1
|
Jones B, Ryan M, Cook NS, Gutzwiller FS. Development of a disease-specific health utility score for chronic obstructive pulmonary disease from a discrete choice experiment patient preference study. Int J Technol Assess Health Care 2024; 40:e30. [PMID: 38695141 DOI: 10.1017/s0266462324000242] [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] [Indexed: 05/18/2024]
Abstract
OBJECTIVES While patient input to health technology assessment (HTA) has traditionally been of a qualitative nature, there is increasing interest to integrate quantitative evidence from patient preference studies into HTA decision making. Preference data can be used to generate disease-specific health utility data. We generated a health utility score for patients with chronic obstructive pulmonary disease (COPD) and consider its use within HTAs. METHODS Based on qualitative research, six symptoms were identified as important to COPD patients: shortness of breath, exacerbations, chronic cough, mucus secretion, sleep disturbance, and urinary incontinence. We employed a discrete choice experiment (DCE) and the random parameter logistic regression technique to estimate utility scores for all COPD health states. The relationship between patients' COPD health utility scores, self-perceived COPD severity, and EQ-5D-3L utility scores was analyzed, with data stratified according to disease severity and comorbidity subgroups. RESULTS The COPD health utility score had face validity, with utility scores negatively correlated with patients' self-perceived COPD severity. The correlation between the COPD health utility scores and EQ-5D-3L values was only moderate. While patient EQ-5D-3L scores were impacted by comorbidities, the COPD health utility score was less impacted by comorbid conditions. CONCLUSIONS Our COPD utility measure, derived from a DCE, provides a patient-centered health utility score and is more sensitive to the COPD health of the individual and less sensitive to other comorbidities. This disease-specific instrument should be considered alongside generic health-related quality of life instruments when valuing new COPD therapies in submissions to licensing and reimbursement agencies.
Collapse
Affiliation(s)
- Byron Jones
- Patient Engagement Science, Novartis Pharma AG, Basel, Switzerland
| | - Mandy Ryan
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Nigel S Cook
- Global Patient Engagement, Novartis Pharma AG, Basel, Switzerland
| | | |
Collapse
|
2
|
Huml RA, Collyar D, Antonijevic Z, Beckman RA, Quek RGW, Ye J. Aiding the Adoption of Master Protocols by Optimizing Patient Engagement. Ther Innov Regul Sci 2023; 57:1136-1147. [PMID: 37615880 DOI: 10.1007/s43441-023-00570-w] [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: 11/15/2022] [Accepted: 07/24/2023] [Indexed: 08/25/2023]
Abstract
Master protocols (MPs) are an important addition to the clinical trial repertoire. As defined by the U.S. Food and Drug Administration (FDA), this term means "a protocol designed with multiple sub-studies, which may have different objectives (goals) and involve coordinated efforts to evaluate one or more investigational drugs in one or more disease subtypes within the overall trial structure." This means we now have a unique, scientifically based MP that describes how a clinical trial will be conducted using one or more potential candidate therapies to treat patients in one or more diseases. Patient engagement (PE) is also a critical factor that has been recognized by FDA through its Patient-Focused Drug Development (PFDD) initiative, and by the European Medicines Agency (EMA), which states on its website that it has been actively interacting with patients since the creation of the Agency in 1995. We propose that utilizing these PE principles in MPs can make them more successful for sponsors, providers, and patients. Potential benefits of MPs for patients awaiting treatment can include treatments that better fit a patient's needs; availability of more treatments; and faster access to treatments. These make it possible to develop innovative therapies (especially for rare diseases and/or unique subpopulations, e.g., pediatrics), to minimize untoward side effects through careful dose escalation practices and, by sharing a control arm, to lower the probability of being assigned to a placebo arm for clinical trial participants. This paper is authored by select members of the American Statistical Association (ASA)/DahShu Master Protocol Working Group (MPWG) People and Patient Engagement (PE) Subteam. DahShu is a 501(c)(3) non-profit organization, founded to promote research and education in data science. This manuscript does not include direct feedback from US or non-US regulators, though multiple regulatory-related references are cited to confirm our observation that improving patient engagement is supported by regulators. This manuscript represents the authors' independent perspective on the Master Protocol; it does not represent the official policy or viewpoint of FDA or any other regulatory organization or the views of the authors' employers. The objective of this manuscript is to provide drug developers, contract research organizations (CROs), third party capital investors, patient advocacy groups (PAGs), and biopharmaceutical executives with a better understanding of how including the patient voice throughout MP development and conduct creates more efficient clinical trials. The PE Subteam also plans to publish a Plain Language Summary (PLS) of this publication for clinical trial participants, patients, caregivers, and the public as they seek to understand the risks and benefits of MP clinical trial participation.
Collapse
Affiliation(s)
| | | | | | - Robert A Beckman
- Departments of Oncology and of Biostatistics, Bioinformatics, & Biomathematics, Lombardi Comprehensive Cancer Center and Innovation Center for Biomedical Informatics, Georgetown University Medical Center, District of Columbia (DC), Washington, USA
| | - Ruben G W Quek
- Health Economics & Outcomes Research, Regeneron Pharmaceuticals, Tarrytown, NY, USA
| | - Jingjing Ye
- Data Science and Operational Excellent, Global Statistics and Data Sciences, BeiGene, Ltd., Washington, DC, USA
| |
Collapse
|
3
|
Bridges JFP, Goldberg JF, Fitzgerald HM, Chumki SR, Beusterien K, Will O, Citrome L. Prioritizing Treatment Goals of People Diagnosed with Bipolar I Disorder in the US: Best-Worst Scaling Results. Patient Prefer Adherence 2023; 17:2545-2555. [PMID: 37849618 PMCID: PMC10578617 DOI: 10.2147/ppa.s419143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 09/29/2023] [Indexed: 10/19/2023] Open
Abstract
Purpose Bipolar I disorder (BP-I) is associated with significant disease burden, but evidence on treatment goals in people diagnosed with BP-I is scarce. This study sought to quantify treatment goals related to the pharmacological management of BP-I in adults in the US and to identify if subgroups of people with similar treatment goals exist. Patients and Methods A best-worst scaling (BWS) of treatment goals was developed based on available literature and input from experts and patients and was distributed as part of a survey between August and September 2021. Survey participants were adults with a self-reported diagnosis of BP-I who were recruited via an online panel in the US. Participants were asked to prioritize the importance of 16 treatment goals using BWS. BWS scores were computed using multinomial logistic regression, with the scores across all goals summing to 100 for each participant. Subgroups of people with similar preferences were identified using latent class analysis. Results The most important treatment goals for people diagnosed with BP-I (N=255) were "being less impulsive, angry, or irritable" (score: 9.73), or being "able to feel pleasure or happiness" (score: 9.54). Goals related to reducing the incidence of various potential adverse events of medication (scores: ≤4.51) or "reducing dependence on others" (score: 3.04) were less important. Two subgroups were identified. One subgroup (n=111) prioritized symptom-focused goals, considering "reducing frequency of mania, depression, and mixed episodes" and "being less impulsive, angry or irritable" the most important (scores: 12.46 and 11.85, respectively). The other subgroup (n=144) placed significantly more importance on social functioning-focused goals, including beginning or maintaining a relationship with a partner/significant other, and with family and/or friends (scores: 8.45 and 7.70, respectively). Conclusion People diagnosed with BP-I prioritized emotional improvements. Subgroups of people with BP-I prioritized either symptom-focused or social functioning-focused treatment goals.
Collapse
Affiliation(s)
- John F P Bridges
- Department of Biomedical Informatics, the Ohio State University College of Medicine, Columbus, OH, USA
| | - Joseph F Goldberg
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Sanjeda R Chumki
- Medical Affairs, Otsuka Pharmaceutical Development & Commercialization Inc, Princeton, NJ, USA
| | | | | | - Leslie Citrome
- Department of Psychiatry & Behavioral Sciences, New York Medical College, Valhalla, NY, USA
| |
Collapse
|
4
|
Kersting C, Hülsmann J, Weckbecker K, Mortsiefer A. Patients' perspective on supposedly patient-relevant process and outcome parameters: a cross-sectional survey within the 'PRO patients study'. BMC Health Serv Res 2022; 22:72. [PMID: 35031052 PMCID: PMC8759763 DOI: 10.1186/s12913-021-07437-6] [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] [Received: 04/09/2021] [Accepted: 12/20/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To be able to make informed choices based on their individual preferences, patients need to be adequately informed about treatment options and their potential outcomes. This implies that studies measure the effects of care based on parameters that are relevant to patients. In a previous scoping review, we found a wide variety of supposedly patient-relevant parameters that equally addressed processes and outcomes of care. We were unable to identify a consistent understanding of patient relevance and therefore aimed to develop an empirically based concept including a generic set of patient-relevant parameters. As a first step we evaluated the process and outcome parameters identified in the scoping review from the patients' perspective. METHODS We conducted a cross-sectional survey among German general practice patients. Ten research practices of Witten/Herdecke University supported the study. During a two-week period in the fall of 2020, patients willing to participate self-administered a short questionnaire. It evaluated the relevance of the 32 parameters identified in the scoping review on a 5-point Likert scale and offered a free-text field for additional parameters. These free-text answers were inductively categorized by two researchers. Quantitative data were analyzed using descriptive statistics. Bivariate analyses were performed to determine whether there are any correlations between rating a parameter as highly relevant and patients' characteristics. RESULTS Data from 299 patients were eligible for analysis. All outcomes except 'sexuality' and 'frequency of healthcare service utilization' were rated important. 'Confidence in therapy' was rated most important, followed by 'prevention of comorbidity' and 'mobility'. Relevance ratings of five parameters were associated with patients' age and gender, but not with their chronic status. The free-text analysis revealed 15 additional parameters, 12 of which addressed processes of care, i.e., 'enough time in physician consultation'. CONCLUSION Patients attach great value to parameters addressing processes of care. It appears as though the way in which patients experience the care process is not less relevant than what comes of it. Relevance ratings were not associated with chronic status, but few parameters were gender- and age-related. TRIAL REGISTRATION Core Outcome Measures in Effectiveness Trials Initiative, registration number: 1685.
Collapse
Affiliation(s)
- Christine Kersting
- Chair of General Practice II and Patient-Centeredness in Primary Care, Institute of General Practice and Primary Care, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen-Str. 50, 58448, Witten, Germany.
| | - Julia Hülsmann
- Chair of General Practice I and Interprofessional Care, Institute of General Practice and Primary Care, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen-Str. 50, 58448, Witten, Germany
| | - Klaus Weckbecker
- Chair of General Practice I and Interprofessional Care, Institute of General Practice and Primary Care, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen-Str. 50, 58448, Witten, Germany
| | - Achim Mortsiefer
- Chair of General Practice II and Patient-Centeredness in Primary Care, Institute of General Practice and Primary Care, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen-Str. 50, 58448, Witten, Germany
| |
Collapse
|
5
|
Benz HL, Caldwell B, Ruiz JP, Saha A, Ho M, Christopher S, Bardot D, Sheehan M, Donnelly A, McLaughlin L, Mange B, Hauber AB, Gwinn K, Heetderks WJ, Sheldon M. Patient-Centered Identification of Meaningful Regulatory Endpoints for Medical Devices to Treat Parkinson's Disease. MDM Policy Pract 2021; 6:23814683211021380. [PMID: 34277950 PMCID: PMC8255597 DOI: 10.1177/23814683211021380] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 04/30/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction. A growing literature has developed on identifying outcomes that matter to patients. This study demonstrates an approach involving patient and regulatory perspectives to identify outcomes that are meaningful in the context of medical devices for Parkinson’s disease (PD). Methods. A systematic process was used for specifying relevant regulatory endpoints by synthesizing inputs of various sources and stakeholders. First, a literature review was conducted to identify important benefits, risks, and other considerations for medical devices to treat PD; patient discussion groups (n = 6) were conducted to refine the list of considerations, followed by a survey (n = 29) to prioritize them; and patient and Food and Drug Administration (FDA) reviewers informed specification of the final endpoints. Two FDA clinicians gave clinical and regulatory perspectives at each step. Results. Movement symptoms were ranked as most important (ranked 1 or 2 by 72% of participants) and psychological and cognitive symptoms as the next most important (ranked 1 or 2 by 52% of participants). Within movement symptoms, falls, impaired movement, bradykinesia, resting tremor, stiffness, and rigidity were ranked highly. Overall, nine attributes were identified and prioritized as patient-centric for use in clinical trial design and quantitative patient preference studies. These attributes were benefits and risks related to therapeutics for PD as well as other considerations, including time until a medical device is available for patient use. Discussion. This prospective approach identified meaningful and relevant benefits, risks, and other considerations that may be used for clinical trial design and quantitative patient preference studies. Although PD was the focus of this study, the approach can be used to study patient perspectives about other disease or treatment areas.
Collapse
Affiliation(s)
- Heather L Benz
- US FDA Center for Devices and Radiological Health, Silver Spring, Maryland
| | - Brittany Caldwell
- US FDA Center for Devices and Radiological Health, Silver Spring, Maryland
| | - John P Ruiz
- US FDA Center for Devices and Radiological Health, Silver Spring, Maryland
| | - Anindita Saha
- US FDA Center for Devices and Radiological Health, Silver Spring, Maryland
| | - Martin Ho
- US FDA Center for Devices and Radiological Health, Silver Spring, Maryland
| | | | - Dawn Bardot
- Medical Device Innovation Consortium, Arlington, Virginia
| | - Margaret Sheehan
- The Michael J. Fox Foundation for Parkinson's Research, New York, New York
| | - Anne Donnelly
- The Michael J. Fox Foundation for Parkinson's Research, New York, New York
| | - Lauren McLaughlin
- The Michael J. Fox Foundation for Parkinson's Research, New York, New York
| | - Brennan Mange
- RTI Health Solutions, Research Triangle Park, North Carolina
| | - A Brett Hauber
- RTI Health Solutions, Research Triangle Park, North Carolina
| | - Katrina Gwinn
- US FDA Center for Devices and Radiological Health, Silver Spring, Maryland
| | | | - Murray Sheldon
- US FDA Center for Devices and Radiological Health, Silver Spring, Maryland
| |
Collapse
|
6
|
Allerby K, Goulding A, Ali L, Waern M. Striving for a more person-centered psychosis care: results of a hospital-based multi-professional educational intervention. BMC Psychiatry 2020; 20:523. [PMID: 33148190 PMCID: PMC7640678 DOI: 10.1186/s12888-020-02871-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 09/15/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Reluctance on the part of mental health professionals constitutes an important barrier to patient participation in care. In order to stimulate person-centeredness in the inpatient care of persons with psychotic illness, we developed and tested an educational intervention for hospital staff (including psychiatrists) at all four wards at the Psychosis Clinic, Sahlgrenska University Hospital in Gothenburg, Sweden. The intervention was co-created by professionals, patients, and researchers using a participatory approach. In addition to lectures and workshops, staff created and implemented small projects to increase person-centeredness on their own wards. A primary focus was to establish a partnership between patient and staff by capturing and utilizing the patient's narrative to support active engagement in the care process. This included the development of a person-centered care plan. We hypothesized that the intervention would be associated with increased patient empowerment (primary outcome) and satisfaction with care (secondary outcome). METHODS A before and after design was used to test group differences in patient empowerment (Empowerment Scale) and consumer satisfaction (UKU-ConSat Rating Scale). All patients receiving inpatient psychosis care during measuring periods were eligible if meeting inclusion criteria of schizophrenia spectrum disorder, age > 18, and ability to comprehend study information. Severe cognitive deficit and inadequate Swedish language skills were exclusion criteria. Data on possible confounding variables including overall health (EQ-5D), symptom burden (PANSS), and functional ability (GAF) were collected alongside outcome measures. RESULTS ANCOVAs with overall health as a confounding variable showed no group differences regarding empowerment before (n = 50) versus after (n = 49) intervention, sample mean = 2.87/2.99, p = .142, eta2 = .02, CI = -.27-.04. Consumer satisfaction (n = 50/50) was higher in the post-implementation group (4.46 versus 11.71, p = .041 eta2 = .04, CI = -14.17- -.31). CONCLUSION The hypothesis regarding the primary outcome, empowerment, was not supported. An increase in the secondary outcome, satisfaction, was observed, although the effect size was small, and results should be interpreted with caution. Findings from this staff educational intervention can inform the development of future studies aimed at improvement of inpatient care for persons with severe mental illness. TRIAL REGISTRATION The trial was retrospectively registered at ClinicalTrials.gov June 9, 2017, identifier: NCT03182283.
Collapse
Affiliation(s)
- Katarina Allerby
- Section of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Blå Stråket 15, 41345, Gothenburg, Sweden. .,Psychosis Department, Region Västra Göraland; Sahlgrenska University Hospital, 41345, Gothenburg, Sweden.
| | - Anneli Goulding
- grid.8761.80000 0000 9919 9582Section of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Blå Stråket 15, 41345 Gothenburg, Sweden ,grid.8761.80000 0000 9919 9582Department of Psychology, University of Gothenburg, Haraldsgatan 1, 41314 Gothenburg, Sweden
| | - Lilas Ali
- grid.8761.80000 0000 9919 9582Institute of Health Care Sciences, Centre for Person-Centred Care, Sahlgrenska Academy, University of Gothenburg, Box 100, 40530 Gothenburg, Sweden ,grid.1649.a000000009445082XPsychiatry Department, Region Västra Götaland, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden
| | - Margda Waern
- grid.8761.80000 0000 9919 9582Section of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Blå Stråket 15, 41345 Gothenburg, Sweden ,grid.1649.a000000009445082XPsychosis Department, Region Västra Göraland; Sahlgrenska University Hospital, 41345 Gothenburg, Sweden
| |
Collapse
|
7
|
Crossnohere NL, Janse S, Janssen E, Bridges JFP. Comparing the Preferences of Patients and the General Public for Treatment Outcomes in Type 2 Diabetes Mellitus. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2020; 14:89-100. [PMID: 32885395 DOI: 10.1007/s40271-020-00450-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Healthcare treatments and interventions are traditionally evaluated from the societal perspective, but a more patient-centric perspective has been proposed in recent years. We sought to compare preferences of patients and the general public for treatment outcomes of type 2 diabetes using both best-worst scaling (BWS) and rating approaches. METHODS A survey evaluating the treatment priorities for type 2 diabetes was conducted in the United States. Members of the general public and patients with type 2 diabetes were recruited from a nationally sampled panel. Participants indicated the importance of seven potential treatment outcomes (hypoglycemic events, glycated hemoglobin [A1c], weight loss, mental health, functioning, glycemic stability, and cardiovascular health) using (1) BWS case 1 and (2) a rating task. Preference differences from BWS prioritizations were explored using mixed logistic regression (BWS preference weights were probability re-scaled so that the weightings of the seven items collectively summed to 100). The consistency of scale between samples was explored using heteroskedastic conditional logistic regression of BWS data. Spearman rank correlation was used to compare standardized BWS preference weights and rating scores for each group. Both groups evaluated the BWS and rating activities using debriefing questions. RESULTS The public and patient samples included 314 and 313 respondents, respectively. The public was on average 16 years younger than patients (48 vs 64 years, P < 0.001). In BWS, patients and the public both ranked A1c, glycemic stability, and cardiovascular health within their top three outcomes. Patients valued the outcome A1c most highly and found it twice as important as did the public (41.0 vs 20.2, P < 0.001). The public valued cardiovascular health most highly, and found it to be twice as important than did patients (31.3 vs 17.4, P < 0.001). Patients were more consistent in their preferences than the public (λ = 1.66, P = 0.01). Preferences elicited using BWS and rating approaches were highly correlated for both patients (ρ = 0.96) and the public (ρ = 0.92). Patients were more likely than the public to endorse the BWS as easy to answer (P < 0.001), easy to understand (P < 0.001), consistent with preferences (P < 0.001), and relevant (P < 0.001). Both patients and the public found the rating activity easier to answer and understand, and more consistent with their preferences, than the BWS (P < 0.001). CONCLUSIONS We provide some of the first evidence demonstrating a difference in patient and public treatment priorities for diabetes. That patients were more consistent in their preferences than the public and found the BWS and Likert rating instruments more relevant suggests that patient priorities may be more appropriate than those of the general public in some medical decision-making contexts.
Collapse
Affiliation(s)
- Norah L Crossnohere
- Department of Biomedical Informatics, The Ohio State University College of Medicine, 1800 Cannon Drive, Columbus, OH, 43210, USA. .,Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA.
| | - Sarah Janse
- Department of Biomedical Informatics, The Ohio State University College of Medicine, 1800 Cannon Drive, Columbus, OH, 43210, USA
| | - Ellen Janssen
- Center for Medical Technology Policy, World Trade Center Baltimore, 401 East Pratt Street, Suite 631, Baltimore, MD, 21202, USA
| | - John F P Bridges
- Department of Biomedical Informatics, The Ohio State University College of Medicine, 1800 Cannon Drive, Columbus, OH, 43210, USA.,Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA
| |
Collapse
|
8
|
Bauer A, Wittenberg R, Ly A, Gustavsson A, Bexelius C, Tochel C, Knapp M, Nelson M, Sudlow C. Valuing Alzheimer's disease drugs: a health technology assessment perspective on outcomes. Int J Technol Assess Health Care 2020; 36:1-7. [PMID: 32847642 DOI: 10.1017/s0266462320000574] [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: 11/06/2022]
Abstract
OBJECTIVES Due to the nature of Alzheimer's disease (AD), health technology assessment (HTA) agencies might face considerable challenges in choosing appropriate outcomes and outcome measures for drugs that treat the condition. This study sought to understand which outcomes informed previous HTAs, to explore possible reasons for prioritizations, and derive potential implications for future assessments of AD drugs. METHOD We conducted a literature review of studies that analyzed decisions made in HTAs (across disease areas) in three European countries: England, Germany, and The Netherlands. We then conducted case studies of technology assessments conducted for AD drugs in these countries. RESULTS Overall, outcomes measured using clinical scales dominated decisions or recommendations about whether to fund AD drugs, or price negotiations. HTA processes did not always allow the inclusion of outcomes relevant to people with AD, their carers, and families. Processes did not include early discussion and agreement on what would constitute appropriate outcome measures and cut-off points for effects. CONCLUSIONS We conclude that in order to ensure that future AD drugs are valued appropriately and timely, early agreement with various stakeholders about outcomes, outcome measures, and cut-offs is important.
Collapse
Affiliation(s)
- Annette Bauer
- Care Policy and Evaluation Centre, London School of Economics and Political Science, Houghton Street, LondonWC2A 2AE, UK
| | - Raphael Wittenberg
- Care Policy and Evaluation Centre, London School of Economics and Political Science, Houghton Street, LondonWC2A 2AE, UK
| | - Amanda Ly
- Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Nine Edinburgh BioQuarter, 9 Little France Road, EdinburghEH16 4UX, UK
| | - Anders Gustavsson
- Quantify Research, Hantverkargatan 8, 112 21Stockholm, Sweden
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Alfred Nobels allé 23, 141 83Stockholm, Sweden
| | - Christin Bexelius
- ROCHE. F. Hoffmann-La Roche Ltd, Grenzacherstrasse 124, 4070Basel, Switzerland
| | - Claire Tochel
- Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Nine Edinburgh BioQuarter, 9 Little France Road, EdinburghEH16 4UX, UK
| | - Martin Knapp
- Care Policy and Evaluation Centre, London School of Economics and Political Science, Houghton Street, LondonWC2A 2AE, UK
| | - Mia Nelson
- Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Nine Edinburgh BioQuarter, 9 Little France Road, EdinburghEH16 4UX, UK
| | - Catherine Sudlow
- Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Nine Edinburgh BioQuarter, 9 Little France Road, EdinburghEH16 4UX, UK
| |
Collapse
|
9
|
Kersting C, Kneer M, Barzel A. Patient-relevant outcomes: what are we talking about? A scoping review to improve conceptual clarity. BMC Health Serv Res 2020; 20:596. [PMID: 32600321 PMCID: PMC7325243 DOI: 10.1186/s12913-020-05442-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 06/18/2020] [Indexed: 12/21/2022] Open
Abstract
Background With respect to patient-centered care, measuring care effects based on patient-relevant outcomes is becoming increasingly important. There is some uncertainty about what outcomes are particularly relevant to patients and who determines their relevance. To determine this, we conducted a scoping review of the international literature with the aim to improve the conceptual clarity regarding (1) the terminology used for supposedly patient-relevant outcomes, (2) the variety of outcomes considered patient-relevant, and (3) justifications for the choice of these specific outcomes. Methods We conducted a systematic search in Embase, PubMed (including Medline), Cochrane Central, Scopus, and Google Scholar with a special focus on article titles. Search terms included patient-relevant, patient-important, patient-preferred, and outcome(s), endpoint(s), parameter(s), indicator(s). We limited the search period from January 2000 to July 2019. Full-text articles reporting outcomes that were described as patient-relevant met the inclusion criteria. Two researchers independently analyzed all eligible articles applying quantitative and structuring content analysis. Results We identified 155 articles, 44 of which met the inclusion criteria. A content analysis revealed 35 different terms used with regard to patient-relevant outcomes. However, authors predominantly referred to patient-important outcomes (23 articles, 52.3%) and patient-relevant outcomes (17 articles, 38.6%). A structuring content analysis of all extracted outcomes revealed a total of 281 codes, pooled in 32 inductive categories. Among these, the following categories dominated: symptoms, adverse events/complications, survival/mortality, pain. In just 16 of the articles (36.4%), authors provided justifications for the choice of the outcome being based either on patient and/or expert opinions. In another 13 articles (29.5%), no justification was provided. Conclusion This scoping review on patient-relevant outcomes was driven by the questions (1) what outcomes are particularly relevant to patients, and (2) who determines their relevance. We found a wide range of supposedly patient-relevant outcomes, with only one third of articles involving patients in the justification of the outcome selection. In view of this conceptual uncertainty it appears difficult to determine or even to compare a particular patient benefit of interventions. A set of generic outcomes relevant to patients would be helpful to contribute to a consistent understanding of patient relevance.
Collapse
Affiliation(s)
- Christine Kersting
- Institute of General Practice and Interprofessional Care, Faculty of Health/School of Medicine, Witten/Herdecke University, Alfred-Herrhausen-Str. 50, 58448, Witten, Germany.
| | - Malte Kneer
- Institute of General Practice and Interprofessional Care, Faculty of Health/School of Medicine, Witten/Herdecke University, Alfred-Herrhausen-Str. 50, 58448, Witten, Germany
| | - Anne Barzel
- Institute of General Practice and Interprofessional Care, Faculty of Health/School of Medicine, Witten/Herdecke University, Alfred-Herrhausen-Str. 50, 58448, Witten, Germany.,Institute of General Medicine, Ulm University, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| |
Collapse
|
10
|
Beentjes TAA, van Gaal BGI, van Achterberg T, Goossens PJJ. Self-Management Support Needs From the Perspectives of Persons With Severe Mental Illness: A Systematic Review and Thematic Synthesis of Qualitative Research. J Am Psychiatr Nurses Assoc 2020; 26:464-482. [PMID: 31578904 DOI: 10.1177/1078390319877953] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND: The development of de-hospitalization policies in mental health has resulted in a growing emphasis on self-management. In the chronic care model, self-management support is an essential element. Because of the episodic nature of severe mental illness (SMI) and its high relapse rates, we assume that the extent of self-management support needs of individuals with an SMI is considerable. However, a clear overview of the nature of the self-management support needs of persons with SMI is missing. AIMS: This study aimed to identify self-management support needs from the perspective of individuals with SMI. METHOD: A systematic review was conducted using the method of thematic synthesis of qualitative studies. After searching the databases MEDLINE, PsycINFO, CINAHL, and EMBASE, we screened the papers for the eligibility criteria: individuals with an SMI, adequately representing the voice of persons with SMI and describing their self-management support needs. Thirty-one papers were included. RESULTS: The main findings showed that participants in the studies described the need for informational support, emotional support, acknowledgment, encouragement, and guidance to make sense of their illness experiences, ease suffering, obtain validation and recognition, execute self-management tasks, and be led through unfamiliar territory. CONCLUSION: The perspectives of persons with SMI can provide a road map for constructing a self-management support intervention for persons with SMI. Important others have an essential role in fulfilling support needs. Independently managing an SMI is difficult. Therefore, it is preferable to let important others participate in self-management interventions and to introduce peer support.
Collapse
Affiliation(s)
- Titus A A Beentjes
- Titus A. A. Beentjes, MScN, APRN, RN, Radboud university medical center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, the Netherlands; Dimence Group Mental Health Care Centre, Deventer, the Netherlands; Centre for Nursing Research, Saxion University of Applied Science, Deventer, the Netherlands
| | - Betsie G I van Gaal
- Betsie G. I. van Gaal, PhD, FEANS, Radboud university medical center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, the Netherlands; HAN University of Applied Sciences, Faculty of Health and Social Studies, Nijmegen, the Netherlands
| | - Theo van Achterberg
- Theo van Achterberg, PhD, FEANS, KU Leuven, Academic Centre for Nursing and Midwifery, Leuven, Belgium
| | - Peter J J Goossens
- Peter J. J. Goossens, PhD, APRN, RN, FEANS, Dimence Group Mental Health Care Centre, Deventer, the Netherlands; University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| |
Collapse
|
11
|
Rand L, Dunn M, Slade I, Upadhyaya S, Sheehan M. Understanding and using patient experiences as evidence in healthcare priority setting. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2019; 17:20. [PMID: 31572067 PMCID: PMC6757378 DOI: 10.1186/s12962-019-0188-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Accepted: 09/03/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND In many countries, committees make priority-setting decisions in order to control healthcare costs. These decisions take into account relevant criteria, including clinical effectiveness, cost-effectiveness, and need, and are supported by evidence usually drawn from clinical and economic studies. These sources of evidence do not include the specific perspective and information that patients can provide about the condition and treatment. METHODS Drawing on arguments from political philosophy and ethics that are the ethical basis for many priority-setting bodies, the authors argue that criteria like need and its effects on patients and caregivers are best supported by evidence generated from patients' experiences. Social sciences and mixed-methods research support the generation and collection of robust evidence. RESULTS Patient experience is required for a decision-making process that considers all relevant evidence. For fair priority-setting, decision-makers should consider relevant evidence and reasons, so patient experience evidence should not be ignored. Patient experience must be gathered in a way that generates high quality and methodologically rigorous evidence. Established quantitative and qualitative methods can assure that evidence is systematic, adherent to quality standards, and valid. Patient, like clinical, evidence should be subject to a transparent review process. DISCUSSION Considering all relevant evidence gives each person an equal opportunity at having their treatment funded. Patient experience gives context to the clinical evidence and also directly informs our understanding of the nature of the condition and its effects, including patients' needs, how to meet them, and the burden of illness. Such evidence also serves to contextualise reported effects of the treatment. The requirement to include patient experience as evidence has important policy implications for bodies that make priority-setting decisions since it proposes that new types of evidence reviews are commissioned and considered.
Collapse
Affiliation(s)
- Leah Rand
- Board on Health Sciences Policy, National Academies of Sciences, Engineering, and Medicine, 500 Fifth Street NW, Washington, DC 20009 USA
| | - Michael Dunn
- Ethox Centre, Nuffield Department of Population Health, Big Data Institute, La Ka Shing Centre for Health Information and Discovery, University of Oxford, Old Road Campus, Oxford, OX3 7LF UK
- Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, UK
| | - Ingrid Slade
- Ethox Centre, Nuffield Department of Population Health, Big Data Institute, La Ka Shing Centre for Health Information and Discovery, University of Oxford, Old Road Campus, Oxford, OX3 7LF UK
| | - Sheela Upadhyaya
- Highly Specialised Technology Program, Centre for Health Technology Evaluation, National Institute for Health and Care Excellence, 10 Spring Gardens, London, SW1A 2BU UK
| | - Mark Sheehan
- Ethox Centre, Nuffield Department of Population Health, Big Data Institute, La Ka Shing Centre for Health Information and Discovery, University of Oxford, Old Road Campus, Oxford, OX3 7LF UK
| |
Collapse
|
12
|
Cohen AN, Pedersen ER, Glynn SM, Hamilton AB, McNagny KP, Reist C, Chemerinski E, Young AS. Preferences for family involvement among veterans in treatment for schizophrenia. Psychiatr Rehabil J 2019; 42:210-219. [PMID: 30920257 PMCID: PMC6902635 DOI: 10.1037/prj0000352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Examine preferences for family involvement in psychiatric care in a large, representative sample of veterans in treatment for schizophrenia. METHOD Veterans with schizophrenia or schizoaffective disorder (N = 801) completed an assessment that included questions about demographic and clinical characteristics, status of family support, and preference for family involvement in their psychiatric care. Open-ended items were independently coded by two raters and categorized; Cohen's kappa was calculated for each category. RESULTS Among the 801 participants, 496 (61.9%) indicated that they had a family member who provided them with regular support; 304 (37.9%) had no family member who provided support; and 1 did not respond. Among the 304 without support, 272 (89.4%) had a living family member. Of the 496 participants who had a supportive family member, 135 (27.2%) wanted their family member involved in their care. Of the 272 participants who did not have a supportive family member, but had living family, 57 (21.0%) wanted their family involved. Barriers to involvement included concerns about privacy and burden. Preferred method of involvement included contact with the patient's psychiatrist and education about the illness. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Preferences indicated by this large representative sample of individuals in care for schizophrenia indicate that a majority have supportive family and a substantial minority want family involved in their psychiatric care. Clinicians can address concerns about privacy and burden and deliver preferred services by phone or mail, overcoming anticipated barriers. Desire for family support groups was limited but present. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
Collapse
Affiliation(s)
- Amy N Cohen
- VA Desert Pacific Mental Health Research, Education, and Clinical Center
| | | | | | - Alison B Hamilton
- VA Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation, & Policy
| | | | | | | | - Alexander S Young
- VA Desert Pacific Mental Health Research, Education, and Clinical Center
| |
Collapse
|
13
|
Cook NS, Nagar SH, Jain A, Balp MM, Mayländer M, Weiss O, Chatterjee S. Understanding Patient Preferences and Unmet Needs in Non-alcoholic Steatohepatitis (NASH): Insights from a Qualitative Online Bulletin Board Study. Adv Ther 2019; 36:478-491. [PMID: 30547371 PMCID: PMC6824346 DOI: 10.1007/s12325-018-0856-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The aim of this work was to understand how patients with non-alcoholic steatohepatitis (NASH) perceive their disease, unmet needs, and expectations regarding future treatment through online bulletin board (OBB) qualitative research. METHODS OBB is an asynchronous online qualitative market research tool that provides an open forum for interactive discussion among participants. Patients with NASH were recruited via physician referral and completed a screener questionnaire to ensure their eligibility and willingness to participate. A trained moderator managed the discussion that allowed open answers and responses to other participants' posts. Patient responses were analyzed using a combination of different qualitative analytical tools. RESULTS The OBB ran for 4 days and included 16 patients (n = 8, UK; n = 8, US) with NASH (fibrosis stages F1-F3) and comorbidities including diabetes/prediabetes (n = 9) and obesity (n = 12). The key insights were (1) patients with NASH have a poor understanding of the disease, its progression, and management-they feel a lack of adequate educational support from their physicians; (2) diagnosis of NASH is incidental in most cases, mainly because patients fail to spontaneously associate their signs or symptoms with their liver condition; (3) comorbidities (obesity and diabetes) are more concerning to patients than NASH; and (4) patients perceive that NASH impacts their social life and work performance in more advanced stages. CONCLUSIONS This OBB provided valuable patient insights into NASH disease perception and management and revealed unmet need areas. In light of no approved therapies, these patient insights can inform early drug development strategies and stakeholder discussions on NASH. FUNDING Novartis Pharma AG, Basel.
Collapse
|
14
|
Goulding A, Allerby K, Ali L, Gremyr A, Waern M. Study protocol design and evaluation of a hospital-based multi-professional educational intervention: Person-Centred Psychosis Care (PCPC). BMC Psychiatry 2018; 18:269. [PMID: 30165822 PMCID: PMC6117979 DOI: 10.1186/s12888-018-1852-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 08/15/2018] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND While patient involvement in mental health care is repeatedly stressed in policy documents, there are actually few studies that evaluate person-centred care interventions within psychiatric services. We present here the design and planned evaluation of an educational intervention for inpatient staff involved in the care of persons with schizophrenia and similar psychoses. METHODS/DESIGN The care intervention will be assessed using a non-randomised trial with a before and after approach. The intervention involves an educational and experimental learning phase for hospital staff, followed by an implementation phase. The intervention is multi-professional; psychiatrists, psychiatric nurses, psychiatric carers, social workers, occupational therapists, and a medical secretary will be engaged in a participatory approach where they practice how to create a partnership and explore recovery-related goals together with patients. Patient-related outcomes include empowerment and satisfaction with care. Ward-level outcomes include daily ward burden, length of inpatient stay, and number of days with involuntary care. In addition, qualitative methods will be applied to capture patient, next-of-kin, and staff perspectives. DISCUSSION The care intervention is expected to contribute to the improvement of inpatient care for persons with severe and complex mental health issues. TRIAL REGISTRATION The trial was retrospectively registered at ClinicalTrials.gov June 9, 2017, identifier: NCT03182283 .
Collapse
Affiliation(s)
- Anneli Goulding
- Psychosis Clinic, Sahlgrenska University Hospital, Mölndalsvägen 31 hus V, 431 80 Mölndal, Gothenburg, Sweden
- Psychology Department, University of Gothenburg, Gothenburg, Sweden
| | - Katarina Allerby
- Psychosis Clinic, Sahlgrenska University Hospital, Mölndalsvägen 31 hus V, 431 80 Mölndal, Gothenburg, Sweden
- Section of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, SU Sahlgrenska, 413 45 Gothenburg, Sweden
| | - Lilas Ali
- Institute of Health Care Sciences, Centre for Person-Centred Care, Sahlgrenska Academy, University of Gothenburg, Box 457, 405 30 Gothenburg, Sweden
| | - Andreas Gremyr
- Psychosis Clinic, Sahlgrenska University Hospital, Mölndalsvägen 31 hus V, 431 80 Mölndal, Gothenburg, Sweden
| | - Margda Waern
- Psychosis Clinic, Sahlgrenska University Hospital, Mölndalsvägen 31 hus V, 431 80 Mölndal, Gothenburg, Sweden
- Section of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, SU Sahlgrenska, 413 45 Gothenburg, Sweden
| |
Collapse
|
15
|
Bridges JFP, Crossnohere NL, Schuster AL, Miller JA, Pastorini C, Aslakson RA. A patient and community-centered approach selecting endpoints for a randomized trial of a novel advance care planning tool. Patient Prefer Adherence 2018; 12:241-249. [PMID: 29445267 PMCID: PMC5810536 DOI: 10.2147/ppa.s150663] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Despite a movement toward patient-centered outcomes, best practices on how to gather and refine patients' perspectives on research endpoints are limited. Advanced care planning (ACP) is inherently patient centered and would benefit from patient prioritization of endpoints for ACP-related tools and studies. OBJECTIVE This investigation sought to prioritize patient-centered endpoints for the content and evaluation of an ACP video being developed for patients undergoing major surgery. We also sought to highlight an approach using complementary engagement and research strategies to document priorities and preferences of patients and other stakeholders. MATERIALS AND METHODS Endpoints identified from a previously published environmental scan were operationalized following rating by a caregiver co-investigator, refinement by a patient co-investigator, review by a stakeholder committee, and validation by patients and family members. Finalized endpoints were taken to a state fair where members of the public who indicated that they or a loved one had undergone major surgery prioritized their most relevant endpoints and provided comments. RESULTS Of the initial 50 ACP endpoints identified from the review, 12 endpoints were selected for public prioritization. At the state fair, 359 individuals prioritized the endpoints, the highest ranking of which was having a meaningful conversation with a physician before surgery (57%). CONCLUSION Using a novel combination of engagement and research techniques provided the opportunity to understand which endpoints were most important to patients and families and fostered framework development clarifying the differential contributions of engagement and research. Results from this study ultimately changed the content and evaluation of the ACP video.
Collapse
Affiliation(s)
- John FP Bridges
- Department of Health Policy and Management, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of Health, Behavior, and Society, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Norah L Crossnohere
- Department of Health, Behavior, and Society, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Anne L Schuster
- Department of Health Policy and Management, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Judith A Miller
- Patient-Centered Outcomes Research Institute (PCORI) Project, Baltimore, MD
| | - Carolyn Pastorini
- Patient-Centered Outcomes Research Institute (PCORI) Project, Baltimore, MD
| | - Rebecca A Aslakson
- Department of Health, Behavior, and Society, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins School of Medicine, Baltimore, MD
- Armstrong Institute for Patient Safety and Quality, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| |
Collapse
|
16
|
Bridges JFP, Beusterien K, Heres S, Such P, Sánchez-Covisa J, Nylander AG, Chan E, de Jong-Laird A. Quantifying the treatment goals of people recently diagnosed with schizophrenia using best-worst scaling. Patient Prefer Adherence 2018; 12:63-70. [PMID: 29379273 PMCID: PMC5757991 DOI: 10.2147/ppa.s152870] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE This study seeks to quantify the treatment goals of people recently diagnosed with schizophrenia and explore their impact on treatment plan. METHODS People aged 18-35 years with a confirmed diagnosis of schizophrenia within the past 5 years were surveyed in the UK, Germany, and Italy. Treatment goals were assessed via a validated best-worst scaling instrument, where participants evaluated subsets of 13 possible treatment goals identified using a balanced incomplete block design. Participants identified the most and least important goals within each task. Data were also collected on current treatment and preference for daily oral versus long-acting injectable (LAI) treatment. Hierarchical Bayes was used to identify preference weights for the goals, and latent class analysis was used to identify segments of people with similar goals. The segments were compared with the current treatment and preference for oral versus LAI treatment. RESULTS Across 100 participants, the average age was 26 years, 75% were male and 50% were diagnosed within 2 years ago. Overall, preferences were most favorable for reduced disease symptoms, think clearly, reduced hospitalizations, reduced anxiety, and take care of self. A total of 61% preferred oral medication and 39% LAI. Two groups were identified with different treatment goals; 50% of participants emphasized clinical goals, including reduced disease symptoms (preference weight =19.7%), reduced hospitalizations (15.5%), and reduced anxiety (10.5%). The other 50% emphasized functional goals, including improved relationships with family/friends (11.4%), increased interest in work (10.6%), experiencing a fuller range of emotions (8.4%), and ability to socialize (7.5%). Those emphasizing functional goals were more likely to be on LAI (44% versus 26%; p=0.059) and preferred LAI (46% versus 32%; p=0.151). CONCLUSIONS People with recent-onset schizophrenia may focus more on clinical goals or functional goals, a discussion of which may help facilitate patient engagement.
Collapse
Affiliation(s)
- John FP Bridges
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Stephan Heres
- Department of Psychiatry and Psychotherapy, Technische Universität München, Munich, Germany
| | - Pedro Such
- Global Medical Affairs, H. Lundbeck A/S, Valby, Denmark
| | | | | | - Elcie Chan
- HEOR/Market Access, Otsuka Pharmaceutical Europe Ltd., Wexham, UK
| | | |
Collapse
|
17
|
Beusterien K, Chan E, Such P, de Jong Laird A, Heres S, Amos K, Loze JY, Nylander AG, Robinson P, Bridges JFP. Development of a stated-preference instrument to prioritize treatment goals in recent onset schizophrenia. Curr Med Res Opin 2017; 33:2129-2136. [PMID: 28945106 DOI: 10.1080/03007995.2017.1384717] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE This study sought to evaluate a new stated-preference instrument to prioritize multiple treatment goals among people with recent onset schizophrenia. METHODS A draft survey instrument was developed to assess preferences for 13 key treatment goals that were identified based on the literature. The survey incorporates best-worst scaling (BWS), which shows repeated subsets comprising 4 of the 13 goals, and respondents identify which is most important and which is least important to them. Pre-test interviews were conducted in the UK, Italy, and Germany among people aged 18 to 35 diagnosed with schizophrenia within the past 5 years. Specifically, participants completed the instrument online in their native language, followed by a telephone interview to provide feedback on the clarity, relevance, and comprehensiveness of the survey. The interview data were analyzed to assess interpretation and content validity of the survey. RESULTS Fifteen participants (five per country) provided feedback (mean age = 31; 60% male). Feedback was comparable across countries and confirmed that the key treatment goals assessed were relevant and meaningful. Probing by interviewers ascertained that respondents interpreted the questions appropriately and identified the treatment goals that were most and least important to them. Based on the characterization of the goals, a conceptual model was developed illustrating hypothesized associations among them. CONCLUSION The results confirm that the BWS methodology and key treatment goals in this new instrument are appropriate for use in recent onset schizophrenia. These results will help guide measurement of patient-relevant endpoints in future studies.
Collapse
Affiliation(s)
| | - Elcie Chan
- b HEOR, Otsuka Pharmaceutical Europe Ltd. , Wexham , UK
| | - Pedro Such
- c Global Medical Affairs, H. Lundbeck A/S , Valby , Denmark
| | | | - Stephan Heres
- e Department of Psychiatry and Psychotherapy , Technische Universität München , Munich , Germany
| | | | - Jean-Yves Loze
- d Medical Affairs, Otsuka Pharmaceutical Europe Ltd. , Wexham , UK
| | | | - Paul Robinson
- b HEOR, Otsuka Pharmaceutical Europe Ltd. , Wexham , UK
| | - John F P Bridges
- f Department of Health Policy and Management , Johns Hopkins Bloomberg School of Public Health , Maryland , USA
| |
Collapse
|
18
|
Abstract
OBJECTIVES Some countries make considerable effort to involve patients and patient groups in their health technology assessment (HTA) processes; others are only just considering or are yet to consider patient involvement in HTA. METHODS This commentary offers four arguments why patient involvement should be prioritized by those HTA agencies that do not yet involve patients: (1) from a patients' rights perspective, (2) based on patient and community values, (3) centering on evidentiary contributions, and (4) from a methodological perspective. RESULTS The first argument builds on the Alma-Ata Declaration, which holds that patients have a right and duty to have a say in the planning and delivery of their health care, individually and collectively. Where HTA is used to determine access to technologies and services, we argue that patients have a right to be heard. The second argues that decisions about treatments and services need to be aligned with the core values and morals of the patients whom the health system serves. The third argues that patients have unique knowledge and insights about living with a health condition and their needs for services and treatments regarding that condition, which can add to the knowledge base and value of the HTA process. The fourth argues that involvement of patients can facilitate methodological advancement of HTA, in areas such as early scientific advice and managed entry with evidence development. CONCLUSIONS An HTA process that includes patient perspectives can, therefore, provide added value to patients, policy makers and healthcare professionals alike.
Collapse
|
19
|
Danner M, Vennedey V, Hiligsmann M, Fauser S, Stock S. Focus Groups in Elderly Ophthalmologic Patients: Setting the Stage for Quantitative Preference Elicitation. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2016; 9:47-57. [PMID: 25726011 DOI: 10.1007/s40271-015-0122-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVES Patients suffering from age-related macular degeneration (AMD) are rarely actively involved in decision-making, despite facing preference-sensitive treatment decisions. This paper presents a qualitative study to prepare quantitative preference elicitation in AMD patients. The aims of this study were (1) to gain familiarity with and learn about the special requirements of the AMD patient population for quantitative data collection; and (2) to select/refine patient-relevant treatment attributes and levels, and gain insights into preference structures. METHODS Semi-structured focus group interviews were performed. An interview guide including preselected categories in the form of seven potentially patient-relevant treatment attributes was followed. To identify the most patient-relevant treatment attributes, a ranking exercise was performed. Deductive content analyses were done by two independent reviewers for each attribute to derive subcategories (potential levels of attributes) and depict preference trends. RESULTS The focus group interviews included 21 patients. The interviews revealed that quantitative preference surveys in this population will have to be interviewer assisted to make the survey feasible for patients. The five most patient-relevant attributes were the effect on visual function [ranking score (RS): 139], injection frequency (RS: 101), approval status (RS: 83), side effects (RS: 79), and monitoring frequency (RS: 76). Attribute and level refinement was based on patients' statements. Preference trends and dependencies between attributes informed the quantitative instrument design. CONCLUSION This study suggests that qualitative research is a very helpful step to prepare the design and administration of quantitative preference elicitation instruments. It especially facilitated familiarization with the target population and its preferences, and it supported attribute/level refinement.
Collapse
Affiliation(s)
- Marion Danner
- Institute for Health Economics and Clinical Epidemiology, Cologne University Hospital, Gleueler Straße 176-178, 50935, Cologne, Germany.
| | - Vera Vennedey
- Institute for Health Economics and Clinical Epidemiology, Cologne University Hospital, Gleueler Straße 176-178, 50935, Cologne, Germany
| | - Mickaël Hiligsmann
- Department of Health Services Research, CAPHRI School for Primary Care and Public Health, Maastricht University, Maastricht, The Netherlands
| | - Sascha Fauser
- Center for Ophthalmology, Cologne University Hospital, Cologne, Germany
| | - Stephanie Stock
- Institute for Health Economics and Clinical Epidemiology, Cologne University Hospital, Gleueler Straße 176-178, 50935, Cologne, Germany
| |
Collapse
|
20
|
dosReis S, Castillo WC, Ross M, Fitz-Randolph M, Vaughn-Lee A, Butler B. Attribute Development Using Continuous Stakeholder Engagement to Prioritize Treatment Decisions: A Framework for Patient-Centered Research. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2016; 19:758-766. [PMID: 27712703 DOI: 10.1016/j.jval.2016.02.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 01/29/2016] [Accepted: 02/20/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To develop a methodological approach for selecting, validating, and prioritizing attributes for health care decision making. METHODS Participants (n = 48) were recruited from community support groups if they had a child aged 26 years or younger diagnosed with a coexisting mental health condition and cognitive impairment. Six in-depth interviews eliciting care management experiences were transcribed and coded into themes following the principles of grounded theory and the constant comparative method. Six focus groups involving 42 participants assessed the relevance, priority, and meaning and inter-relationship among the themes. The positive predictive value and sensitivity assessed agreement on thematic meaning. A final list was selected from the top priorities with good agreement as candidate attributes. Attribute levels reflecting the range of experiences in care management decisions emerged from the verbatim passages within each coded theme. RESULTS Participants were the child's mother (73%), white (77%), married (69%), and on average 48 years old. The children were on average 14 years old; 44% had an intellectual disability, 25% had autism, and more than half had anxiety or attention-deficit/hyperactivity disorder. All 14 attributes identified from the in-depth interviews were deemed relevant. The positive predictive value exceeded 90%, and the sensitivity ranged from 64% to 89%. The final set of attributes formed the framework for care management decisions consisting of six attributes (medication, behavior, services, social, treatment effects, and school) each with three levels. CONCLUSIONS A systematic approach grounded in qualitative methods produced a framework of relevant, important, and actionable attributes representing competing alternatives in clinical decisions.
Collapse
Affiliation(s)
- Susan dosReis
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA.
| | - Wendy Camelo Castillo
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Melissa Ross
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | | | - Angela Vaughn-Lee
- University of Maryland PIONEER Study Community Partners, Baltimore, MD, USA
| | - Beverly Butler
- University of Maryland PIONEER Study Community Partners, Baltimore, MD, USA
| |
Collapse
|
21
|
Staley K, Doherty C. It's not evidence, it's insight: bringing patients' perspectives into health technology appraisal at NICE. RESEARCH INVOLVEMENT AND ENGAGEMENT 2016; 2:4. [PMID: 29062505 PMCID: PMC5611625 DOI: 10.1186/s40900-016-0018-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 02/06/2016] [Indexed: 05/23/2023]
Abstract
PLAIN ENGLISH SUMMARY Health technology appraisal involves reviewing the findings from clinical trials and economic data to produce guidance on how health technology should be used. This task is carried out by appraisal committees in NICE. One of the several ways in which patients can feed their views into these committees is via a written patient statement. We asked nine committee members about what difference the information from patients makes to their decision-making. The Committee members reported that written patient statements offer a different perspective when reviewing the clinical and economic data. This can have a profound impact when a committee draws conclusions based solely on the data, which may not reflect the reality of patients' lives. The patients' and carers' input provides meaning to the data, 'bringing the numbers to life'. It identifies if the technology has any wider impacts than what's been reported in the clinical trial, and also if the trial has measured what's important to patients. We conclude that the written patient statement adds value to the decision-making process by helping Committee members to make sense of the clinical and economic data-it makes them look at the evidence 'in a different light'. Patients' stories are very effective in this context, because they have the power to communicate and to challenge Committee members' assumptions. Understanding this difference between analysing research evidence and drawing on patients' insights is important in thinking about what's needed in a written patient statement and the best way to obtain it. ABSTRACT Background Health technology appraisal involves reviewing clinical and economic data to inform guidance on the use of technology. In England this task is carried out by appraisal committees within the National Institute for Health and Care Excellence (NICE). Patients are not committee members as they have a vested interest in the outcome, but one of the several ways they are involved is through submitting a written patient statement, which is considered by the committee during its deliberations. We aimed to find out how the written patient statement adds value to the decision-making process by exploring how it is used in practice. Methods Semi-structured interviews were conducted with nine members of NICE appraisal committees. The interviews were transcribed and analysed thematically. We drew on published evidence of the impact of patient involvement on clinical research and our experience of supporting organisations to produce written patient statements to analyse the findings. Results Committee members reported that written patient statements offer a different perspective when evaluating clinical and economic data. This can have a profound impact when a committee draws conclusions based on data that may not reflect the reality of the patient experience. Information from patients and carers also provides context and meaning to the data, by explaining its real-life implications. It identifies wider impacts of a technology that may not have been assessed in a clinical trial, as well as commenting on whether what has been measured in a trial is relevant to patients. The main barrier to using the written patient statement is the misperception that it is a form of research 'evidence', when in fact it takes the form of experiential knowledge - or insight. Conclusions The written patient statement adds value by aiding Committee members in their interpretation of existing evidence - it enables them to consider this evidence 'in a different light'. In this context, patients' experiential knowledge is effective because it is subjective, emotional and anecdotal. It then has the power to communicate and to challenge assumptions based on the data alone. Understanding this difference between using evidence and insights has implications for the content of a written patient statement and the approaches used to obtain it.
Collapse
|
22
|
Aslakson RA, Schuster ALR, Reardon J, Lynch T, Suarez-Cuervo C, Miller JA, Moldovan R, Johnston F, Anton B, Weiss M, Bridges JFP. Promoting perioperative advance care planning: a systematic review of advance care planning decision aids. J Comp Eff Res 2015; 4:615-50. [PMID: 26346494 DOI: 10.2217/cer.15.43] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
This systematic review identifies possible decision aids that promote perioperative advance care planning (ACP) and synthesizes the available evidence regarding their use. Using PubMed, EMBASE, Cochrane, SCOPUS, Web of Science, CINAHL, PsycINFO and Sociological Abstracts, researchers identified and screened articles for eligibility. Data were abstracted and risk of bias assessed for included articles. Thirty-nine of 5327 articles satisfied the eligibility criteria. Primarily completed in outpatient ambulatory populations, studies evaluated a variety of ACP decision aids. None were evaluated in a perioperative population. Fifty unique outcomes were reported with no head-to-head comparisons conducted. Findings are likely generalizable to a perioperative population and can inform development of a perioperative ACP decision aid. Future studies should compare the effectiveness of ACP decision aids.
Collapse
Affiliation(s)
- Rebecca A Aslakson
- Department of Anesthesiology & Critical Care Medicine, The Johns Hopkins Hospital, Baltimore, MD 21287, USA
| | - Anne L R Schuster
- Department of Health Policy & Management, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 22105, USA
| | - Jessica Reardon
- Department of Anesthesiology & Critical Care Medicine, The Johns Hopkins Hospital, Baltimore, MD 21287, USA
| | - Thomas Lynch
- Department of Anesthesiology & Critical Care Medicine, The Johns Hopkins Hospital, Baltimore, MD 21287, USA
| | - Catalina Suarez-Cuervo
- The Johns Hopkins Evidence-based Practice Center, Department of Health Policy & Management, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Judith A Miller
- Patient/Family Member Co-investigator, Architecture by Design, Ellicott City, MD 21042, USA
| | - Rita Moldovan
- Department of Medicine Nursing, The Johns Hopkins Hospital, Baltimore, MD 21287, USA
| | - Fabian Johnston
- Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Blair Anton
- William H. Welch Medical Library, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Matthew Weiss
- Department of Surgery, The Johns Hopkins University, Baltimore, MD 21287, USA
| | - John F P Bridges
- Department of Health Policy & Management, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 22105, USA
| |
Collapse
|
23
|
Schooler NR, Buchanan RW, Laughren T, Leucht S, Nasrallah HA, Potkin SG, Abi-Saab D, Berardo CG, Bugarski-Kirola D, Blaettler T, Edgar CJ, Nordstroem AL, O'Gorman C, Garibaldi G. Defining therapeutic benefit for people with schizophrenia: focus on negative symptoms. Schizophr Res 2015; 162:169-74. [PMID: 25579053 DOI: 10.1016/j.schres.2014.12.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 12/01/2014] [Accepted: 12/01/2014] [Indexed: 01/31/2023]
Abstract
Schizophrenia is a complex, heterogeneous, multidimensional disorder within which negative symptoms are a significant and disabling feature. Whilst there is no established treatment for these symptoms, some pharmacological and psychosocial interventions have shown promise and this is an active area of research. Despite the effort to identify effective interventions, as yet there is no broadly accepted definition of therapeutic success. This article reviews concepts of clinical relevance and reports on a consensus conference whose goal was to apply these concepts to the treatment of negative symptoms. A number of key issues were identified and discussed including: assessment of specific negative symptom domains; defining response and remission for negative symptoms; assessment of functional outcomes; measurement of outcomes within clinical trials; and the assessment of duration/persistence of a response. The group reached a definition of therapeutic success using an achieved threshold of function that persisted over time. Recommendations were agreed upon with respect to: assessment of negative symptom domains of apathy-avolition and deficit of expression symptoms; thresholds for response and remission of negative symptoms based on level of symptomatology; assessing multiple domains of function including social occupation, activities of daily living, and socialization; the need for clinical trial data to include rate of change over time and converging sources of evidence; use of clinician, patient and caregiver perspectives to assess success; and the need for establishing criteria for the persistence of therapeutic benefit. A consensus statement and associated research criteria are offered as an initial step towards developing broad agreement regarding outcomes of negative symptoms treatment.
Collapse
Affiliation(s)
- Nina R Schooler
- State University of New York, Downstate Medical Center, Brooklyn, NY, USA.
| | - Robert W Buchanan
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, Technische Universität University Hospital, Munich, Germany
| | - Henry A Nasrallah
- Department of Neurology and Psychiatry, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Steven G Potkin
- Department of Psychiatry and Human Behavior, University of CA, Irvine, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Wärdig R, Bachrach‐Lindström M, Hultsjö S, Lindström T, Foldemo A. Persons with psychosis perceptions of participating in a lifestyle intervention. J Clin Nurs 2015; 24:1815-24. [DOI: 10.1111/jocn.12782] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Rikard Wärdig
- Department of Medical and Health Sciences Linköping University Linköping Sweden
| | | | - Sally Hultsjö
- Psychiatric Clinic Ryhov County Hospital Jönköping Sweden
| | - Torbjörn Lindström
- Department of Medical and Health Sciences Linköping University Linköping Sweden
| | - Anniqa Foldemo
- Department of Medical and Health Sciences Linköping University Linköping Sweden
| |
Collapse
|
25
|
Janssen IM, Gerhardus A, Schröer-Günther MA, Scheibler F. A descriptive review on methods to prioritize outcomes in a health care context. Health Expect 2014; 18:1873-93. [PMID: 25156207 DOI: 10.1111/hex.12256] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2014] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Evidence synthesis has seen major methodological advances in reducing uncertainty and estimating the sizes of the effects. Much less is known about how to assess the relative value of different outcomes. OBJECTIVE To identify studies that assessed preferences for outcomes in health conditions. METHODS SEARCH STRATEGY we searched MEDLINE, EMBASE, PsycINFO and the Cochrane Library in February 2014. INCLUSION CRITERIA eligible studies investigated preferences of patients, family members, the general population or healthcare professionals for health outcomes. The intention of this review was to include studies which focus on theoretical alternatives; studies which assessed preferences for distinct treatments were excluded. DATA EXTRACTION study characteristics as study objective, health condition, participants, elicitation method, and outcomes assessed in the study were extracted. MAIN RESULTS One hundred and twenty-four studies were identified and categorized into four groups: (1) multi criteria decision analysis (MCDA) (n = 71), (2) rating or ranking (n = 25), (3) utility eliciting (n = 5) and (4) studies comparing different methods (n = 23). The number of outcomes assessed by method group varied. The comparison of different methods or subgroups within one study often resulted in different hierarchies of outcomes. CONCLUSIONS A dominant method most suitable for application in evidence syntheses was not identified. As preferences of patients differ from those of other stakeholders (especially medical professionals), the choice of the group to be questioned is consequential. Further research needs to focus on validity and applicability of the identified methods.
Collapse
Affiliation(s)
- Inger M Janssen
- Department of Epidemiology & International Public Health, University of Bielefeld, Bielefeld, Germany.,Department of Health Information, Institute for Quality and Efficiency in Healthcare (IQWiG), Köln, Germany
| | - Ansgar Gerhardus
- Department of Health Services Research, Institute for Public Health and Nursing Science, University of Bremen, Bremen, Germany
| | - Milly A Schröer-Günther
- Department of Non-Drug Interventions, Institute for Quality and Efficiency in Healthcare (IQWiG), Köln, Germany
| | - Fülöp Scheibler
- Department of Non-Drug Interventions, Institute for Quality and Efficiency in Healthcare (IQWiG), Köln, Germany
| |
Collapse
|
26
|
Schuster ALR, Aslakson RA, Bridges JFP. Creating an advance-care-planning decision aid for high-risk surgery: a qualitative study. BMC Palliat Care 2014; 13:32. [PMID: 25067908 PMCID: PMC4110535 DOI: 10.1186/1472-684x-13-32] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 06/12/2014] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND High-risk surgery patients may lose decision-making capacity as a result of surgical complications. Advance care planning prior to surgery may be beneficial, but remains controversial and is hindered by a lack of appropriate decision aids. This study sought to examine stakeholders' views on the appropriateness of using decision aids, in general, to support advance care planning among high-risk surgery populations and the design of such a decision aid. METHODS Key informants were recruited through purposive and snowball sampling. Semi-structured interviews were conducted by phone until data collected reached theoretical saturation. Key informants were asked to discuss their thoughts about advance care planning and interventions to support advance care planning, particularly for this population. Researchers took de-identified notes that were analyzed for emerging concordant, discordant, and recurrent themes using interpretative phenomenological analysis. RESULTS Key informants described the importance of initiating advance care planning preoperatively, despite potential challenges present in surgical settings. In general, decision aids were viewed as an appropriate approach to support advance care planning for this population. A recipe emerged from the data that outlines tools, ingredients, and tips for success that are needed to design an advance care planning decision aid for high-risk surgical settings. CONCLUSIONS Stakeholders supported incorporating advance care planning in high-risk surgical settings and endorsed the appropriateness of using decision aids to do so. Findings will inform the next stages of developing the first advance care planning decision aid for high-risk surgery patients.
Collapse
Affiliation(s)
- Anne LR Schuster
- Department of Health Policy and Management, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Rebecca A Aslakson
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - John FP Bridges
- Department of Health Policy and Management, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
27
|
Rotter JS, Foerster D, Bridges JFP. The changing role of economic evaluation in valuing medical technologies. Expert Rev Pharmacoecon Outcomes Res 2014; 12:711-23. [DOI: 10.1586/erp.12.73] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
28
|
Bridges JFP, Slawik L, Schmeding A, Reimer J, Naber D, Kuhnigk O. A test of concordance between patient and psychiatrist valuations of multiple treatment goals for schizophrenia. Health Expect 2013; 16:164-76. [PMID: 21668795 PMCID: PMC5060657 DOI: 10.1111/j.1369-7625.2011.00704.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND While much discussion has been placed on the problem of poor compliance in the treatment of schizophrenia, there has been little discussion on the concordance between patients and psychiatrists, an important contributing factor to patient-centred care. OBJECTIVE To estimate the concordance between patients' and psychiatrists' (ordinal and cardinal) valuations of multiple goals for schizophrenia treatment and to illustrate the utility of the self-explicated method in valuing a large number of treatment goals. DESIGN Twenty treatment goals were identified during focus groups and literature review and were presented to patients and psychiatrists during structured interviews. Respondents were asked to rank the multiple treatment goals and rate them on a 5-point Likert scale. Three scores were calculated based on the ranking (1-20), rating (Likert scale) (1-5) and a self-explicated method estimated as the product of rating and ranking score (1-100). Concordance was tested using Spearman's rho for overall ordinal rankings and via anova and F-test for the cardinal values assigned to a specific treatment goal. PARTICIPANTS A total of 105 outpatients diagnosed with schizophrenia and 160 psychiatrists in Germany. RESULTS Patient and psychiatrist values were concordant when the ordinal properties of their valuations were assessed by rating (ρ = 0.63; P = 0.002), ranking (ρ = 0.51; P = 0.02) and self-explicated methods (ρ = 0.54; P = 0.01). Significant discordances were found when comparing the cardinal value placed on any given treatment goal using all three approaches, but the self-explicated method produced a more discerning statistic. Relative to patients, psychiatrists significantly (P < 0.05) overvalued reduced lack of emotion, improved sexual pleasure and improved communication while undervaluing reuptake of activities of daily living, improved satisfaction and recovered capacity for work. CONCLUSIONS While there is an overall concordance between patients' and psychiatrists' valuation, significantly different valuations on specific goals can be identified. Here, psychiatrists tend to focus on 'textbook' outcomes, while patients are more concerned with functioning and living a normal life. This study also demonstrates the importance of comparing the concordance in treatment goals and the importance of preference-based methods, such as the self-explicated method, in the study of concordance.
Collapse
Affiliation(s)
- John F P Bridges
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
| | | | | | | | | | | |
Collapse
|
29
|
Trujols J, Portella MJ, Iraurgi I, Campins MJ, Siñol N, de Los Cobos JP. Patient-reported outcome measures: are they patient-generated, patient-centred or patient-valued? J Ment Health 2013; 22:555-62. [PMID: 23323928 DOI: 10.3109/09638237.2012.734653] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND In the past two decades, there has been a growing interest in the development of a more patient-centred approach to assessing treatment outcomes. This interest has resulted in the increasing use of patient-reported outcome measures (PROMs) in both clinical trials and usual clinical practice. AIMS To briefly discuss the paucity of efficacy and effectiveness studies in the field of mental health (exemplified by schizophrenia, depression and opioid dependence) that significantly incorporate the patient's perspective. The limited concordance between the perspectives of patients and clinicians in outcome assessment is also addressed. Finally, we propose a new PROM classification system based on the degree to which these instruments incorporate the patient's perspective. CONCLUSIONS PROMs may differ little from traditional instruments unless they truly incorporate the patient's perspective and not just the perspectives of clinicians and researchers. Efforts to develop new PROMs that provide a more patient-centred outcome assessment should use qualitative and participatory methods to capture and incorporate patient perspectives and values.
Collapse
Affiliation(s)
- Joan Trujols
- Unitat de Conductes Addictives, Servei de Psiquiatria, Hospital de la Santa Creu i Sant Pau , Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau) , Barcelona , Spain
| | | | | | | | | | | |
Collapse
|
30
|
Kinter ET, Prior TJ, Carswell CI, Bridges JFP. A Comparison of Two Experimental Design Approaches in Applying Conjoint Analysis in Patient-Centered Outcomes Research. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2012; 5:279-94. [DOI: 10.1007/bf03262499] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
31
|
Gagnon MP, Desmartis M, Gagnon J, St-Pierre M, Gauvin FP, Rhainds M, Lepage-Savary D, Coulombe M, Dipankui MT, Légaré F. Introducing the patient's perspective in hospital health technology assessment (HTA): the views of HTA producers, hospital managers and patients. Health Expect 2012; 17:888-900. [PMID: 23046439 DOI: 10.1111/hex.12010] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2012] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The recent establishment of health technology assessment (HTA) units in University hospitals in the Province of Quebec (Canada) provides a unique opportunity to foster increased participation of patients in decisions regarding health technologies and interventions at the local level. However, little is known about factors that influence whether the patient's perspective is taken into consideration when such decisions are made. OBJECTIVE To explore the practices, perceptions and views of the various HTA stakeholders concerning patient involvement in HTA at the local level. METHOD Data were collected using semi-structured interviews with 24 HTA producers and hospital managers and two focus groups with a total of 13 patient representatives. RESULTS Patient representatives generally showed considerable interest in being involved in HTA. Our findings support the hypothesis that the patient perspective contributes to a more accurate and contextualized assessment of health technologies and produces HTA reports that are more useful for decision makers. They also suggest that participation throughout the assessment process could empower patients and improve their knowledge. Barriers to patient involvement in HTA at the local level are also discussed as well as potential strategies to overcome them. DISCUSSION AND CONCLUSION This study contributes to knowledge that could guide interventions in favour of patient participation in HTA activities at the local level. Experimenting with different patient involvement strategies and assessing their impact is needed to provide evidence that will inform future interventions of this kind.
Collapse
Affiliation(s)
- Marie-Pierre Gagnon
- Centre de recherche du Centre hospitalier universitaire de Québec (CHUQ), Québec, Canada; Faculty of Nursing, Université Laval, Québec, Canada
| | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Bridges JFP, Lataille AT, Buttorff C, White S, Niparko JK. Consumer preferences for hearing aid attributes: a comparison of rating and conjoint analysis methods. Trends Amplif 2012; 16:40-8. [PMID: 22514094 DOI: 10.1177/1084713811434617] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Low utilization of hearing aids has drawn increased attention to the study of consumer preferences using both simple ratings (e.g., Likert scale) and conjoint analyses, but these two approaches often produce inconsistent results. The study aims to directly compare Likert scales and conjoint analysis in identifying important attributes associated with hearing aids among those with hearing loss. Seven attributes of hearing aids were identified through qualitative research: performance in quiet settings, comfort, feedback, frequency of battery replacement, purchase price, water and sweat resistance, and performance in noisy settings. The preferences of 75 outpatients with hearing loss were measured with both a 5-point Likert scale and with 8 paired-comparison conjoint tasks (the latter being analyzed using OLS [ordinary least squares] and logistic regression). Results were compared by examining implied willingness-to-pay and Pearson's Rho. A total of 56 respondents (75%) provided complete responses. Two thirds of respondents were male, most had sensorineural hearing loss, and most were older than 50; 44% of respondents had never used a hearing aid. Both methods identified improved performance in noisy settings as the most valued attribute. Respondents were twice as likely to buy a hearing aid with better functionality in noisy environments (p < .001), and willingness to pay for this attribute ranged from US$2674 on the Likert to US$9000 in the conjoint analysis. The authors find a high level of concordance between the methods-a result that is in stark contrast with previous research. The authors conclude that their result stems from constraining the levels on the Likert scale.
Collapse
Affiliation(s)
- John F P Bridges
- Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Rm 689, Baltimore, MD 21205, USA.
| | | | | | | | | |
Collapse
|
33
|
Gagnon MP, Gagnon J, St-Pierre M, Gauvin FP, Piron F, Rhainds M, Coulombe M, Lepage-Savary D, Desmartis M, Tantchou Dipankui M, Légaré F. Involving patients in HTA activities at local level: a study protocol based on the collaboration between researchers and knowledge users. BMC Health Serv Res 2012; 12:14. [PMID: 22248231 PMCID: PMC3274445 DOI: 10.1186/1472-6963-12-14] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Accepted: 01/16/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The literature recognizes a need for greater patient involvement in health technology assessment (HTA), but few studies have been reported, especially at the local level. Following the decentralisation of HTA in Quebec, Canada, the last few years have seen the creation of HTA units in many Quebec university hospital centres. These units represent a unique opportunity for increased patient involvement in HTA at the local level. Our project will engage patients in an assessment being carried out by a local HTA team to assess alternatives to isolation and restraint for hospitalized or institutionalized adults. Our objectives are to: 1) validate a reference framework for exploring the relevance and applicability of various models of patient involvement in HTA, 2) implement strategies that involve patients (including close relatives and representatives) at different stages of the HTA process, 3) evaluate intervention processes, and 4) explore the impact of these interventions on a) the applicability and acceptability of recommendations arising from the assessment, b) patient satisfaction, and c) the sustainability of this approach in HTA. METHODS For Objective 1, we will conduct individual interviews with various stakeholders affected by the use of alternatives to isolation and restraint for hospitalized or institutionalized adults. For Objective 2, we will implement three specific strategies for patient involvement in HTA: a) direct participation in the HTA process, b) consultation of patients or their close relatives through data collection, and c) patient involvement in the dissemination of HTA results. For Objectives 3 and 4, we will evaluate the intervention processes and the impact of patient involvement strategies on the recommendations arising from the HTA and the understanding of the ethical and social implications of the HTA. DISCUSSION This project is likely to influence future HTA practices because it directly targets knowledge users' need for strategies that increase patient involvement in HTA. By documenting the processes and outcomes of these involvement strategies, the project will contribute to the knowledge base related to patient involvement in HTA.
Collapse
Affiliation(s)
- Marie-Pierre Gagnon
- Centre hospitalier universitaire de Québec (CHUQ) Research Centre, Hôpital Saint-François d'Assise, 10 rue de l'Espinay, D6-726, Quebec, QC, G1L 3L5, Canada
- Faculty of Nursing, Université Laval, Quebec, Canada
| | - Johanne Gagnon
- Centre hospitalier universitaire de Québec (CHUQ) Research Centre, Hôpital Saint-François d'Assise, 10 rue de l'Espinay, D6-726, Quebec, QC, G1L 3L5, Canada
- Faculty of Nursing, Université Laval, Quebec, Canada
| | | | | | - Florence Piron
- Department of Information and Communication, Université Laval, Quebec, Canada
| | - Marc Rhainds
- Centre hospitalier universitaire de Québec, Quebec, Canada
| | | | | | - Marie Desmartis
- Centre hospitalier universitaire de Québec (CHUQ) Research Centre, Hôpital Saint-François d'Assise, 10 rue de l'Espinay, D6-726, Quebec, QC, G1L 3L5, Canada
| | | | - France Légaré
- Centre hospitalier universitaire de Québec (CHUQ) Research Centre, Hôpital Saint-François d'Assise, 10 rue de l'Espinay, D6-726, Quebec, QC, G1L 3L5, Canada
- Department of Family Medicine, Université Laval, Quebec, Canada
| |
Collapse
|
34
|
Bridges JF, Kinter ET, Schmeding A, Rudolph I, Mühlbacher A. Can Patients Diagnosed with Schizophrenia Complete Choice-Based Conjoint Analysis Tasks? PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2011; 4:267-75. [DOI: 10.2165/11589190-000000000-00000] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
|
35
|
Bridges JFP, Gallego G, Kudo M, Okita K, Han KH, Ye SL, Blauvelt BM. Identifying and prioritizing strategies for comprehensive liver cancer control in Asia. BMC Health Serv Res 2011; 11:298. [PMID: 22047535 PMCID: PMC3227633 DOI: 10.1186/1472-6963-11-298] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Accepted: 11/02/2011] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Liver cancer is both common and burdensome in Asia. Effective liver cancer control, however, is hindered by a complex etiology and a lack of coordination across clinical disciplines. We sought to identify strategies for inclusion in a comprehensive liver cancer control for Asia and to compare qualitative and quantitative methods for prioritization. METHODS Qualitative interviews (N = 20) with international liver cancer experts were used to identify strategies using Interpretative Phenomenological Analysis and to formulate an initial prioritization through frequency analysis. Conjoint analysis, a quantitative stated-preference method, was then applied among Asian liver cancer experts (N = 20) who completed 12 choice tasks that divided these strategies into two mutually exclusive and exhaustive subsets. Respondents' preferred plan was the primary outcome in a choice model, estimated using ordinary least squares (OLS) and logistic regression. Priorities were then compared using Spearman's Rho. RESULTS Eleven strategies were identified: Access to treatments; Centers of excellence; Clinical education; Measuring social burden; Monitoring of at-risk populations; Multidisciplinary management; National guidelines; Public awareness; Research infrastructure; Risk-assessment and referral; and Transplantation infrastructure. Qualitative frequency analysis indicated that Risk-assessment and referral (85%), National guidelines (80%) and Monitoring of at-risk populations (80%) received the highest priority, while conjoint analysis pointed to Monitoring of at-risk populations (p < 0.001), Centers of excellence (p = 0.002), and Access to treatments (p = 0.004) as priorities, while Risk-assessment and referral was the lowest priority (p = 0.645). We find moderate concordance between the qualitative and quantitative methods (rho = 0.20), albeit insignificant (p = 0.554), and a strong concordance between the OLS and logistic regressions (rho = 0.979; p < 0.0001). CONCLUSIONS Identified strategies can be conceptualized as the ABCs of comprehensive liver cancer control as they focus on Antecedents, Better care and Connections within a national strategy. Some concordance was found between the qualitative and quantitative methods (e.g. Monitoring of at-risk populations), but substantial differences were also identified (e.g. qualitative methods gave highest priority to risk-assessment and referral, but it was the lowest for the quantitative methods), which may be attributed to differences between the methods and study populations, and potential framing effects in choice tasks. Continued research will provide more generalizable estimates of priorities and account for variation across stakeholders and countries.
Collapse
Affiliation(s)
- John FP Bridges
- Department of Health Policy and Management Johns Hopkins Bloomberg School of Public Health 624 N. Broadway, Room 689 Baltimore, MD 212105 USA
| | - Gisselle Gallego
- Department of Health Policy and Management Johns Hopkins Bloomberg School of Public Health 624 N. Broadway, Room 689 Baltimore, MD 212105 USA
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology Kinki University School of Medicine 377-2 Ohno-Higashi, Osaka-Sayama Osaka, Japan
| | - Kiwamu Okita
- Yamaguchi University Shimonoseki Kohsei Hospital Kamishinchi-cho 3-3-8 Shimonoseki City, Japan
| | - Kwang-Hyub Han
- Division of Gastroenterology Department of Internal Medicine Chief, Liver Cancer Special Clinic Severance Hospital Director, Liver Cirrhosis Clinical Research Center Yonsei University College of Medicine 134 Shinchon-dong, Seodaemun-gu Seoul, Korea
| | - Sheng-Long Ye
- Liver Cancer Institute Zhongshan Hospital Fudan University 136 Yixueyuan Road Shanghai, PR China
| | - Barri M Blauvelt
- Institute for Global Health, University of Massachusetts, 102 Hasbrouck, University of Massachusetts Amherst, MA 01035, USA
| |
Collapse
|
36
|
Bridges JFP, Hauber AB, Marshall D, Lloyd A, Prosser LA, Regier DA, Johnson FR, Mauskopf J. Conjoint analysis applications in health--a checklist: a report of the ISPOR Good Research Practices for Conjoint Analysis Task Force. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2011; 14:403-13. [PMID: 21669364 DOI: 10.1016/j.jval.2010.11.013] [Citation(s) in RCA: 1241] [Impact Index Per Article: 95.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2010] [Accepted: 11/24/2010] [Indexed: 05/09/2023]
Abstract
BACKGROUND The application of conjoint analysis (including discrete-choice experiments and other multiattribute stated-preference methods) in health has increased rapidly over the past decade. A wider acceptance of these methods is limited by an absence of consensus-based methodological standards. OBJECTIVE The International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Good Research Practices for Conjoint Analysis Task Force was established to identify good research practices for conjoint-analysis applications in health. METHODS The task force met regularly to identify the important steps in a conjoint analysis, to discuss good research practices for conjoint analysis, and to develop and refine the key criteria for identifying good research practices. ISPOR members contributed to this process through an extensive consultation process. A final consensus meeting was held to revise the article using these comments, and those of a number of international reviewers. RESULTS Task force findings are presented as a 10-item checklist covering: 1) research question; 2) attributes and levels; 3) construction of tasks; 4) experimental design; 5) preference elicitation; 6) instrument design; 7) data-collection plan; 8) statistical analyses; 9) results and conclusions; and 10) study presentation. A primary question relating to each of the 10 items is posed, and three sub-questions examine finer issues within items. CONCLUSIONS Although the checklist should not be interpreted as endorsing any specific methodological approach to conjoint analysis, it can facilitate future training activities and discussions of good research practices for the application of conjoint-analysis methods in health care studies.
Collapse
Affiliation(s)
- John F P Bridges
- Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | | | | | | | | | | | | | | |
Collapse
|
37
|
Introducing patients' and the public's perspectives to health technology assessment: A systematic review of international experiences. Int J Technol Assess Health Care 2011; 27:31-42. [DOI: 10.1017/s0266462310001315] [Citation(s) in RCA: 117] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Objectives:The aim of this study was to review international experiences of patient or public involvement in the field of health technology assessment (HTA).Methods:A systematic review of the scientific literature was conducted. A literature search was performed across nine databases. Other literature was identified through citation tracking, government websites (HTA agencies), and Internet search engines. Characteristics of the studies, description of the activities related to patient or public involvement, impact of these activities on the HTA process, and factors facilitating or limiting involvement were abstracted independently by two reviewers.Results:A total of 1,441 potentially relevant papers were identified by the main search strategy. Among these, seventeen papers met the inclusion criteria; other search strategies identified seven additional documents. The findings reveal that patient or public involvement in HTA activities was reported in two domains, research and HTA process. In the research domain, patients are consulted to gather evidence about their perspectives, experiences, or preferences about a health technology. These perspectives could add key dimensions to the evaluation of health technologies that might otherwise be overlooked. In the domain of the HTA process, patients or public representatives participate in different stages of this process: prioritization, evidence assessment, or dissemination of findings.Conclusions:There are few published examples of experiences involving patients and the public in HTA. These examples show that patients' or the public's perspectives could add important dimensions to the evaluation of health technologies. However, there is a need to develop more systematic approaches to considering patients' and the public's perspectives in HTA.
Collapse
|
38
|
Bridges JF, Cohen JP, Grist PG, Mühlbacher AC. International experience with comparative effectiveness research: Case studies from England/Wales and Germany. PHARMACEUTICAL MARKETS AND INSURANCE WORLDWIDE 2010; 22:29-50. [DOI: 10.1108/s0731-2199(2010)0000022005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
|