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Aouad P, Ahmed MU, Nassar N, Miskovic-Wheatley J, Touyz S, Maguire S, Cunich M. Appraisal of the costs, health effects, and cost-effectiveness of screening, prevention, treatment and policy-indicated evidence-based interventions for eating disorders: a systematic review protocol. J Eat Disord 2023; 11:83. [PMID: 37226270 DOI: 10.1186/s40337-023-00802-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 05/06/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Having reliable information to make decisions about the allocation of healthcare resources is needed to improve well-being and quality-of-life of individuals with eating disorders (EDs). EDs are a main concern for healthcare administrators globally, particularly due to the severity of health effects, urgent and complex healthcare needs, and relatively high and long-term healthcare costs. A rigorous assessment of up-to-date health economic evidence on interventions for EDs is essential for informing decision-making in this area. To date, health economic reviews on this topic lack a comprehensive assessment of the underlying clinical utility, type and amount of resources used, and methodological quality of included economic evaluations. The current review aims to (1) detail the type of costs (direct and indirect), costing approaches, health effects, and cost-effectiveness of interventions for EDs; (2) assess the nature and quality of available evidence to provide meaningful insights into the health economics associated with EDs. METHODS All interventions for screening, prevention, treatment, and policy-based approaches for all Diagnostic and Statistics Manual (DSM-IV and DSM-5) listed EDs among children, adolescents, and adults will be included. A range of study designs will be considered, including randomised controlled trials, panel studies, cohort studies, and quasi-experimental trials. Economic evaluations will consider key outcomes, including type of resources used (time and valued in a currency), costs (direct and indirect), costing approach, health effects (clinical and quality-of-life), cost-effectiveness, economic summaries used, and reporting and quality assessments. Fifteen general academic and field-specific (psychology and economics) databases will be searched using subject headings and keywords that consolidate costs, health effects, cost-effectiveness and EDs. Quality of included clinical studies will be assessed using risk-of-bias tools. Reporting and quality of the economic studies will be assessed using the widely accepted Consolidated Health Economic Evaluation Reporting Standards and Quality of Health Economic Studies frameworks, with findings of the review presented in tables and narratively. DISCUSSION Results emanating from this systematic review are expected to highlight gaps in healthcare interventions/policy-focused approaches, under-estimates of the economic costs and disease-burden, potential under-utilisation of ED-related resources, and a pressing need for more complete health economic evaluations.
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Affiliation(s)
- Phillip Aouad
- MAINSTREAM Centre for Health System Research & Translation in Eating Disorders Collaboration, InsideOut Institute, University of Sydney, Sydney, NSW, Australia.
- InsideOut Institute, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Sydney, NSW, Australia.
- Boden Initiative, Charles Perkins Centre, Faculty of Medicine and Health (Central Clinical School), University of Sydney, Sydney, NSW, Australia.
| | - Moin Uddin Ahmed
- MAINSTREAM Centre for Health System Research & Translation in Eating Disorders Collaboration, InsideOut Institute, University of Sydney, Sydney, NSW, Australia
- Boden Initiative, Charles Perkins Centre, Faculty of Medicine and Health (Central Clinical School), University of Sydney, Sydney, NSW, Australia
| | - Natasha Nassar
- MAINSTREAM Centre for Health System Research & Translation in Eating Disorders Collaboration, InsideOut Institute, University of Sydney, Sydney, NSW, Australia
- Boden Initiative, Charles Perkins Centre, Faculty of Medicine and Health (Central Clinical School), University of Sydney, Sydney, NSW, Australia
- Menzies Centre for Health Policy and Economics, Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Jane Miskovic-Wheatley
- MAINSTREAM Centre for Health System Research & Translation in Eating Disorders Collaboration, InsideOut Institute, University of Sydney, Sydney, NSW, Australia
- InsideOut Institute, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Sydney, NSW, Australia
- Boden Initiative, Charles Perkins Centre, Faculty of Medicine and Health (Central Clinical School), University of Sydney, Sydney, NSW, Australia
| | - Stephen Touyz
- MAINSTREAM Centre for Health System Research & Translation in Eating Disorders Collaboration, InsideOut Institute, University of Sydney, Sydney, NSW, Australia
- InsideOut Institute, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Sydney, NSW, Australia
- Boden Initiative, Charles Perkins Centre, Faculty of Medicine and Health (Central Clinical School), University of Sydney, Sydney, NSW, Australia
- Sydney Local Health District, Sydney, NSW, Australia
| | - Sarah Maguire
- MAINSTREAM Centre for Health System Research & Translation in Eating Disorders Collaboration, InsideOut Institute, University of Sydney, Sydney, NSW, Australia
- InsideOut Institute, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Sydney, NSW, Australia
- Boden Initiative, Charles Perkins Centre, Faculty of Medicine and Health (Central Clinical School), University of Sydney, Sydney, NSW, Australia
- Menzies Centre for Health Policy and Economics, Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
- Sydney Local Health District, Sydney, NSW, Australia
| | - Michelle Cunich
- MAINSTREAM Centre for Health System Research & Translation in Eating Disorders Collaboration, InsideOut Institute, University of Sydney, Sydney, NSW, Australia
- InsideOut Institute, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Sydney, NSW, Australia
- Boden Initiative, Charles Perkins Centre, Faculty of Medicine and Health (Central Clinical School), University of Sydney, Sydney, NSW, Australia
- Sydney Health Economics Collaborative, Sydney Local Health District, Camperdown, NSW, Australia
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Ahonen‐Jonnarth U, Andersson H, Bökman F. How do people aggregate value? An experiment with relative importance of criteria and relative goodness of alternatives as inputs. JOURNAL OF MULTI-CRITERIA DECISION ANALYSIS 2021. [DOI: 10.1002/mcda.1773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Hanna Andersson
- Department of Computer and Geospatial Sciences University of Gävle Gävle Sweden
- Department of Building Engineering, Energy Systems and Sustainability Science, Faculty of Engineering and Sustainable Development University of Gävle Gävle Sweden
| | - Fredrik Bökman
- Department of Computer and Geospatial Sciences University of Gävle Gävle Sweden
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Kremer IEH, Jongen PJ, Evers SMAA, Hoogervorst ELJ, Verhagen WIM, Hiligsmann M. Patient decision aid based on multi-criteria decision analysis for disease-modifying drugs for multiple sclerosis: prototype development. BMC Med Inform Decis Mak 2021; 21:123. [PMID: 33836742 PMCID: PMC8033667 DOI: 10.1186/s12911-021-01479-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 03/23/2021] [Indexed: 01/20/2023] Open
Abstract
Background Since decision making about treatment with disease-modifying drugs (DMDs) for multiple sclerosis (MS) is preference sensitive, shared decision making between patient and healthcare professional should take place. Patient decision aids could support this shared decision making process by providing information about the disease and the treatment options, to elicit the patient’s preference and to support patients and healthcare professionals in discussing these preferences and matching them with a treatment. Therefore, a prototype of a patient decision aid for MS patients in the Netherlands—based on the principles of multi-criteria decision analysis (MCDA) —was developed, following the recommendations of the International Patient Decision Aid Standards. MCDA was chosen as it might reduce cognitive burden of considering treatment options and matching patient preferences with the treatment options. Results After determining the scope to include DMDs labelled for relapsing-remitting MS and clinically isolated syndrome, users’ informational needs were assessed using focus groups (N = 19 patients) and best-worst scaling surveys with patients (N = 185), neurologists and nurses (N = 60) to determine which information about DMDs should be included in the patient decision aid. Next, an online format and computer-based delivery of the patient decision aid was chosen to enable embedding of MCDA. A literature review was conducting to collect evidence on the effectiveness and burden of use of the DMDs. A prototype was developed next, and alpha testing to evaluate its comprehensibility and usability with in total thirteen patients and four healthcare professionals identified several issues regarding content and framing, methods for weighting importance of criteria in the MCDA structure, and the presentation of the conclusions of the patient decision aid ranking the treatment options according to the patient’s preferences. Adaptations were made accordingly, but verification of the rankings provided, validation of the patient decision aid, evaluation of the feasibility of implementation and assessing its value for supporting shared decision making should be addressed in further development of the patient decision aid. Conclusion This paper aimed to provide more transparency regarding the developmental process of an MCDA-based patient decision aid for treatment decisions for MS and the challenges faced during this process. Issues identified in the prototype were resolved as much as possible, though some issues remain. Further development is needed to overcome these issues before beta pilot testing with patients and healthcare professionals at the point of clinical decision-making can take place to ultimately enable making conclusions about the value of the MCDA-based patient decision aid for MS patients, healthcare professionals and the quality of care. Supplementary Information The online version contains supplementary material available at 10.1186/s12911-021-01479-w.
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Affiliation(s)
- I E H Kremer
- Department of Health Services Research, School CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.
| | - P J Jongen
- MS4 Research Institute, Nijmegen, The Netherlands.,Department of Community and Occupational Medicine, University Medical Centre Groningen, Groningen, The Netherlands
| | - S M A A Evers
- Department of Health Services Research, School CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.,Public Mental Health, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - E L J Hoogervorst
- Department of Neurology, St. Antonius Hospital, Utrecht, The Netherlands
| | - W I M Verhagen
- Department of Neurology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - M Hiligsmann
- Department of Health Services Research, School CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
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Mortimer D, Iezzi A, Dickins M, Johnstone G, Lowthian J, Enticott J, Ogrin R. Using co-creation and multi-criteria decision analysis to close service gaps for underserved populations. Health Expect 2019; 22:1058-1068. [PMID: 31187600 PMCID: PMC6803401 DOI: 10.1111/hex.12923] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 04/29/2019] [Accepted: 05/14/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Navigating treatment pathways remains a challenge for populations with complex needs due to bottlenecks, service gaps and access barriers. The application of novel methods may be required to identify and remedy such problems. OBJECTIVE To demonstrate a novel approach to identifying persistent service gaps, generating potential solutions and prioritizing action. DESIGN Co-creation and multi-criteria decision analysis in the context of a larger, mixed methods study. SETTING AND PARTICIPANTS Community-dwelling sample of older women living alone (OWLA), residing in Melbourne, Australia (n = 13-37). Convenience sample of (n = 11) representatives from providers and patient organizations. INTERVENTIONS Novel interventions co-created to support health, well-being and independence for OWLA and bridge missing links in pathways to care. MAIN OUTCOME MEASURES Performance criteria, criterion weights , performance ratings, summary scores and ranks reflecting the relative value of interventions to OWLA. RESULTS The co-creation process generated a list of ten interventions. Both OWLA and stakeholders considered a broad range of criteria when evaluating the relative merits of these ten interventions and a "Do Nothing" alternative. Combining criterion weights with performance ratings yielded a consistent set of high priority interventions, with "Handy Help," "Volunteer Drivers" and "Exercise Buddies" most highly ranked by both OWLA and stakeholder samples. DISCUSSION AND CONCLUSIONS The present study described and demonstrated the use of multi-criteria decision analysis to prioritize a set of novel interventions generated via a co-creation process. Application of this approach can add community voice to the policy debate and begin to bridge the gap in service provision for underserved populations.
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Affiliation(s)
- Duncan Mortimer
- Centre for Health Economics, Monash Business SchoolMonash UniversityClaytonVictoriaAustralia
| | - Angelo Iezzi
- Centre for Health Economics, Monash Business SchoolMonash UniversityClaytonVictoriaAustralia
| | - Marissa Dickins
- Bolton Clarke Research InstituteBolton ClarkeBrisbaneQueenslandAustralia
- Southern Synergy, Department of Psychiatry at Monash Health, Southern Clinical SchoolMonash UniversityClaytonVictoriaAustralia
| | - Georgina Johnstone
- Bolton Clarke Research InstituteBolton ClarkeBrisbaneQueenslandAustralia
| | - Judy Lowthian
- Bolton Clarke Research InstituteBolton ClarkeBrisbaneQueenslandAustralia
- School of Public Health and Preventive MedicineMonash UniversityClaytonVictoriaAustralia
| | - Joanne Enticott
- Southern Synergy, Department of Psychiatry at Monash Health, Southern Clinical SchoolMonash UniversityClaytonVictoriaAustralia
- Department of General Practice, School of Primary and Allied Health CareMonash UniversityClaytonVictoriaAustralia
| | - Rajna Ogrin
- Bolton Clarke Research InstituteBolton ClarkeBrisbaneQueenslandAustralia
- Austin Health Clinical SchoolUniversity of MelbourneMelbourneVictoriaAustralia
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Blythe R, Naidoo S, Abbott C, Bryant G, Dines A, Graves N. Development and pilot of a multicriteria decision analysis (MCDA) tool for health services administrators. BMJ Open 2019; 9:e025752. [PMID: 31023757 PMCID: PMC6502058 DOI: 10.1136/bmjopen-2018-025752] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Health administration is complex and serves many masters. Value, quality, infrastructure and reimbursement are just a sample of the competing interests influencing executive decision-making. This creates a need for decision processes that are rational and holistic. METHODS We created a multicriteria decision analysis tool to evaluate six fields of healthcare provision: return on investment, capacity, outcomes, safety, training and risk. The tool was designed for prospective use, at the beginning of each funding round for competing projects. Administrators were asked to rank their criteria in order of preference. Each field was assigned a representative weight determined from the rankings. Project data were then entered into the tool for each of the six fields. The score for each field was scaled as a proportion of the highest scoring project, then weighted by preference. We then plotted findings on a cost-effectiveness plane. The project was piloted and developed over successive uses by the hospital's executive board. RESULTS Twelve projects competing for funding at the Royal Brisbane and Women's Hospital were scored by the tool. It created a priority ranking for each initiative based on the weights assigned to each field by the executive board. Projects were plotted on a cost-effectiveness plane with score as the x-axis and cost of implementation as the y-axis. Projects to the bottom right were considered dominant over projects above and to the left, indicating that they provided greater benefit at a lower cost. Projects below the x-axis were cost-saving and recommended provided they did not harm patients. All remaining projects above the x-axis were then recommended in order of lowest to highest cost-per-point scored. CONCLUSION This tool provides a transparent, objective method of decision analysis using accessible software. It would serve health services delivery organisations that seek to achieve value in healthcare.
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Affiliation(s)
- Robin Blythe
- Australian Centre for Health Services Innovation, Institute of Health and Biomedical Innovation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Shamesh Naidoo
- Administration, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Cameron Abbott
- Administration, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Geoffrey Bryant
- Administration, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Amanda Dines
- Administration, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Nicholas Graves
- Australian Centre for Health Services Innovation, Institute of Health and Biomedical Innovation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
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From Rapid Recommendation to Online Preference-Sensitive Decision Support: The Case of Severe Aortic Stenosis. Med Sci (Basel) 2018; 6:medsci6040109. [PMID: 30501062 PMCID: PMC6313661 DOI: 10.3390/medsci6040109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 11/22/2018] [Accepted: 11/27/2018] [Indexed: 12/25/2022] Open
Abstract
The launch of ‘Rapid Recommendations’ by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) group, in collaboration with Making GRADE the Irresistible Choice (MAGIC) and the British Medical Journal (BMJ), is a very interesting recent development in e-healthcare. Designed to respond quickly to developments that have created new decision situations, their first project resulted from the arrival of minimally invasive Transcatheter Aortic Valve Implantation (TAVI) as an alternative to Surgical Aortic Valve Replacement (SAVR), for patients with symptomatic severe aortic stenosis. The interactive MAGIC decision aid that accompanies a Rapid Recommendation and is the main route to its clinical implementation, represents a major advance in e-health, for a cardiovascular decision in this case. However, it needs to go further in order to facilitate fully person-centred care, where the weighted preferences of the individual person are elicited at the point of decision, and transparently integrated with the best (most personalised) estimates of option performances, to produce personalised, preference-sensitive option evaluations. This can be achieved by inputting the collated GRADE evidence on the criteria relevant in the TAVI/SAVR choice into a Multi-Criteria Decision Analysis-based decision support tool, generating a personalised, preference-sensitive opinion. A demonstration version of this add-on to the MAGIC aid, divested of recommendations, is available online as proof of method.
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Eiring Ø, Nytrøen K, Kienlin S, Khodambashi S, Nylenna M. The development and feasibility of a personal health-optimization system for people with bipolar disorder. BMC Med Inform Decis Mak 2017; 17:102. [PMID: 28693482 PMCID: PMC5504814 DOI: 10.1186/s12911-017-0481-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 06/02/2017] [Indexed: 01/14/2023] Open
Abstract
Background People with bipolar disorder often experience ill health and have considerably reduced life expectancies. Suboptimal treatment is common and includes a lack of effective medicines, overtreatment, and non-adherence to medical interventions and lifestyle measures. E- and m-health applications support patients in optimizing their treatment but often exhibit conceptual and technical shortcomings. The objective of this work was to develop and test the usability of a system targeting suboptimal treatment and compare the service to other genres and strategies. Methods Based on the frameworks of shared decision-making, multi-criteria decision analysis, and single-subject research design, we interviewed potential users, reviewed research and current approaches, and created a first version using a rapid prototyping framework. We then iteratively improved and expanded the service based on formative usability testing with patients, healthcare providers, and laypeople from Norway, the UK, and Ukraine. The evidence-based health-optimization system was developed using systematic methods. The System Usability Scale and a questionnaire were administered in formative and summative tests. A comparison of the system to current standards for clinical practice guidelines and patient decision aids was performed. Results Seventy-eight potential users identified 82 issues. Driven by user feedback, the limited first version was developed into a more comprehensive system. The current version encompasses 21 integrated core features, supporting 6 health-optimization strategies. One crucial feature enables patients and clinicians to explore the likely value of treatments based on mathematical integration of self-reported and research data and the patient’s preferences. The mean ± SD (median) system usability score of the patient-oriented subsystem was 71 ± 18 (73). The mean ± SD (median) system usability score in the summative usability testing was 78 ± 18 (75), well above the norm score of 68. Feedback from the questionnaire was generally positive. Eighteen out of 23 components in the system are not required in international standards for patient decision aids and clinical practice guidelines. Conclusion We have developed the first evidence-based health-optimization system enabling patients, clinicians, and caregivers to collaborate in optimizing the patient’s health on a shared platform. User tests indicate that the feasibility of the system is acceptable. Electronic supplementary material The online version of this article (doi:10.1186/s12911-017-0481-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Øystein Eiring
- Faculty of Medicine, University of Oslo, Postbox 1072, Blindern, N-0316, Oslo, Norway.,Norwegian Institute of Public Health, Postbox 4404, Nydalen, N-0403, Oslo, Norway.,Department of Medicine and Healthcare, South-Eastern Norway Regional Health Authority, Postbox 404, N-2303, Hamar, Norway
| | - Kari Nytrøen
- Faculty of Medicine, University of Oslo, Postbox 1072, Blindern, N-0316, Oslo, Norway. .,Department of Medicine and Healthcare, South-Eastern Norway Regional Health Authority, Postbox 404, N-2303, Hamar, Norway. .,Oslo University Hospital, Postbox 4950, Nydalen, N-0424, Oslo, Norway.
| | - Simone Kienlin
- Department of Medicine and Healthcare, South-Eastern Norway Regional Health Authority, Postbox 404, N-2303, Hamar, Norway.,Department of Medicine, University Hospital of North Norway, Postbox 6050, N-9037, Langnes, Tromsø, Norway
| | | | - Magne Nylenna
- Faculty of Medicine, University of Oslo, Postbox 1072, Blindern, N-0316, Oslo, Norway.,Norwegian Institute of Public Health, Postbox 4404, Nydalen, N-0403, Oslo, Norway
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Wortley S, Street J, Lipworth W, Howard K. What factors determine the choice of public engagement undertaken by health technology assessment decision-making organizations? J Health Organ Manag 2017; 30:872-90. [PMID: 27681022 DOI: 10.1108/jhom-08-2015-0119] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Purpose Public engagement in health technology assessment (HTA) is increasingly considered crucial for good decision making. Determining the "right" type of engagement activity is key in achieving the appropriate consideration of public values. Little is known about the factors that determine how HTA organizations (HTAOs) decide on their method of public engagement, and there are a number of possible factors that might shape these decisions. The purpose of this paper is to understand the potential drivers of public engagement from an organizational perspective. Design/methodology/approach The published HTA literature is reviewed alongside existing frameworks of public engagement in order to elucidate key factors influencing the choice of public engagement process undertaken by HTAOs. A conceptual framework is then developed to illustrate the factors identified from the literature that appear to influence public engagement choice. Findings Determining the type of public engagement undertaken in HTA is based on multiple factors, some of which are not always explicitly acknowledged. These factors included the: perceived complexity of the policy-making issue, perceived impact of the decision, transparency and opportunities for public involvement in governance, as well as time and resource constraints. The influences of these factors vary depending on the context, indicating that a one size fits all approach to public engagement may not be effective. Originality/value Awareness of the various factors that might influence the type of public engagement undertaken would enable decision makers to reflect on their choices and be more accountable and transparent about their choice of engagement process in eliciting public values and preferences in a HTAO.
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Affiliation(s)
- Sally Wortley
- School of Public Health, The University of Sydney , Sydney, Australia
| | - Jackie Street
- School of Population Health, The University of Adelaide , Adelaide, Australia
| | - Wendy Lipworth
- Centre for Values, Ethics & Law in Medicine (VELIM), School of Public Health, The University of Sydney , Sydney, Australia
| | - Kirsten Howard
- School of Public Health, The University of Sydney , Sydney, Australia
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Weernink MGM, van Til JA, Groothuis-Oudshoorn CGM, IJzerman MJ. Patient and Public Preferences for Treatment Attributes in Parkinson's Disease. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2017; 10:763-772. [PMID: 28508354 PMCID: PMC5681616 DOI: 10.1007/s40271-017-0247-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background Patient and public preferences for therapeutic outcomes or medical technologies are often elicited, and discordance between the two is frequently reported. Objective Our main objective was to compare patient and public preferences for treatment attributes in Parkinson’s disease (PD). Methods A representative sample from Dutch PD patients and the general public were invited to complete a best–worst scaling case 2 experiment consisting of six health-related outcomes and one attribute describing the specific treatment (brain surgery, pump, oral medication). Data were analyzed using mixed logit models, and attribute impact was estimated and compared between populations (and population subgroups). Results Both the public (N = 276) and patient (N = 198) populations considered treatment modality the most important attribute, although patients assigned higher relative importance. Both groups assigned high disutility to pump infusion and brain surgery and preferred drug treatment. Most health outcomes were valued equally by patients and the public, with the exception of reducing dizziness (more important to the public) and improving slow movement (more important to patients). Discussion Although these data do not support definite conclusions on whether patients are less likely to undergo invasive treatments, the (predicted) choice probability of undergoing brain surgery or having pump infusion technology would be low based on the (un)desirability of the attribute levels. Patients with PD might have adapted to their condition and are not willing to undergo advanced treatments in order to receive health improvements. Both public and patient preferences entail information that is potentially relevant for decision makers, and patient preferences can inform decision makers about the likelihood of adaptation to a specific condition. Electronic supplementary material The online version of this article (doi:10.1007/s40271-017-0247-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marieke G M Weernink
- Department of Health Technology and Services Research, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, P.O. Box 217, 7500 AE, Enschede, The Netherlands.
| | - Janine A van Til
- Department of Health Technology and Services Research, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, P.O. Box 217, 7500 AE, Enschede, The Netherlands
| | - Catharina G M Groothuis-Oudshoorn
- Department of Health Technology and Services Research, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, P.O. Box 217, 7500 AE, Enschede, The Netherlands
| | - Maarten J IJzerman
- Department of Health Technology and Services Research, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, P.O. Box 217, 7500 AE, Enschede, The Netherlands
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10
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Chim L, Salkeld G, Stockler MR, Mileshkin L. Weighing up the benefits and harms of a new anti-cancer drug: a survey of Australian oncologists. Intern Med J 2016; 45:834-42. [PMID: 25950615 DOI: 10.1111/imj.12802] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Accepted: 04/26/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Little is known about the relative importance that oncologists attribute to the benefits and harms of anti-cancer drugs when considering treatment options with their patients. AIM To quantify the trade-offs made between overall survival, progression-free survival and adverse effects. METHODS A web-based survey elicited importance weights for the benefits and harms of bevacizumab or everolimus. Combining the importance weights with trial-based probabilities produced a score and ranking for each treatment option. RESULTS A total of 40 responses was received for the bevacizumab scenario and 32 for the everolimus scenario. All respondents regarded overall survival and progression-free survival as the most important attributes - more important than avoiding the potential harms regardless of drugs. Among the potential harms, respondents allocated the highest mean importance weight to gastrointestinal (GI) perforation and rated absolute improvement in overall survival as 1.6 times and 2.3 times as important as avoiding GI perforation in the two versions of the bevacizumab scenario respectively. For the everolimus scenario, stomatitis and pneumonitis were allocated the highest mean importance weights with absolute improvement in overall survival rated as 2.2 times as important as avoiding stomatitis/pneumonitis. All 40 respondents (100%) favoured treatment option with bevacizumab to no bevacizumab based on respondents' determined weights for treatment attributes. The converse was found for everolimus with 22 (69%) of respondents preferring the 'no everolimus' option. CONCLUSION Oncologists' preferences over the benefits and harms of treatment do, when combined with evidence of effect, influence treatment decisions for anti-cancer drugs.
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Affiliation(s)
- L Chim
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - G Salkeld
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - M R Stockler
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,National Health and Medical Research Council (NHMRC) Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia.,Sydney Cancer Centre, RPA and Concord Hospital, Sydney, New South Wales, Australia
| | - L Mileshkin
- Division of Haematology and Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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11
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Salkeld G, Cunich M, Dowie J, Howard K, Patel MI, Mann G, Lipworth W. The Role of Personalised Choice in Decision Support: A Randomized Controlled Trial of an Online Decision Aid for Prostate Cancer Screening. PLoS One 2016; 11:e0152999. [PMID: 27050101 PMCID: PMC4822955 DOI: 10.1371/journal.pone.0152999] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Accepted: 03/22/2016] [Indexed: 11/18/2022] Open
Abstract
Importance Decision support tools can assist people to apply population-based evidence on benefits and harms to individual health decisions. A key question is whether “personalising” choice within decisions aids leads to better decision quality. Objective To assess the effect of personalising the content of a decision aid for prostate cancer screening using the Prostate Specific Antigen (PSA) test. Design Randomized controlled trial. Setting Australia. Participants 1,970 men aged 40–69 years were approached to participate in the trial. Intervention 1,447 men were randomly allocated to either a standard decision aid with a fixed set of five attributes or a personalised decision aid with choice over the inclusion of up to 10 attributes. Outcome Measures To determine whether there was a difference between the two groups in terms of: 1) the emergent opinion (generated by the decision aid) to have a PSA test or not; 2) self-rated decision quality after completing the online decision aid; 3) their intention to undergo screening in the next 12 months. We also wanted to determine whether men in the personalised choice group made use of the extra decision attributes. Results 5% of men in the fixed attribute group scored ‘Have a PSA test’ as the opinion generated by the aid, as compared to 62% of men in the personalised choice group (χ2 = 569.38, 2df, p< 0001). Those men who used the personalised decision aid had slightly higher decision quality (t = 2.157, df = 1444, p = 0.031). The men in the personalised choice group made extensive use of the additional decision attributes. There was no difference between the two groups in terms of their stated intention to undergo screening in the next 12 months. Conclusions Together, these findings suggest that personalised decision support systems could be an important development in shared decision-making and patient-centered care. Trial Registration Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12612000723886
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Affiliation(s)
- Glenn Salkeld
- Faculty of Social Sciences, University Of Wollongong, Wollongong, NSW, Australia
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
- * E-mail:
| | - Michelle Cunich
- Faculty of Pharmacy and Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
| | - Jack Dowie
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Kirsten Howard
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Manish I. Patel
- Westmead Clinical School, Westmead Hospital, Sydney, NSW, Australia
| | - Graham Mann
- Westmead Institute for Medical Research, Westmead Hospital, Sydney, NSW, Australia
| | - Wendy Lipworth
- Centre for Values, Ethics and the Law in Medicine, University of Sydney, Sydney, NSW, Australia
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Woods M, Crabbe H, Close R, Studden M, Milojevic A, Leonardi G, Fletcher T, Chalabi Z. Decision support for risk prioritisation of environmental health hazards in a UK city. Environ Health 2016; 15 Suppl 1:29. [PMID: 26961184 PMCID: PMC4895771 DOI: 10.1186/s12940-016-0099-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND There is increasing appreciation of the proportion of the health burden that is attributed to modifiable population exposure to environmental health hazards. To manage this avoidable burden in the United Kingdom (UK), government policies and interventions are implemented. In practice, this procedure is interdisciplinary in action and multi-dimensional in context. Here, we demonstrate how Multi Criteria Decision Analysis (MCDA) can be used as a decision support tool to facilitate priority setting for environmental public health interventions within local authorities. We combine modelling and expert elicitation to gather evidence on the impacts and ranking of interventions. METHODS To present the methodology, we consider a hypothetical scenario in a UK city. We use MCDA to evaluate and compare the impact of interventions to reduce the health burden associated with four environmental health hazards and rank them in terms of their overall performance across several criteria. For illustrative purposes, we focus on heavy goods vehicle controls to reduce outdoor air pollution, remediation to control levels of indoor radon, carbon monoxide and fitting alarms, and encouraging cycling to target the obesogenic environment. Regional data was included as model evidence to construct a ratings matrix for the city. RESULTS When MCDA is performed with uniform weights, the intervention of heavy goods vehicle controls to reduce outdoor air pollution is ranked the highest. Cycling and the obesogenic environment is ranked second. CONCLUSIONS We argue that a MCDA based approach provides a framework to guide environmental public health decision makers. This is demonstrated through an online interactive MCDA tool. We conclude that MCDA is a transparent tool that can be used to compare the impact of alternative interventions on a set of pre-defined criteria. In our illustrative example, we ranked the best intervention across the equally weighted selected criteria out of the four alternatives. Further work is needed to test the tool with decision makers and stakeholders.
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Affiliation(s)
- Mae Woods
- Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Chilton, OX11 0RQ, UK.
- Department of Cell and Developmental Biology, University College London, London, WC1E 6BT, UK.
| | - Helen Crabbe
- Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Chilton, OX11 0RQ, UK.
| | - Rebecca Close
- Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Chilton, OX11 0RQ, UK.
| | - Mike Studden
- Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Chilton, OX11 0RQ, UK
| | - Ai Milojevic
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, WC1H 9SH, UK.
| | - Giovanni Leonardi
- Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Chilton, OX11 0RQ, UK.
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, WC1H 9SH, UK.
| | - Tony Fletcher
- Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Chilton, OX11 0RQ, UK.
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, WC1H 9SH, UK.
| | - Zaid Chalabi
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, WC1H 9SH, UK.
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Kaltoft MK, Turner R, Cunich M, Salkeld G, Nielsen JB, Dowie J. Addressing preference heterogeneity in public health policy by combining Cluster Analysis and Multi-Criteria Decision Analysis: Proof of Method. HEALTH ECONOMICS REVIEW 2015; 5:10. [PMID: 25992305 PMCID: PMC4429422 DOI: 10.1186/s13561-015-0048-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 04/08/2015] [Indexed: 05/31/2023]
Abstract
The use of subgroups based on biological-clinical and socio-demographic variables to deal with population heterogeneity is well-established in public policy. The use of subgroups based on preferences is rare, except when religion based, and controversial. If it were decided to treat subgroup preferences as valid determinants of public policy, a transparent analytical procedure is needed. In this proof of method study we show how public preferences could be incorporated into policy decisions in a way that respects both the multi-criterial nature of those decisions, and the heterogeneity of the population in relation to the importance assigned to relevant criteria. It involves combining Cluster Analysis (CA), to generate the subgroup sets of preferences, with Multi-Criteria Decision Analysis (MCDA), to provide the policy framework into which the clustered preferences are entered. We employ three techniques of CA to demonstrate that not only do different techniques produce different clusters, but that choosing among techniques (as well as developing the MCDA structure) is an important task to be undertaken in implementing the approach outlined in any specific policy context. Data for the illustrative, not substantive, application are from a Randomized Controlled Trial of online decision aids for Australian men aged 40-69 years considering Prostate-specific Antigen testing for prostate cancer. We show that such analyses can provide policy-makers with insights into the criterion-specific needs of different subgroups. Implementing CA and MCDA in combination to assist in the development of policies on important health and community issues such as drug coverage, reimbursement, and screening programs, poses major challenges -conceptual, methodological, ethical-political, and practical - but most are exposed by the techniques, not created by them.
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Affiliation(s)
- Mette Kjer Kaltoft
- Research Unit for General Practice, Department of Public Health University of Southern Denmark, J.B. Winsløws Vej 9 B, 5000 Odense C, Denmark
| | - Robin Turner
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW 2052 Australia
| | - Michelle Cunich
- NHMRC Clinical Trials Centre, Sydney Medical School, Charles Perkins Centre, Johns Hopkins Drive, Camperdown, NSW 2050 Australia
| | - Glenn Salkeld
- Faculty of Medicine, School of Public Health University of Sydney, Edward Ford Building (A27), Sydney, NSW 2006 Australia
| | - Jesper Bo Nielsen
- Research Unit for General Practice, Department of Public Health University of Southern Denmark, J.B. Winsløws Vej 9 B, 5000 Odense C, Denmark
| | - Jack Dowie
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH UK
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Kaltoft MK, Nielsen JB, Salkeld G, Lander J, Dowie J. Bringing Feedback in From the Outback via a Generic and Preference-Sensitive Instrument for Course Quality Assessment. JMIR Res Protoc 2015; 4:e15. [PMID: 25720558 PMCID: PMC4376236 DOI: 10.2196/resprot.4012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 12/05/2014] [Indexed: 11/20/2022] Open
Abstract
Background Much effort and many resources have been put into developing ways of eliciting valid and informative student feedback on courses in medical, nursing, and other health professional schools. Whatever their motivation, items, and setting, the response rates have usually been disappointingly low, and there seems to be an acceptance that the results are potentially biased. Objective The objective of the study was to look at an innovative approach to course assessment by students in the health professions. This approach was designed to make it an integral part of their educational experience, rather than a marginal, terminal, and optional add-on as “feedback”. It becomes a weighted, but ungraded, part of the course assignment requirements. Methods A ten-item, two-part Internet instrument, MyCourseQuality (MCQ-10D), was developed following a purposive review of previous instruments. Shorthand labels for the criteria are: Content, Organization, Perspective, Presentations, Materials, Relevance, Workload, Support, Interactivity, and Assessment. The assessment is unique in being dually personalized. In part 1, at the beginning of the course, the student enters their importance weights for the ten criteria. In part 2, at its completion, they rate the course on the same criteria. Their ratings and weightings are combined in a simple expected-value calculation to produce their dually personalized and decomposable MCQ score. Satisfactory (technical) completion of both parts contributes 10% of the marks available in the course. Providers are required to make the relevant characteristics of the course fully transparent at enrollment, and the course is to be rated as offered. A separate item appended to the survey allows students to suggest changes to what is offered. Students also complete (anonymously) the standard feedback form in the setting concerned. Results Piloting in a medical school and health professional school will establish the organizational feasibility and acceptability of the approach (a version of which has been employed in one medical school previously), as well as its impact on provider behavior and intentions, and on student engagement and responsiveness. The priorities for future improvements in terms of the specified criteria are identified at both individual and group level. The group results from MCQ will be compared with those from the standard feedback questionnaire, which will also be completed anonymously by the same students (or some percentage of them). Conclusions We present a protocol for the piloting of a student-centered, dually personalized course quality instrument that forms part of the assignment requirements and is therefore an integral part of the course. If, and how, such an essentially formative Student-Reported Outcome or Experience Measure can be used summatively, at unit or program level, remains to be determined, and is not our concern here.
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Affiliation(s)
- Mette K Kaltoft
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
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Kovacs Burns K, Bellows M, Eigenseher C, Jackson K, Gallivan J, Rees J. Exploring patient engagement practices and resources within a health care system: Applying a multi-phased mixed methods knowledge mobilization approach. ACTA ACUST UNITED AC 2015. [DOI: 10.1080/18340806.2014.11082063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Kaltoft MK, Nielsen JB, Salkeld G, Dowie J. Increasing User Involvement in Health Care and Health Research Simultaneously: A Proto-Protocol for "Person-as-Researcher" and Online Decision Support Tools. JMIR Res Protoc 2014; 3:e61. [PMID: 25424354 PMCID: PMC4260062 DOI: 10.2196/resprot.3690] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2014] [Accepted: 09/27/2014] [Indexed: 01/25/2023] Open
Abstract
Background User involvement is appearing increasingly on policy agendas in many countries, with a variety of proposals for facilitating it. The belief is that it will produce better health for individuals and community, as well as demonstrate greater respect for the basic principles of autonomy and democracy. Objective Our Web-based project aims to increase involvement in health care and health research and is presented in the form of an umbrella protocol for a set of project-specific protocols. We conceptualize the person as a researcher engaged in a continual, living, informal “n-of-1”-type study of the effects of different actions and interventions on their health, including those implying contact with health care services. We see their research as primarily carried out in order to make better decisions for themselves, but they can offer to contribute the results to the wider population. We see the efforts of the "person-as-researcher" as contributing to the total amount of research undertaken in the community, with research not being confined to that undertaken by professional researchers and institutions. This view is fundamentally compatible with both the emancipatory and conventional approaches to increased user involvement, though somewhat more aligned with the former. Methods Our online decision support tools, delivered directly to the person in the community and openly accessible, are to be seen as research resources. They will take the form of interactive decision aids for a variety of specific health conditions, as well as a generic one that supports all health and health care decisions through its focus on key aspects of decision quality. We present a high-level protocol for the condition-specific studies that will implement our approach, organized within the Populations, Interventions, Comparators, Outcomes, Timings, and Settings (PICOTS) framework. Results Our underlying hypothesis concerns the person-as-researcher who is equipped with a prescriptive, transparent, expected value-based opinion—an opinion that combines their criterion importance weights with the Best Estimates Available Now for how well each of the available options performs on each of those outcomes. The hypothesis is that this person-as-researcher is more likely to be able to position themselves as an active participant in a clinical encounter, if they wish, than someone who has engaged with a descriptive decision aid that attempts to work with their existing cognitive processes and stresses the importance of information. The precise way this is hypothesis tested will be setting-specific and condition-specific and will be spelled out in the individual project protocols. Conclusions Decision resources that provide fast access to the results of slower thinking can provide the stimulus that many individuals need to take a more involved role in their own health. Our project, advanced simply as one approach to increased user involvement, is designed to make progress in the short term with minimal resources and to do so at the point of decision need, when motivation is highest. Some basic distinctions, such as those between science and non-science, research and practice, community and individual, and lay and professional become somewhat blurred and may need to be rethought in light of this approach.
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Affiliation(s)
- Mette Kjer Kaltoft
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark
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Bansback N, Li LC, Lynd L, Bryan S. Development and preliminary user testing of the DCIDA (Dynamic computer interactive decision application) for 'nudging' patients towards high quality decisions. BMC Med Inform Decis Mak 2014; 14:62. [PMID: 25084808 PMCID: PMC4130126 DOI: 10.1186/1472-6947-14-62] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Accepted: 07/25/2014] [Indexed: 11/25/2022] Open
Abstract
Background Patient decision aids (PtDA) are developed to facilitate informed, value-based decisions about health. Research suggests that even when informed with necessary evidence and information, cognitive errors can prevent patients from choosing the option that is most congruent with their own values. We sought to utilize principles of behavioural economics to develop a computer application that presents information from conventional decision aids in a way that reduces these errors, subsequently promoting higher quality decisions. Method The Dynamic Computer Interactive Decision Application (DCIDA) was developed to target four common errors that can impede quality decision making with PtDAs: unstable values, order effects, overweighting of rare events, and information overload. Healthy volunteers were recruited to an interview to use three PtDAs converted to the DCIDA on a computer equipped with an eye tracker. Participants were first used a conventional PtDA, and then subsequently used the DCIDA version. User testing was assessed based on whether respondents found the software both usable: evaluated using a) eye-tracking, b) the system usability scale, and c) user verbal responses from a ‘think aloud’ protocol; and useful: evaluated using a) eye-tracking, b) whether preferences for options were changed, and c) and the decisional conflict scale. Results Of the 20 participants recruited to the study, 11 were male (55%), the mean age was 35, 18 had at least a high school education (90%), and 8 (40%) had a college or university degree. Eye-tracking results, alongside a mean system usability scale score of 73 (range 68–85), indicated a reasonable degree of usability for the DCIDA. The think aloud study suggested areas for further improvement. The DCIDA also appeared to be useful to participants wherein subjects focused more on the features of the decision that were most important to them (21% increase in time spent focusing on the most important feature). Seven subjects (25%) changed their preferred option when using DCIDA. Conclusion Preliminary results suggest that DCIDA has potential to improve the quality of patient decision-making. Next steps include larger studies to test individual components of DCIDA and feasibility testing with patients making real decisions.
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Affiliation(s)
- Nick Bansback
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3, Canada.
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