rehabilitation. To test the factorial validity of the 20-item checklist, confirmatory factor analysis was performed, and Cronbach's α coefficients were calculated. RESULTS The participants' mean age was 28 (25-75th percentile, range: 25-32) years. Of the 385 participants, 163 were home-visit rehabilitation therapists. Our model revealed a fair fit to data (χ2 statistic = 602.0) and standardized path coefficients ranged from 0.67 to 0.95. Path coefficients were at least 0.41 for all 20 items. Cronbach's α for goal setting, problem analysis, problem solving method proposals, and formulation and implementation of specific plans were 0.896, 0.890, 0.935, and 0.925, respectively. CONCLUSION Based on the assessment of therapists' practice over 1 month using the developed checklist, the factorial validity and internal consistency of these checklist items were considered acceptable. Education based on these checklist items might support goal setting and planning and improve patient outcomes.
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20
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Shen KY, Chuang YC, Tung TH. Clinical Knowledge Supported Acute Kidney Injury (AKI) Risk Assessment Model for Elderly Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041607. [PMID: 33567671 PMCID: PMC7915995 DOI: 10.3390/ijerph18041607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 02/04/2021] [Accepted: 02/04/2021] [Indexed: 11/16/2022]
Abstract
From the clinical viewpoint, the statistical approach is still the cornerstone for exploring many diseases. This study was conducted to explore the risk factors related to acute kidney injury (AKI) for elderly patients using the multiple criteria decision-making (MCDM) approach. Ten nephrologists from a teaching hospital in Taipei took part in forming the AKI risk assessment model. The key findings are: (1) Comorbidity and Laboratory Values would influence Comprehensive Geriatric Assessment; (2) Frailty is the highest influential AKI risk factor for elderly patients; and (3) Elderly patients could enhance their daily activities and nutrition to improve frailty and lower AKI risk. Furthermore, we illustrate how to apply MCDM methods to retrieve clinical experience from seasoned doctors, which may serve as a knowledge-based system to support clinical prognoses. In conclusion, this study has shed light on integrating multiple research approaches to assist medical decision-making in clinical practice.
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Affiliation(s)
- Kao-Yi Shen
- Department of Banking & Finance, Chinese Culture University, Taipei 11114, Taiwan
- Correspondence:
| | - Yen-Ching Chuang
- Taiwan Association of Health Industry Management and Development, Taipei 10351, Taiwan;
| | - Tao-Hsin Tung
- Evidence-Based Medicine Center, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai 317000, China;
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21
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Yamoah L, Dragojlovic N, Smith A, Lynd LD, Marra CA. Evaluating New Zealanders' Values for Drug Coverage Decision Making: Trade-Offs between Treatments for Rare and Common Conditions. PHARMACOECONOMICS 2021; 39:109-119. [PMID: 33150565 DOI: 10.1007/s40273-020-00974-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/24/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND New Zealand's near static healthcare budget limits access to expensive medications including those for rare conditions. As such, it is necessary to know the public's priority for values in the drug funding decision-making process. OBJECTIVES The objectives of this study were to measure the relative societal importance of values of New Zealanders in informing drug funding decisions and to determine how New Zealanders trade off funding in various scenarios between common and rare diseases. METHODS An online survey was conducted between 17 April and 17 May, 2019 on a sample of 500 New Zealanders aged ≥ 18 years. Participants ranked 13 values using an analytical hierarchy process. Participants were then presented with different trade-off scenarios to measure their attitudes towards funding drugs for common and rare diseases. RESULTS The values ranked in the top five by most were potential effect on quality of life (71.8%), ability of the drug to work (57.6%), severity (57.6%), safety (57%), and potential to extend life (56%). Adherence and rarity held the lowest and second lowest ranking. Most believe that resources should be allocated towards drugs that have been proven to work and have the greatest health benefits. In trade-offs between access to an expensive drug therapy for a rare disease with uncertain benefits or receive a fixed cash payment, the overwhelming consensus was to receive the cash payment. CONCLUSIONS New Zealanders ultimately value drug-related factors (e.g. quality of life and efficacy) and disease-related factors (e.g. severity of disease and equity) the most but did not value disease rarity.
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Affiliation(s)
- Linda Yamoah
- Pharmacy Intern, Wellington, New Zealand
- School of Pharmacy, University of Otago, PO Box 56, Dunedin, 9054, New Zealand
| | - Nick Dragojlovic
- Collaboration for Research and Evaluation (CORE), Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Alesha Smith
- School of Pharmacy, University of Otago, PO Box 56, Dunedin, 9054, New Zealand
| | - Larry D Lynd
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Carlo A Marra
- School of Pharmacy, University of Otago, PO Box 56, Dunedin, 9054, New Zealand.
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22
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Ramaswamy B, Jones J, Baker K, Oliver B. Methodology of exercise resources development for professionals providing services for people with Parkinson's: a technical report. Physiotherapy 2020; 112:49-54. [PMID: 34020202 DOI: 10.1016/j.physio.2020.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Indexed: 11/18/2022]
Abstract
The complexity of motor and non-motor symptoms seen in Parkinson's, with their variability and progressive nature, have a significant and potentially detrimental effect on mobility and subsequent quality of life for those with the condition. A considerable body of evidence now exists advocating the positive value of physical activity and exercise on both the motor and non-motor symptoms of Parkinson's, whilst limiting the impact and effects of the secondary complications. The literature is signposting to early adoption of higher intensity exercise, with reported benefits at a neurophysiological level, and a potential to influence a diminution in the rate of progression of the condition. It lacks clarity about structure of activity throughout the course of Parkinson's, and occasionally raises conflicting information about the differences in physical activity and 'best' exercise. This report describes the method for development of two Parkinson's exercise resources for professionals co-ordinated through the charity Parkinson's UK. The process uses the six-step Analytic Hierarchy Process to understand how the growing number of questions asked by people with Parkinson's, and by professionals about physical activity and exercise has informed: a) An Exercise Framework resource, which provides an understanding of what style of exercise might be beneficial, and just as significantly, takes into account the individual's changing needs and abilities over the course of Parkinson's, and b) An adaptable teaching template (PowerPoint Presentation) containing the supporting evidence for use by the exercise prescribing community.
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Affiliation(s)
- Bhanu Ramaswamy
- Sheffield Hallam University Collegiate Campus, College House, Collegiate Crescent, Sheffield S10 2BP, UK.
| | - Julie Jones
- School of Health Sciences, Robert Gordon University, Aberdeen AB10 7QE, UK.
| | - Katherine Baker
- Department of Sport, Exercise & Rehabilitation, Faculty of Health & Life Sciences, Northumbria University, Newcastle, UK.
| | - Beccy Oliver
- Thorpes Physiotherapy, 259 Yorktown Road, Sandhurst GU47 0RT, UK.
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Rahimi SA, Dery J, Lamontagne ME, Jamshidi A, Lacroix E, Ruiz A, Ait-Kadi D, Routhier F. Prioritization of patients access to outpatient augmentative and alternative communication services in Quebec: a decision tool. Disabil Rehabil Assist Technol 2020; 17:8-15. [PMID: 32501741 DOI: 10.1080/17483107.2020.1751314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose: A large number of people living with a chronic disability wait a long time to access publicly funded rehabilitation services such as Augmentative and Alternative Communication (AAC) services, and there is no standardized tool to prioritize these patients. We aimed to develop a prioritization tool to improve the organization and access to the care for this population.Methods: In this sequential mixed methods study, we began with a qualitative phase in which we conducted semi-structured interviews with 14 stakeholders including patients, their caregivers, and AAC service providers in Quebec City, Canada to gather their ideas about prioritization criteria. Then, during a half-day consensus group meeting with stakeholders, using a consensus-seeking technique (i.e. Technique for Research of Information by Animation of a Group of Experts), we reached consensus on the most important prioritization criteria. These criteria informed the quantitative phase in which used an electronic questionnaire to collect stakeholders' views regarding the relative weights for each of the selected criteria. We analyzed these data using a hybrid quantitative method called group based fuzzy analytical hierarchy process, to obtain the importance weights of the selected eight criteria.Results: Analyses of the interviews revealed 48 criteria. Collectively, the stakeholders reached consensus on eight criteria, and through the electronic questionnaire they defined the selected criteria's importance weights. The selected eight prioritization criteria and their importance weights are: person's safety (weight: 0.274), risks development potential (weight: 0.144), psychological well-being (weight: 0.140), physical well-being (weight: 0.124), life prognosis (weight: 0.106), possible impact on social environment (weight: 0.085), interpersonal relationships (weight: 0.073), and responsibilities and social role (weight: 0.054).Conclusion: In this study, we co-developed a prioritization decision tool with the key stakeholders for prioritization of patients who are referred to AAC services in rehabilitation settings.IMPLICATIONS FOR REHABILIATIONStudies in Canada have shown that people in Canada with a need for rehabilitation services are not receiving publicly available services in a timely manner.There is no standardized tool for the prioritization of AAC patients.In this mixed methods study, we co-developed a prioritization tool with key stakeholders for prioritization of patients who are referred to AAC services in a rehabilitation center in Quebec, Canada.
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Affiliation(s)
- Samira Abbasgholizadeh Rahimi
- Department of Family Medicine, McGill University, Montreal, Canada.,Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
| | - Julien Dery
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Quebec City, Canada.,Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, Canada
| | - Marie-Eve Lamontagne
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Quebec City, Canada.,Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, Canada
| | - Afshin Jamshidi
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Quebec City, Canada.,Department of Mechanical Engineering, Faculty of Science and Engineering, Université Laval, Quebec City, Canada
| | - Emilie Lacroix
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Quebec City, Canada
| | - Angel Ruiz
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Quebec City, Canada.,Department of Operations and Decision Systems, Faculty of Administration Sciences, Université Laval, Quebec City, Canada
| | - Daoud Ait-Kadi
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Quebec City, Canada.,Department of Mechanical Engineering, Faculty of Science and Engineering, Université Laval, Quebec City, Canada
| | - François Routhier
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Quebec City, Canada.,Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, Canada
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Kang J, Jeong YJ, Hong J. Cut-Off Values of the Post-Intensive Care Syndrome Questionnaire for the Screening of Unplanned Hospital Readmission within One Year. J Korean Acad Nurs 2020; 50:787-798. [PMID: 33441526 DOI: 10.4040/jkan.20233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/20/2020] [Accepted: 11/30/2020] [Indexed: 11/09/2022]
Abstract
PURPOSE This study aimed to assign weights for subscales and items of the Post-Intensive Care Syndrome questionnaire and suggest optimal cut-off values for screening unplanned hospital readmissions of critical care survivors. METHODS Seventeen experts participated in an analytic hierarchy process for weight assignment. Participants for cut-off analysis were 240 survivors who had been admitted to intensive care units for more than 48 hours in three cities in Korea. We assessed participants using the 18-item Post-Intensive Care Syndrome questionnaire, generated receiver operating characteristic curves, and analysed cut-off values for unplanned readmission based on sensitivity, specificity, and positive likelihood ratios. RESULTS Cognitive, physical, and mental subscale weights were 1.13, 0.95, and 0.92, respectively. Incidence of unplanned readmission was 25.4%. Optimal cut-off values were 23.00 for raw scores and 23.73 for weighted scores (total score 54.00), with an area of under the curve (AUC) of .933 and .929, respectively. There was no significant difference in accuracy for original and weighted scores. CONCLUSION The optimal cut-off value accuracy is excellent for screening of unplanned readmissions. We recommend that nurses use the Post-Intensive Care Syndrome Questionnaire to screen for readmission risk or evaluating relevant interventions for critical care survivors.
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Affiliation(s)
- Jiyeon Kang
- College of Nursing, Dong-A University, Busan, Korea
| | | | - Jiwon Hong
- College of Nursing, Dong-A University, Busan, Korea.
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25
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Developing a Landscape Sustainability Assessment Model Using an Analytic Hierarchy Process in Korea. SUSTAINABILITY 2019. [DOI: 10.3390/su12010301] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
With the increasing interest in integrative sustainable development, there has been a strong need for a landscape sustainability assessment tool independent from the existing green building rating system. This study aimed to establish an assessment model to objectively evaluate landscape sustainability using an analytic hierarchy process (AHP). Through an extensive literature review and expert survey, an initial list of assessment items was derived and used to set up an AHP model. An AHP survey with landscape architects and architects/engineers was then conducted to determine the importance of the assessment factors. In addition, the model was applied to three projects that were previously certified by a green building rating system in Korea. The AHP results showed that “site context” ranked as the most important factor of landscape sustainability followed by “soil and vegetation,” “maintenance,” “water,” “health and wellbeing,” and “materials.” Among the 20 assessment factors, “monitoring plan” was evaluated as the most important index, followed by “protection of cultural heritage” and “long-term management plan.” Landscape architects evaluated “soil and vegetation” as the most important in the assessment, while the engineers/architects group rated “site context” as the most important. When tested by applying them to the previously certified projects, the developed factors provided more objective and detailed information on landscape sustainability.
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Abstract
This study proposes a cuboid model for soil moisture assessment. In the model, the three edges were the meteorological, soil, and vegetation feature parameters highly related to soil moisture, and the edge lengths represented the degree of influence of each feature parameter on soil moisture. Soil moisture is assessed by the cuboid diagonal, which is referred to as the cuboid soil moisture index (CSMI) in this paper. The model was applied and validated in the Huang-Huai-Hai Plain. The results showed that (1) the difference in land surface temperature between day and night (ΔLST), land surface water index (LSWI), and accumulated precipitation (AP) were most closely correlated with soil moisture observation data in our study area, and were therefore selected as soil, crop, and meteorological system parameters to participate in CSMI calculations, respectively. (2) CSMI-1, with a cuboid length coefficient of 2/1/2, was the best model. The correlation of soil moisture derived from CSMI-1 with observed values was 0.64, 0.60, and 0.52 at depths of 10 cm, 20 cm, and 50 cm, respectively. (3) CSMI-1 had good applicability to the evaluation of soil moisture under different vegetation coverage. When the normalized difference vegetation index (NDVI)was 0–0.7, CSMI-1 was highly correlated with soil moisture at a significance level of 0.01. (4) The three-dimensional (3D) CSMI model can be easily converted to a two-dimensional (2D) model to adapt to different surface conditions (as long as the weight coefficient of one parameter is set to 0). Irrigation information (if available) can be considered as artificial recharge precipitation added in the AP to improve the accuracy of soil moisture inversion. This study provides a reference for soil moisture inversion using optical remote sensing images by integrating soil, vegetation, and meteorological feature parameters.
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27
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Midterm Fire Danger Prediction Using Satellite Imagery and Auxiliary Thematic Layers. REMOTE SENSING 2019. [DOI: 10.3390/rs11232786] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Wildfires constitute a significant environmental pressure in Europe, particularly in the Mediterranean countries. The prediction of fire danger is essential for sustainable forest fire management since it provides critical information for designing effective prevention measures and for facilitating response planning to potential fire events. This study presents a new midterm fire danger index (MFDI) using satellite and auxiliary geographic data. The proposed methodology is based on estimations of a dry fuel connectivity measure calculated from the Moderate Imaging Spectrometer (MODIS) time-series data, which are combined with biophysical and topological variables to obtain accurate fire ignition danger predictions for the following eight days. The index’s accuracy was assessed using historical fire data from four large wildfires in Greece. The results showcase that the index predicted high fire danger (≥3 on a scale within [ 1 , 4 ] ) within the identified fire ignition areas, proving its strong potential for deriving reliable estimations of fire danger, despite the fact that no meteorological measurements or forecasts are used for its calculation.
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28
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Abbasgholizadeh Rahimi S, Archambault PM, Ravitsky V, Lemoine ME, Langlois S, Forest JC, Giguère AMC, Rousseau F, Dolan JG, Légaré F. An Analytical Mobile App for Shared Decision Making About Prenatal Screening: Protocol for a Mixed Methods Study. JMIR Res Protoc 2019; 8:e13321. [PMID: 31596249 PMCID: PMC6913686 DOI: 10.2196/13321] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 05/09/2019] [Accepted: 05/25/2019] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Decisions about prenatal screening to assess the risk of genetic conditions such as Down syndrome are complex and should be well informed. Moreover, the number of available tests is increasing. Shared decision making (SDM) about testing could be facilitated by decision aids powered by mobile technology. OBJECTIVE In this mixed methods study, we aim to (1) assess women's needs and preferences regarding using an app for considering prenatal screening, (2) develop a decision model using the analytical hierarchy process, and (3) develop an analytical app and assess its usability and usefulness. METHODS In phase 1, we will assess the needs of 90 pregnant women and their partners (if available). We will identify eligible participants in 3 clinical sites (a midwife-led birthing center, a family practice clinic, and an obstetrician-led hospital-based clinic) in Quebec City and Montreal, Canada. Using semistructured interviews, we will assess participants' attitudes toward mobile apps for decision making about health, their current use of apps for health purposes, and their expectations of an app for prenatal testing decisions. Self-administered questionnaires will collect sociodemographic information, intentions to use an app for prenatal testing, and perceived importance of decision criteria. Qualitative data will be transcribed verbatim and analyzed thematically. Quantitative data will be analyzed using descriptive statistics and the analytic hierarchy process (AHP) method. In phase 2, we will develop a decision model using the AHP whereby users can assign relative importance to criteria when deciding between options. We will validate the model with potential users and a multidisciplinary team of patients, family physicians, primary care researchers, decision sciences experts, engineers, and experts in SDM, genetics, and bioethics. In phase 3, we will develop a prototype of the app using the results of the first 2 phases, pilot test its usefulness and usability among a sample of 15 pregnant women and their partners (if available), and improve it through 3 iterations. Data will be collected with a self-administered questionnaire. Results will be analyzed using descriptive statistics. RESULTS Recruitment for phase 1 will begin in 2019. We expect results to be available in 2021. CONCLUSIONS This study will result in a validated analytical app that will provide pregnant women and their partners with up-to-date information about prenatal screening options and their risks and benefits. It will help them clarify their values and enable them to weigh the options to make informed choices consistent with their preferences and values before meeting face-to-face with their health care professional. The app will be easy to update with the latest information and will provide women with a user-friendly experience using their smartphones or tablets. This study and the resulting app will contribute to high-quality SDM between pregnant women and their health care team. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/13321.
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Affiliation(s)
- Samira Abbasgholizadeh Rahimi
- Department of Family Medicine, McGill University, Montreal, QC, Canada.,Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
| | - Patrick M Archambault
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Québec, QC, Canada.,Centre de recherche, Centre intégré en santé et services sociaux de Chaudière-Appalaches, Lévis, QC, Canada.,Centre de recherche sur les soins et les services de première ligne de l'Université Laval, Université Laval, Québec, QC, Canada
| | - Vardit Ravitsky
- Programmes de bioéthique, Département de médecine sociale et préventive, École de santé publique de l'Université de Montréal, Université de Montréal, Montréal, QC, Canada
| | - Marie-Eve Lemoine
- Programmes de bioéthique, Département de médecine sociale et préventive, École de santé publique de l'Université de Montréal, Université de Montréal, Montréal, QC, Canada
| | - Sylvie Langlois
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
| | - Jean-Claude Forest
- Centre de recherche, Centre hospitalier universitaire de Québec, Québec, QC, Canada.,Department of Molecular Biology, Medical Biochemistry and Pathology, Faculty of Medicine, Université Laval, Québec, QC, Canada
| | - Anik M C Giguère
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Québec, QC, Canada.,Canadian Research Chair in Shared Decision Making and Knowledge Translation, Québec, QC, Canada
| | - François Rousseau
- Department of Molecular Biology, Medical Biochemistry and Pathology, Faculty of Medicine, Université Laval, Québec, QC, Canada
| | - James G Dolan
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, United States
| | - France Légaré
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Québec, QC, Canada.,Centre de recherche sur les soins et les services de première ligne de l'Université Laval, Université Laval, Québec, QC, Canada
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Qu H, Hu X, Singh JA. Factors influencing implementation of a computerized, individualized, culturally tailored lupus decision aid in lupus clinics: a qualitative semi-structured interview study. Clin Rheumatol 2019; 38:2793-2801. [PMID: 31222574 DOI: 10.1007/s10067-019-04643-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 05/29/2019] [Accepted: 06/11/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To identify factors that might facilitate or impede the implementation of a shared decision-making in lupus electronic tool (SMILE) in clinics by assessing perspectives of clinicians, clinic champions, and patient advocacy organization leaders. METHODS We conducted a series of semi-structured telephone interviews (25-45 minutes) about facilitators and barriers of implementing the SMILE decision-aid tool with 23 lupus care providers (18 physicians, 5 champions), and leaders of two patient advocacy organizations. Interviews were audio recorded, transcribed, coded, and analyzed. RESULTS Physicians and clinic champions were from 18 geographically diverse US clinics. The patient advocacy leaders were from the Lupus Foundation of America and the Arthritis Foundation. Most of the clinics were rheumatology specialty (94%), at university-based academic centers (72%), located in urban areas (72%), had a specialized lupus clinic (72%), were very interested (72%) in the SMILE tool and were ready to implement it (89%). Several specific factors, composed as four themes, were identified that could either facilitate or impede the implementation of the SMILE tool: (1) patient-related theme: patient recruitment and education, and the clinic visit time; (2) clinic-related theme: staff work-load and time, and physical space to view and use the SMILE tool; (3) technology-related theme: Wi-Fi connection and iPad navigation; and (4) management-related theme: influence on the clinics' daily workflow, the need of a study champion and coordination, and leadership support. CONCLUSION Physicians, staff, and patient advocacy leaders perceived the SMILE as a promising tool to facilitate patient-provider communication and quality improvement in lupus. Identification of the patient-, clinic-, technology-, and management-related barriers to the SMILE implementation will allow its integration into busy clinical practice workflow. Key Points • Physicians, staff and patient advocacy leaders perceived computerized lupus decision aid to be a promising tool to facilitate shared decision-making for lupus treatment. • Stakeholder identified patient-related, clinic-resource-related, technology-related and clinic-management related themes as barriers or facilitators to viewing computerized lupus decision aid during regular clinic visits.
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Affiliation(s)
- Haiyan Qu
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, SHPB 580D, 1716 9th Avenue, South Birmingham, AL, 35294-1212, USA
| | - Xuejun Hu
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, SHPB 580D, 1716 9th Avenue, South Birmingham, AL, 35294-1212, USA
| | - Jasvinder A Singh
- Division of Clinical Immunology and Rheumatology, School of Medicine, University of Alabama at Birmingham, 510 20th Street, South Faculty Office Tower 805B, Birmingham, AL, 35294, USA.
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30
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Hancerliogullari Koksalmis G, Hancerliogullari KO, Cetinguc B, Durucu M, Calisir F. Medical decision making: Selection of the appropriate surgical mode for undescended testicle treatment. JOURNAL OF MULTI-CRITERIA DECISION ANALYSIS 2019. [DOI: 10.1002/mcda.1679] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | | | - Basak Cetinguc
- Faculty of Engineering, Industrial Engineering DepartmentYalova University Yalova Turkey
| | - Murat Durucu
- Management Faculty, Industrial Engineering DepartmentIstanbul Technical University Istanbul Turkey
| | - Fethi Calisir
- Management Faculty, Industrial Engineering DepartmentIstanbul Technical University Istanbul Turkey
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31
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de Angst IB, Weernink MGM, Kil PJM, van Til JA, Cornel EB, Takkenberg JJM. Development and usability testing of a multi-criteria value clarification methods for patients with localized prostate cancer. Health Informatics J 2019; 26:486-498. [DOI: 10.1177/1460458219832055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Current guidelines for the development of decision aids recommend that they have to include a process for helping patients clarify their personal values, for example, by using values clarification methods. In this article, we extensively described the development process of the web-based values clarification method for patients with localized low- to intermediate-risk prostate cancer based on the analytic hierarchy process. With analytic hierarchy process, the relative importance of different attributes of available treatments can be determined through series of pairwise comparisons of potential outcomes. Furthermore, analytic hierarchy process is able to use this information to present respondents with a quantitative overall treatment score and can therefore give actual treatment advice upon patients’ request. The addition of this values clarification method to an existing web-based treatment decision aid for patients with localized prostate cancer is thought to improve the support offered to patients in their decision-making process and their decision quality.
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Affiliation(s)
- Isabel B de Angst
- Elisabeth-TweeSteden Hospital, The Netherlands; Erasmus MC, The Netherlands
| | | | - Paul JM Kil
- Elisabeth-TweeSteden Hospital, The Netherlands
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32
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Rizzardo S, Bansback N, Dragojlovic N, Douglas C, Li KH, Mitton C, Marra C, Blanis L, Lynd LD. Evaluating Canadians' Values for Drug Coverage Decision Making. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2019; 22:362-369. [PMID: 30832975 DOI: 10.1016/j.jval.2018.08.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 08/14/2018] [Accepted: 08/15/2018] [Indexed: 05/28/2023]
Abstract
BACKGROUND Decision makers are facing growing challenges in prioritizing drugs for reimbursement because of soaring drug costs and increasing pressures on financial resources. In addition to cost and effectiveness, payers are using other values to dictate which drugs are prioritized for funding, yet there are limited data on the Canadian public's priorities. OBJECTIVES To measure the relative societal importance of values considered most relevant in informing drug reimbursement decisions in a representative sample of Canadians. METHODS An online survey of 2539 Canadians aged 19 years and older was performed in which 13 values used in drug funding prioritization were ranked and then weighted using an analytic hierarchy process. RESULTS Canadians value safe and efficacious drugs that have certainty of evidence. The values ranked in the top 5 by most of our subjects were potential effect on quality of life (65.4%), severity of the disease (62.6%), ability of drug to work (61.1%), safety (60.5%), and potential to extend life (49.4%). Values related to patient or disease characteristics such as rarity, socioeconomic status, and health and lifestyle choices held the lowest rankings and weights. CONCLUSIONS Canadians value, above all, treatment-related factors (eg, efficacy and safety) and disease-related factors (eg, severity and equity). Decision makers are currently using additional justifications to prioritize drugs for reimbursement, such as rarity and unmet need, which were not found to be highly valued by Canadians. Decision makers should integrate the public's values into a Canadian reimbursement framework for prioritization of drugs competing for limited funds.
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Affiliation(s)
- Shirin Rizzardo
- Pharmaceutical Services Division, British Columbia Ministry of Health, Victoria, BC, Canada
| | - Nick Bansback
- Faculty of Medicine, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada; Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, BC, Canada
| | - Nick Dragojlovic
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Conor Douglas
- Department of Science and Technology Studies, York University, Toronto, ON, Canada
| | - Kathy H Li
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Craig Mitton
- Faculty of Medicine, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada; Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Carlo Marra
- National School of Pharmacy, University of Otago, Dunedin, New Zealand
| | - Litsa Blanis
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Larry D Lynd
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, BC, Canada; Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada.
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Owczarek AJ, Smertka M, Jędrusik P, Gębska-Kuczerowska A, Chudek J, Wojnicz R. Computerized Systems Supporting Clinical Decision in Medicine. STUDIES IN LOGIC, GRAMMAR AND RHETORIC 2018; 56:107-120. [DOI: 10.2478/slgr-2018-0044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
Abstract
Statistics is the science of collection, summarizing, presentation and interpretation of data. Moreover, it yields methods used in the verification of research hypotheses. The presence of a statistician in a research group remarkably improves both the quality of design and research and the optimization of financial resources. Moreover, the involvement of a statistician in a research team helps the physician to effectively utilize the time and energy spent on diagnosing, which is an important aspect in view of limited healthcare resources. Precise, properly designed and implemented Computerized Clinical Decision Support Systems certainly lead to the improvement of healthcare and the quality of medical services, which increases patient satisfaction and reduces financial burdens on healthcare systems.
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Affiliation(s)
- Aleksander J. Owczarek
- Department of Statistics, Department of Instrumental Analysis , School of Pharmacy with the Division of Laboratory Medicine in Sosnowiec , Medical University of Silesia in Katowice , Poland
| | - Mike Smertka
- Pathophysiology Unit, Department of Pathophysiology , School of Medicine in Katowice , Medical University of Silesia in Katowice , Poland
| | - Przemysław Jędrusik
- Department of Computer Biomedical Systems, Institute of Computer Science , University of Silesia , Poland
| | | | - Jerzy Chudek
- Department of Internal Medicine and Oncological Chemotherapy, Medical Faculty in Katowice , Medical University of Silesia in Katowice , Poland
| | - Romuald Wojnicz
- Department of Histology and Embryology , School of Medicine with the Division of Dentistry in Zabrze , Medical University of Silesia in Katowice , Poland
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Weernink MGM, Vaanholt MCW, Groothuis-Oudshoorn CGM, von Birgelen C, IJzerman MJ, van Til JA. Patients' Priorities for Oral Anticoagulation Therapy in Non-valvular Atrial Fibrillation: a Multi-criteria Decision Analysis. Am J Cardiovasc Drugs 2018; 18:493-502. [PMID: 30132140 PMCID: PMC6267541 DOI: 10.1007/s40256-018-0293-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Introduction Effectiveness of oral anticoagulants (OACs) is critically dependent on patients’ adherence to intake regimens. We studied the relative impact of attributes related to effectiveness, safety, convenience, and costs on the value of OAC therapy from the perspective of patients with non-valvular atrial fibrillation. Methods Four attributes were identified by literature review and expert interviews: effectiveness (risk of ischemic stroke), safety (risk of major bleeding, minor bleeding, gastrointestinal complaints), convenience (intake frequency, diet restrictions, international normalized ratio [INR] blood monitoring, pill type/intake instructions), and out-of-pocket costs. Focus groups were held in Spain, Germany, France, Italy and the United Kingdom (N = 48) to elicit patients’ preferences through the use of the analytical hierarchy process method. Results Effectiveness (60%) and side effects (27%) have a higher impact on the perceived value of OACs than drug convenience (7%) and out-of-pocket costs (6%). As for convenience, eliminating monthly INR monitoring was given the highest priority (40%), followed by reducing diet restrictions (27%), reducing intake frequency (17%) and improving the pill type/intake instructions (15%). The most important side effect was major bleeding (75%), followed by minor bleeding (15%) and gastrointestinal complaints (10%). Furthermore, 71% of patients preferred once-daily intake to twice-daily intake. Discussion Although the relative impact of convenience on therapy value is small, patients have different preferences for options within convenience criteria. Besides considerations on safety and effectiveness, physicians should also discuss attributes of convenience with patients, as it can be assumed that alignment to patient preferences in drug prescription and better patient education could result in higher adherence. Electronic supplementary material The online version of this article (10.1007/s40256-018-0293-0) contains supplementary material, which is available to authorized users.
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Yu Y, Jia L, Meng Y, Hu L, Liu Y, Nie X, Zhang M, Zhang X, Han S, Peng X, Wang X. Method Development for Clinical Comprehensive Evaluation of Pediatric Drugs Based on Multi-Criteria Decision Analysis: Application to Inhaled Corticosteroids for Children with Asthma. Paediatr Drugs 2018; 20:195-204. [PMID: 29247424 DOI: 10.1007/s40272-017-0278-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Establishing a comprehensive clinical evaluation system is critical in enacting national drug policy and promoting rational drug use. In China, the 'Clinical Comprehensive Evaluation System for Pediatric Drugs' (CCES-P) project, which aims to compare drugs based on clinical efficacy and cost effectiveness to help decision makers, was recently proposed; therefore, a systematic and objective method is required to guide the process. METHODS An evidence-based multi-criteria decision analysis model that involved an analytic hierarchy process (AHP) was developed, consisting of nine steps: (1) select the drugs to be reviewed; (2) establish the evaluation criterion system; (3) determine the criterion weight based on the AHP; (4) construct the evidence body for each drug under evaluation; (5) select comparative measures and calculate the original utility score; (6) place a common utility scale and calculate the standardized utility score; (7) calculate the comprehensive utility score; (8) rank the drugs; and (9) perform a sensitivity analysis. The model was applied to the evaluation of three different inhaled corticosteroids (ICSs) used for asthma management in children (a total of 16 drugs with different dosage forms and strengths or different manufacturers). RESULTS By applying the drug analysis model, the 16 ICSs under review were successfully scored and evaluated. Budesonide suspension for inhalation (drug ID number: 7) ranked the highest, with comprehensive utility score of 80.23, followed by fluticasone propionate inhaled aerosol (drug ID number: 16), with a score of 79.59, and budesonide inhalation powder (drug ID number: 6), with a score of 78.98. In the sensitivity analysis, the ranking of the top five and lowest five drugs remains unchanged, suggesting this model is generally robust. CONCLUSIONS An evidence-based drug evaluation model based on AHP was successfully developed. The model incorporates sufficient utility and flexibility for aiding the decision-making process, and can be a useful tool for the CCES-P.
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Affiliation(s)
- Yuncui Yu
- Clinical Research Center, Beijing Children's Hospital, Capital Medical University, No. 56 Nanlishi Road, Beijing, 100045, China
| | - Lulu Jia
- Clinical Research Center, Beijing Children's Hospital, Capital Medical University, No. 56 Nanlishi Road, Beijing, 100045, China.
| | - Yao Meng
- Clinical Research Center, Beijing Children's Hospital, Capital Medical University, No. 56 Nanlishi Road, Beijing, 100045, China
| | - Lihua Hu
- Clinical Research Center, Beijing Children's Hospital, Capital Medical University, No. 56 Nanlishi Road, Beijing, 100045, China
| | - Yiwei Liu
- Clinical Research Center, Beijing Children's Hospital, Capital Medical University, No. 56 Nanlishi Road, Beijing, 100045, China
| | - Xiaolu Nie
- Center for Clinical Epidemiology and Evidence-Based Medicine, Beijing Children's Hospital, Capital Medical University, No. 56 Nanlishi Road, Beijing, 100045, China
| | - Meng Zhang
- Clinical Research Center, Beijing Children's Hospital, Capital Medical University, No. 56 Nanlishi Road, Beijing, 100045, China
| | - Xuan Zhang
- Clinical Research Center, Beijing Children's Hospital, Capital Medical University, No. 56 Nanlishi Road, Beijing, 100045, China
| | - Sheng Han
- International Research Center of Medicinal Administration, Peking University, No. 38 XueyuanLu Road, Beijing, 100191, China
| | - Xiaoxia Peng
- Center for Clinical Epidemiology and Evidence-Based Medicine, Beijing Children's Hospital, Capital Medical University, No. 56 Nanlishi Road, Beijing, 100045, China
| | - Xiaoling Wang
- Clinical Research Center, Beijing Children's Hospital, Capital Medical University, No. 56 Nanlishi Road, Beijing, 100045, China.
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El Mokrini A, Benabbou L, Berrado A. Multi-criteria distribution network redesign - case of the public sector pharmaceutical supply chain in Morocco. SUPPLY CHAIN FORUM 2018. [DOI: 10.1080/16258312.2018.1433436] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Asmae El Mokrini
- Equipe de recherche AMIPS, Ecole Mohammadia d’Ingénieurs, Mohammed V University, Rabat, Morocco
- Laboratoire QUARTZ EA 7393, IUT de Montreuil - Université Paris 8, Montreuil, France
| | - Loubna Benabbou
- Equipe de recherche MOAD-SCM, Ecole Mohammadia d’Ingénieurs, Mohammed V University, Rabat, Morocco
| | - Abdelaziz Berrado
- Equipe de recherche AMIPS, Ecole Mohammadia d’Ingénieurs, Mohammed V University, Rabat, Morocco
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PATIENT-CENTERED DECISION MAKING: LESSONS FROM MULTI-CRITERIA DECISION ANALYSIS FOR QUANTIFYING PATIENT PREFERENCES. Int J Technol Assess Health Care 2017; 34:105-110. [PMID: 29277175 DOI: 10.1017/s0266462317001118] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Patient preferences should be a central consideration in healthcare decision making. However, stories of patients challenging regulatory and reimbursement decisions has led to questions on whether patient voices are being considered sufficiently during those decision making processes. This has led some to argue that it is necessary to quantify patient preferences before they can be adequately considered. METHODS This study considers the lessons from the use of multi-criteria decision analysis (MCDA) for efforts to quantify patient preferences. It defines MCDA and summarizes the benefits it can provide to decision makers, identifies examples of MCDAs that have involved patients, and summarizes good practice guidelines as they relate to quantifying patient preferences. RESULTS The guidance developed to support the use of MCDA in healthcare provide some useful considerations for the quantification of patient preferences, namely that researchers should give appropriate consideration to: the heterogeneity of patient preferences, and its relevance to decision makers; the cognitive challenges posed by different elicitation methods; and validity of the results they produce. Furthermore, it is important to consider how the relevance of these considerations varies with the decision being supported. CONCLUSIONS The MCDA literature holds important lessons for how patient preferences should be quantified to support healthcare decision making.
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Marsh K, Caro JJ, Hamed A, Zaiser E. Amplifying Each Patient's Voice: A Systematic Review of Multi-criteria Decision Analyses Involving Patients. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2017; 15:155-162. [PMID: 27928659 DOI: 10.1007/s40258-016-0299-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Qualitative methods tend to be used to incorporate patient preferences into healthcare decision making. However, for patient preferences to be given adequate consideration by decision makers they need to be quantified. Multi-criteria decision analysis (MCDA) is one way to quantify and capture the patient voice. The objective of this review was to report on existing MCDAs involving patients to support the future use of MCDA to capture the patient voice. METHODS MEDLINE and EMBASE were searched in June 2014 for English-language papers with no date restriction. The following search terms were used: 'multi-criteria decision*', 'multiple criteria decision*', 'MCDA', 'benefit risk assessment*', 'risk benefit assessment*', 'multicriteri* decision*', 'MCDM', 'multi-criteri* decision*'. Abstracts were included if they reported the application of MCDA to assess healthcare interventions where patients were the source of weights. Abstracts were excluded if they did not apply MCDA, such as discussions of how MCDA could be used; or did not evaluate healthcare interventions, such as MCDAs to assess the level of health need in a locality. Data were extracted on weighting method, variation in patient and expert preferences, and discussion on different weighting techniques. RESULTS The review identified ten English-language studies that reported an MCDA to assess healthcare interventions and involved patients as a source of weights. These studies reported 12 applications of MCDA. Different methods of preference elicitation were employed: direct weighting in workshops; discrete choice experiment surveys; and the analytical hierarchy process using both workshops and surveys. There was significant heterogeneity in patient responses and differences between patients, who put greater weight on disease characteristics and treatment convenience, and experts, who put more weight on efficacy. The studies highlighted cognitive challenges associated with some weighting methods, though patients' views on their ability to undertake weighting tasks was positive. CONCLUSION This review identified several recent examples of MCDA used to elicit patient preferences, which support the feasibility of using MCDA to capture the patient voice. Challenges identified included, how best to reflect the heterogeneity of patient preferences in decision making and how to manage the cognitive burden associated with some MCDA tasks.
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Affiliation(s)
- Kevin Marsh
- Evidera, Metro Building 6th Floor, 1 Butterwick, London, W6 8DL, UK.
| | | | | | - Erica Zaiser
- Evidera, Metro Building 6th Floor, 1 Butterwick, London, W6 8DL, UK
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Marsh K, Zaiser E, Orfanos P, Salverda S, Wilcox T, Sun S, Dixit S. Evaluation of COPD Treatments: A Multicriteria Decision Analysis of Aclidinium and Tiotropium in the United States. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2017; 20:132-140. [PMID: 28212954 DOI: 10.1016/j.jval.2016.08.724] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 08/05/2016] [Accepted: 08/14/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Comparisons of the use of aclidinium bromide and tiotropium bromide for the treatment of chronic obstructive pulmonary disease often concentrate on key end points (exacerbations) at the expense of other benefits and risks. Multicriteria decision analysis (MCDA) can help overcome this by using stakeholder preferences to combine multiple end points into an overall value estimate. OBJECTIVES To evaluate the use of aclidinium bromide twice daily via Pressair™ (AstraZeneca Pharmaceuticals LP, Wilmington, DE) and of tiotropium once daily via HandiHaler® (Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT) from the perspective of patients using MCDA. METHODS Literature reviews and clinician engagement were used to identify value criteria. Performance of criteria was estimated from a clinical trial and clinician opinion. Scores and swing weights came from six clinicians who, during a 2-day workshop, reflected their patients' preferences. Scenario and sensitivity analyses were used to explore uncertainty in model designs and inputs. RESULTS Fourteen criteria, covering clinical effectiveness, safety, and convenience of the treatments of chronic obstructive pulmonary disease, were identified. Exacerbations and device preloading were identified as the most important to patients; the least important was rescue medication use. Tiotropium's higher overall clinical effectiveness score was offset by aclidinium's better performance on safety and convenience outcomes. The MCDA generated a -42 (worst performance) to 100 (best performance) scale. The net impact of benefits over risks of aclidinium (38.5) exceeded that of tiotropium (13.2), and patients preferred aclidinium 79.7% of the time. CONCLUSIONS When considering clinical benefits and risks, aclidinium and tiotropium generate similar value to patients, but when convenience criteria are considered, aclidinium may be preferred. Further work is required to replicate these results, including eliciting preferences directly from patients.
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Affiliation(s)
| | | | | | | | | | - Shawn Sun
- Forest Research Institute (an affiliate of Actavis, Inc.), Jersey City, NJ, USA
| | - Shailja Dixit
- Forest Research Institute (an affiliate of Actavis, Inc.), Jersey City, NJ, USA
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Schmidt K, Babac A, Pauer F, Damm K, von der Schulenburg JM. Measuring patients' priorities using the Analytic Hierarchy Process in comparison with Best-Worst-Scaling and rating cards: methodological aspects and ranking tasks. HEALTH ECONOMICS REVIEW 2016; 6:50. [PMID: 27844450 PMCID: PMC5108732 DOI: 10.1186/s13561-016-0130-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 10/25/2016] [Indexed: 05/25/2023]
Abstract
BACKGROUND Identifying patient priorities and preference measurements have gained importance as patients claim a more active role in health care decision making. Due to the variety of existing methods, it is challenging to define an appropriate method for each decision problem. This study demonstrates the impact of the non-standardized Analytic Hierarchy Process (AHP) method on priorities, and compares it with Best-Worst-Scaling (BWS) and ranking card methods. METHODS We investigated AHP results for different Consistency Ratio (CR) thresholds, aggregation methods, and sensitivity analyses. We also compared criteria rankings of AHP with BWS and ranking cards results by Kendall's tau b. RESULTS The sample for our decision analysis consisted of 39 patients with rare diseases and mean age of 53.82 years. The mean weights of the two groups of CR ≤ 0.1 and CR ≤ 0.2 did not differ significantly. For the aggregation by individual priority (AIP) method, the CR was higher than for aggregation by individual judgment (AIJ). In contrast, the weights of AIJ were similar compared to AIP, but some criteria's rankings differed. Weights aggregated by geometric mean, median, and mean showed deviating results and rank reversals. Sensitivity analyses showed instable rankings. Moderate to high correlations between the rankings resulting from AHP and BWS. LIMITATIONS Limitations were the small sample size and the heterogeneity of the patients with different rare diseases. CONCLUSION In the AHP method, the number of included patients is associated with the threshold of the CR and choice of the aggregation method, whereas both directions of influence could be demonstrated. Therefore, it is important to implement standards for the AHP method. The choice of method should depend on the trade-off between the burden for participants and possibilities for analyses.
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Affiliation(s)
- Katharina Schmidt
- Center for Health Economics Research Hannover (CHERH), Leibniz University of Hannover, Otto-Brenner-Str. 1, D-30159 Hanover, Germany
| | - Ana Babac
- Center for Health Economics Research Hannover (CHERH), Leibniz University of Hannover, Otto-Brenner-Str. 1, D-30159 Hanover, Germany
| | - Frédéric Pauer
- Center for Health Economics Research Hannover (CHERH), Leibniz University of Hannover, Otto-Brenner-Str. 1, D-30159 Hanover, Germany
| | - Kathrin Damm
- Center for Health Economics Research Hannover (CHERH), Leibniz University of Hannover, Otto-Brenner-Str. 1, D-30159 Hanover, Germany
| | - J-Matthias von der Schulenburg
- Center for Health Economics Research Hannover (CHERH), Leibniz University of Hannover, Otto-Brenner-Str. 1, D-30159 Hanover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hanover, Germany
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Pauer F, Schmidt K, Babac A, Damm K, Frank M, von der Schulenburg JMG. Comparison of different approaches applied in Analytic Hierarchy Process - an example of information needs of patients with rare diseases. BMC Med Inform Decis Mak 2016; 16:117. [PMID: 27613239 PMCID: PMC5016921 DOI: 10.1186/s12911-016-0346-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 08/03/2016] [Indexed: 11/10/2022] Open
Abstract
Background The Analytic Hierarchy Process (AHP) is increasingly used to measure patient priorities. Studies have shown that there are several different approaches to data acquisition and data aggregation. The aim of this study was to measure the information needs of patients having a rare disease and to analyze the effects of these different AHP approaches. The ranking of information needs is then used to display information categories on a web-based information portal about rare diseases according to the patient’s priorities. Methods The information needs of patients suffering from rare diseases were identified by an Internet research study and a preliminary qualitative study. Hence, we designed a three-level hierarchy containing 13 criteria. For data acquisition, the differences in outcomes were investigated using individual versus group judgements separately. Furthermore, we analyzed the different effects when using the median and arithmetic and geometric means for data aggregation. A consistency ratio ≤0.2 was determined to represent an acceptable consistency level. Results Forty individual and three group judgements were collected from patients suffering from a rare disease and their close relatives. The consistency ratio of 31 individual and three group judgements was acceptable and thus these judgements were included in the study. To a large extent, the local ranks for individual and group judgements were similar. Interestingly, group judgements were in a significantly smaller range than individual judgements. According to our data, the ranks of the criteria differed slightly according to the data aggregation method used. Conclusions It is important to explain and justify the choice of an appropriate method for data acquisition because response behaviors differ according to the method. We conclude that researchers should select a suitable method based on the thematic perspective or investigated topics in the study. Because the arithmetic mean is very vulnerable to outliers, the geometric mean and the median seem to be acceptable alternatives for data aggregation. Overall, using the AHP to identify patient priorities and enhance the user-friendliness of information websites offers an important contribution to medical informatics. Electronic supplementary material The online version of this article (doi:10.1186/s12911-016-0346-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Frédéric Pauer
- Center for Health Economics Research Hannover (CHERH), Leibniz University of Hannover, Otto-Brenner-Straße 1, Hannover, 30159, Germany.
| | - Katharina Schmidt
- Center for Health Economics Research Hannover (CHERH), Leibniz University of Hannover, Otto-Brenner-Straße 1, Hannover, 30159, Germany
| | - Ana Babac
- Center for Health Economics Research Hannover (CHERH), Leibniz University of Hannover, Otto-Brenner-Straße 1, Hannover, 30159, Germany
| | - Kathrin Damm
- Center for Health Economics Research Hannover (CHERH), Leibniz University of Hannover, Otto-Brenner-Straße 1, Hannover, 30159, Germany
| | - Martin Frank
- Center for Health Economics Research Hannover (CHERH), Leibniz University of Hannover, Otto-Brenner-Straße 1, Hannover, 30159, Germany
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Cabrera-Barona P, Blaschke T, Kienberger S. Explaining Accessibility and Satisfaction Related to Healthcare: A Mixed-Methods Approach. SOCIAL INDICATORS RESEARCH 2016; 133:719-739. [PMID: 28890596 PMCID: PMC5569143 DOI: 10.1007/s11205-016-1371-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/23/2016] [Indexed: 05/09/2023]
Abstract
Accessibility and satisfaction related to healthcare services are conceived as multidimensional concepts. These concepts can be studied using objective and subjective measures. In this study, we created two indices: a composite healthcare accessibility index (CHCA) and a composite healthcare satisfaction index (CHCS). To calculate the CHCA index we used three indicators based on three components of multidimensional healthcare accessibility: availability, acceptability and accessibility. In the indicator based on the component of accessibility, we included an innovative perceived time-decay parameter. The three indicators of the CHCA index were weighted through the application of a principal components analysis. To calculate the CHCS index, we used three indicators: the waiting time after the patient arrives at the healthcare service, the quality of the healthcare, and the healthcare service supply. These three indicators making up the CHCA index were weighted by applying an analytical hierarchy process. Three kinds of regressions were subsequently applied in order to explain the CHCA and CHCS indices: namely the Linear Least Squares, Ordinal Logistic, and Random Forests regressions. In these regressions, we used different independent social and health-related variables. These variables represented the predisposing, enabling, and need factors of people´s behaviors related to healthcare. All the calculations were applied to a study area: the city of Quito, Ecuador. Results showed that there are health-related inequalities in regard to healthcare accessibility and healthcare satisfaction in our study area. We also identified specific social factors that explained the indices developed. The present work is a mixed-methods approach to evaluate multidimensional healthcare accessibility and healthcare satisfaction, incorporating a pluralistic perspective, as well as a multidisciplinary framework. The results obtained can also be considered as tools for healthcare and urban planners, for more integrative social analyses that can improve the quality of life in urban residents.
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Affiliation(s)
- Pablo Cabrera-Barona
- Interfaculty Department of Geoinformatics - Z_GIS, University of Salzburg, Schillerstraße 30, 5020 Salzburg, Austria
| | - Thomas Blaschke
- Interfaculty Department of Geoinformatics - Z_GIS, University of Salzburg, Schillerstraße 30, 5020 Salzburg, Austria
| | - Stefan Kienberger
- Interfaculty Department of Geoinformatics - Z_GIS, University of Salzburg, Schillerstraße 30, 5020 Salzburg, Austria
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Salkeld G, Cunich M, Dowie J, Howard K, Patel MI, Mann G, Lipworth W. The Role of Personalised Choice in Decision Support: A Randomized Controlled Trial of an Online Decision Aid for Prostate Cancer Screening. PLoS One 2016; 11:e0152999. [PMID: 27050101 PMCID: PMC4822955 DOI: 10.1371/journal.pone.0152999] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Accepted: 03/22/2016] [Indexed: 11/18/2022] Open
Abstract
Importance Decision support tools can assist people to apply population-based evidence on benefits and harms to individual health decisions. A key question is whether “personalising” choice within decisions aids leads to better decision quality. Objective To assess the effect of personalising the content of a decision aid for prostate cancer screening using the Prostate Specific Antigen (PSA) test. Design Randomized controlled trial. Setting Australia. Participants 1,970 men aged 40–69 years were approached to participate in the trial. Intervention 1,447 men were randomly allocated to either a standard decision aid with a fixed set of five attributes or a personalised decision aid with choice over the inclusion of up to 10 attributes. Outcome Measures To determine whether there was a difference between the two groups in terms of: 1) the emergent opinion (generated by the decision aid) to have a PSA test or not; 2) self-rated decision quality after completing the online decision aid; 3) their intention to undergo screening in the next 12 months. We also wanted to determine whether men in the personalised choice group made use of the extra decision attributes. Results 5% of men in the fixed attribute group scored ‘Have a PSA test’ as the opinion generated by the aid, as compared to 62% of men in the personalised choice group (χ2 = 569.38, 2df, p< 0001). Those men who used the personalised decision aid had slightly higher decision quality (t = 2.157, df = 1444, p = 0.031). The men in the personalised choice group made extensive use of the additional decision attributes. There was no difference between the two groups in terms of their stated intention to undergo screening in the next 12 months. Conclusions Together, these findings suggest that personalised decision support systems could be an important development in shared decision-making and patient-centered care. Trial Registration Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12612000723886
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Affiliation(s)
- Glenn Salkeld
- Faculty of Social Sciences, University Of Wollongong, Wollongong, NSW, Australia
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
- * E-mail:
| | - Michelle Cunich
- Faculty of Pharmacy and Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
| | - Jack Dowie
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Kirsten Howard
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Manish I. Patel
- Westmead Clinical School, Westmead Hospital, Sydney, NSW, Australia
| | - Graham Mann
- Westmead Institute for Medical Research, Westmead Hospital, Sydney, NSW, Australia
| | - Wendy Lipworth
- Centre for Values, Ethics and the Law in Medicine, University of Sydney, Sydney, NSW, Australia
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Thokala P, Devlin N, Marsh K, Baltussen R, Boysen M, Kalo Z, Longrenn T, Mussen F, Peacock S, Watkins J, Ijzerman M. Multiple Criteria Decision Analysis for Health Care Decision Making--An Introduction: Report 1 of the ISPOR MCDA Emerging Good Practices Task Force. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2016; 19:1-13. [PMID: 26797229 DOI: 10.1016/j.jval.2015.12.003] [Citation(s) in RCA: 352] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 12/01/2015] [Indexed: 05/23/2023]
Abstract
Health care decisions are complex and involve confronting trade-offs between multiple, often conflicting, objectives. Using structured, explicit approaches to decisions involving multiple criteria can improve the quality of decision making and a set of techniques, known under the collective heading multiple criteria decision analysis (MCDA), are useful for this purpose. MCDA methods are widely used in other sectors, and recently there has been an increase in health care applications. In 2014, ISPOR established an MCDA Emerging Good Practices Task Force. It was charged with establishing a common definition for MCDA in health care decision making and developing good practice guidelines for conducting MCDA to aid health care decision making. This initial ISPOR MCDA task force report provides an introduction to MCDA - it defines MCDA; provides examples of its use in different kinds of decision making in health care (including benefit risk analysis, health technology assessment, resource allocation, portfolio decision analysis, shared patient clinician decision making and prioritizing patients' access to services); provides an overview of the principal methods of MCDA; and describes the key steps involved. Upon reviewing this report, readers should have a solid overview of MCDA methods and their potential for supporting health care decision making.
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Affiliation(s)
- Praveen Thokala
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK.
| | | | | | - Rob Baltussen
- Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Meindert Boysen
- National Institute for Health and Clinical Excellence (NICE), Manchester, UK
| | - Zoltan Kalo
- Department of Health Policy and Health Economics, Eötvös Loránd University (ELTE); Syreon Research Institute, Budapest, Hungary
| | | | - Filip Mussen
- Regional Regulatory Affairs, Janssen Pharmaceutical Companies of Johnson & Johnson, Antwerp, Belgium
| | - Stuart Peacock
- Canadian Centre for Applied Research in Cancer Control (ARCC), British Columbia Cancer Agency, Vancouver, WA, USA; Leslie Diamond Chair in Cancer Survivorship, Simon Fraser University, Vancouver, WA, USA
| | - John Watkins
- Formulary Development, Premera Blue Cross, Bothell, WA, USA; University of Washington, Seattle, WA, USA
| | - Maarten Ijzerman
- Department of Health Technology & Services Research, University of Twente, Enschede, The Netherlands
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Broekhuizen H, Groothuis-Oudshoorn CGM, Hauber AB, Jansen JP, IJzerman MJ. Estimating the value of medical treatments to patients using probabilistic multi criteria decision analysis. BMC Med Inform Decis Mak 2015; 15:102. [PMID: 26626279 PMCID: PMC4667469 DOI: 10.1186/s12911-015-0225-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 11/27/2015] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Estimating the value of medical treatments to patients is an essential part of healthcare decision making, but is mostly done implicitly and without consulting patients. Multi criteria decision analysis (MCDA) has been proposed for the valuation task, while stated preference studies are increasingly used to measure patient preferences. In this study we propose a methodology for using stated preferences to weigh clinical evidence in an MCDA model that includes uncertainty in both patient preferences and clinical evidence explicitly. METHODS A probabilistic MCDA model with an additive value function was developed and illustrated using a case on hypothetical treatments for depression. The patient-weighted values were approximated with Monte Carlo simulations and compared to expert-weighted results. Decision uncertainty was calculated as the probability of rank reversal for the first rank. Furthermore, scenario analyses were done to assess the relative impact of uncertainty in preferences and clinical evidence, and of assuming uniform preference distributions. RESULTS The patient-weighted values for drug A, drug B, drug C, and placebo were 0.51 (95% CI: 0.48 to 0.54), 0.51 (95% CI: 0.48 to 0.54), 0.54 (0.49 to 0.58), and 0.15 (95% CI: 0.13 to 0.17), respectively. Drug C was the most preferred treatment and the rank reversal probability for first rank was 27%. This probability decreased to 18% when uncertainty in performances was not included and increased to 41% when uncertainty in criterion weights was not included. With uniform preference distributions, the first rank reversal probability increased to 61%. The expert-weighted values for drug A, drug B, drug C, and placebo were 0.67 (95% CI: 0.65 to 0.68), 0.57 (95% CI: 0.56 to 0.59), 0.67 (95% CI: 0.61 to 0.71), and 0.19 (95% CI: 0.17 to 0.21). The rank reversal probability for the first rank according to experts was 49%. CONCLUSIONS Preferences elicited from patients can be used to weigh clinical evidence in a probabilistic MCDA model. The resulting treatment values can be contrasted to results from experts, and the impact of uncertainty can be quantified using rank probabilities. Future research should focus on integrating the model with regulatory decision frameworks and on including other types of uncertainty.
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Affiliation(s)
- Henk Broekhuizen
- Department of Health Technology and Services Research, MIRA Institute, University of Twente, Enschede, The Netherlands.
| | | | | | - Jeroen P Jansen
- Department Public Health and Community Medicine, School of Medicine, TUFTS University, Boston, MA, USA.
| | - Maarten J IJzerman
- Department of Health Technology and Services Research, MIRA Institute, University of Twente, Enschede, The Netherlands.
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Dowie J, Kjer Kaltoft M, Salkeld G, Cunich M. Towards generic online multicriteria decision support in patient-centred health care. Health Expect 2015; 18:689-702. [PMID: 23910715 PMCID: PMC5060847 DOI: 10.1111/hex.12111] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2013] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To introduce a new online generic decision support system based on multicriteria decision analysis (MCDA), implemented in practical and user-friendly software (Annalisa©). BACKGROUND All parties in health care lack a simple and generic way to picture and process the decisions to be made in pursuit of improved decision making and more informed choice within an overall philosophy of person- and patient-centred care. METHODS The MCDA-based system generates patient-specific clinical guidance in the form of an opinion as to the merits of the alternative options in a decision, which are all scored and ranked. The scores for each option combine, in a simple expected value calculation, the best estimates available now for the performance of those options on patient-determined criteria, with the individual patient's preferences, expressed as importance weightings for those criteria. The survey software within which the Annalisa file is embedded (Elicia©) customizes and personalizes the presentation and inputs. Principles relevant to the development of such decision-specific MCDA-based aids are noted and comparisons with alternative implementations presented. The necessity to trade-off practicality (including resource constraints) with normative rigour and empirical complexity, in both their development and delivery, is emphasized. CONCLUSION The MCDA-/Annalisa-based decision support system represents a prescriptive addition to the portfolio of decision-aiding tools available online to individuals and clinicians interested in pursuing shared decision making and informed choice within a commitment to transparency in relation to both the evidence and preference bases of decisions. Some empirical data establishing its usability are provided.
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Affiliation(s)
- Jack Dowie
- London School of Hygiene and Tropical MedicineLondonUK
| | | | - Glenn Salkeld
- Sydney School of Public HealthUniversity of SydneySydneyNSWAustralia
| | - Michelle Cunich
- NHMRC Clinical Trials CentreUniversity of SydneySydneyNSWAustralia
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Tu C, Fang Y, Huang Z, Tan R. Application of the analytic hierarchy process to a risk assessment of emerging infectious diseases in Shaoxing city in southern China. Jpn J Infect Dis 2015; 67:417-22. [PMID: 25410554 DOI: 10.7883/yoken.67.417] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study aimed to assess the likelihood of an outbreak or epidemic of emerging infectious diseases (EIDs) in Shaoxing city, China, and its resulting impact to provide decision makers with quantitative, directive results. Factors related to the risk of EIDs were selected through meeting with experts and were arranged in a hierarchical structure. These evaluation factors were also weighted to allow the use of a point system for evaluation. As a result, 14 evaluation factors comprising a 3-layer hierarchy were generated. The riskiest top 10 EIDs were HIV/AIDS (consistency index [CI] = 3.206), cholera (CI = 3.103), SARS (CI = 2.804), acute schistosomiasis (CI = 2.784), malaria (CI = 2.777), legionellosis (CI = 2.743), avian influenza A/H5N1 (CI = 2.734), dengue fever (CI = 2.702), Escherichia coli O157:H7 enteritis (CI = 2.593), and plague (CI = 2.553). The risk assessment was specifically intended to support local and national government agencies in the management of high risk EIDs in their efforts to (i) make resource allocation decisions, (ii) make high-level planning decisions, and (iii) raise public awareness of the EID risk. The results showed that the EID risk in Shaoxing could be effectively assessed through an analytic hierarchy process.
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Affiliation(s)
- Chunyu Tu
- Shaoxing Center for Disease Control and Prevention
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Broekhuizen H, Groothuis-Oudshoorn CGM, van Til JA, Hummel JM, IJzerman MJ. A review and classification of approaches for dealing with uncertainty in multi-criteria decision analysis for healthcare decisions. PHARMACOECONOMICS 2015; 33:445-55. [PMID: 25630758 PMCID: PMC4544539 DOI: 10.1007/s40273-014-0251-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Multi-criteria decision analysis (MCDA) is increasingly used to support decisions in healthcare involving multiple and conflicting criteria. Although uncertainty is usually carefully addressed in health economic evaluations, whether and how the different sources of uncertainty are dealt with and with what methods in MCDA is less known. The objective of this study is to review how uncertainty can be explicitly taken into account in MCDA and to discuss which approach may be appropriate for healthcare decision makers. A literature review was conducted in the Scopus and PubMed databases. Two reviewers independently categorized studies according to research areas, the type of MCDA used, and the approach used to quantify uncertainty. Selected full text articles were read for methodological details. The search strategy identified 569 studies. The five approaches most identified were fuzzy set theory (45% of studies), probabilistic sensitivity analysis (15%), deterministic sensitivity analysis (31%), Bayesian framework (6%), and grey theory (3%). A large number of papers considered the analytic hierarchy process in combination with fuzzy set theory (31%). Only 3% of studies were published in healthcare-related journals. In conclusion, our review identified five different approaches to take uncertainty into account in MCDA. The deterministic approach is most likely sufficient for most healthcare policy decisions because of its low complexity and straightforward implementation. However, more complex approaches may be needed when multiple sources of uncertainty must be considered simultaneously.
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Affiliation(s)
- Henk Broekhuizen
- Department of Health Technology and Services Research, MIRA Institute, University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands,
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Suner A, Karakülah G, Dicle O, Sökmen S, Çelikoğlu C. CorRECTreatment: a web-based decision support tool for rectal cancer treatment that uses the analytic hierarchy process and decision tree. Appl Clin Inform 2015; 6:56-74. [PMID: 25848413 PMCID: PMC4377560 DOI: 10.4338/aci-2014-10-ra-0087] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 12/22/2014] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The selection of appropriate rectal cancer treatment is a complex multi-criteria decision making process, in which clinical decision support systems might be used to assist and enrich physicians' decision making. OBJECTIVE The objective of the study was to develop a web-based clinical decision support tool for physicians in the selection of potentially beneficial treatment options for patients with rectal cancer. METHODS The updated decision model contained 8 and 10 criteria in the first and second steps respectively. The decision support model, developed in our previous study by combining the Analytic Hierarchy Process (AHP) method which determines the priority of criteria and decision tree that formed using these priorities, was updated and applied to 388 patients data collected retrospectively. Later, a web-based decision support tool named corRECTreatment was developed. The compatibility of the treatment recommendations by the expert opinion and the decision support tool was examined for its consistency. Two surgeons were requested to recommend a treatment and an overall survival value for the treatment among 20 different cases that we selected and turned into a scenario among the most common and rare treatment options in the patient data set. RESULTS In the AHP analyses of the criteria, it was found that the matrices, generated for both decision steps, were consistent (consistency ratio<0.1). Depending on the decisions of experts, the consistency value for the most frequent cases was found to be 80% for the first decision step and 100% for the second decision step. Similarly, for rare cases consistency was 50% for the first decision step and 80% for the second decision step. CONCLUSIONS The decision model and corRECTreatment, developed by applying these on real patient data, are expected to provide potential users with decision support in rectal cancer treatment processes and facilitate them in making projections about treatment options.
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Affiliation(s)
- A. Suner
- Ege University, School of Medicine, Department of Biostatistics and Medical Informatics, Bornova-Izmir, 35040, Turkey
| | - G. Karakülah
- Neurobiology-Neurodegeneration and Repair Laboratory, National Eye Institute, National Institutes of Health, Bethesda, Maryland, 20892, USA
- Dokuz Eylül University, Health Sciences Institute, Department of Medical Informatics, Inciraltı-Izmir, 35340, Turkey
| | - O. Dicle
- Dokuz Eylül University, Health Sciences Institute, Department of Medical Informatics, Inciraltı-Izmir, 35340, Turkey
- Dokuz Eylül University, School of Medicine, Department of Radiology, Inciraltı-Izmir, 35340, Turkey
| | - S. Sökmen
- FACS, FASCRS, FASPSM Member from Dokuz Eylül University, School of Medicine, Department of General Surgery, Colorectal and Pelvic Surgery Unit, Inciraltı-Izmir, 35340, Turkey
| | - C.C. Çelikoğlu
- Dokuz Eylül University, Faculty of Science, Department of Statistics, Buca-Izmir, 35160, Turkey
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Wudhikarn K, Link BK. Comparative effectiveness research in follicular lymphoma: current and future perspectives and challenges. J Comp Eff Res 2014; 3:95-107. [PMID: 24345259 DOI: 10.2217/cer.13.86] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Follicular lymphoma (FL) is the most common indolent non-Hodgkin's lymphoma in northern America. FL is an incurable disease with relapsing-remitting courses requiring serial intermittent treatments. Duration of remission will often become progressively shorter and most patients will die from refractory disease or transformation to aggressive lymphoma. Given the incurable nature of FL, current goals of treatment are focused on improving symptoms and survival by a variety of available treatment options, while considering potential adverse events. Although randomized controlled trials are universally perceived as the gold standard of clinical research, randomized controlled trials are not always practical and have several limitations. Therapeutic and diagnostic options of FLs are expanding faster than randomized controlled trials can test them, so employing comparative effectiveness research on other research designs are needed to efficiently improve global FL care. Implementing comparative effectiveness research with judicious use of appropriate research designs will hopefully fill current knowledge gaps and provide insights for FL managements.
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Affiliation(s)
- Kitsada Wudhikarn
- Division of Blood & Marrow Transplant, Department of Medicine, Stanford University, CA, USA
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