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Liu T, Tsang W, Huang F, Lau OY, Chen Y, Sheng J, Guo Y, Akinwunmi B, Zhang CJ, Ming WK. Patients' Preferences for Artificial Intelligence Applications Versus Clinicians in Disease Diagnosis During the SARS-CoV-2 Pandemic in China: Discrete Choice Experiment. J Med Internet Res 2021; 23:e22841. [PMID: 33493130 PMCID: PMC7903977 DOI: 10.2196/22841] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/15/2020] [Accepted: 01/20/2021] [Indexed: 12/31/2022] Open
Abstract
Background Misdiagnosis, arbitrary charges, annoying queues, and clinic waiting times among others are long-standing phenomena in the medical industry across the world. These factors can contribute to patient anxiety about misdiagnosis by clinicians. However, with the increasing growth in use of big data in biomedical and health care communities, the performance of artificial intelligence (Al) techniques of diagnosis is improving and can help avoid medical practice errors, including under the current circumstance of COVID-19. Objective This study aims to visualize and measure patients’ heterogeneous preferences from various angles of AI diagnosis versus clinicians in the context of the COVID-19 epidemic in China. We also aim to illustrate the different decision-making factors of the latent class of a discrete choice experiment (DCE) and prospects for the application of AI techniques in judgment and management during the pandemic of SARS-CoV-2 and in the future. Methods A DCE approach was the main analysis method applied in this paper. Attributes from different dimensions were hypothesized: diagnostic method, outpatient waiting time, diagnosis time, accuracy, follow-up after diagnosis, and diagnostic expense. After that, a questionnaire is formed. With collected data from the DCE questionnaire, we apply Sawtooth software to construct a generalized multinomial logit (GMNL) model, mixed logit model, and latent class model with the data sets. Moreover, we calculate the variables’ coefficients, standard error, P value, and odds ratio (OR) and form a utility report to present the importance and weighted percentage of attributes. Results A total of 55.8% of the respondents (428 out of 767) opted for AI diagnosis regardless of the description of the clinicians. In the GMNL model, we found that people prefer the 100% accuracy level the most (OR 4.548, 95% CI 4.048-5.110, P<.001). For the latent class model, the most acceptable model consists of 3 latent classes of respondents. The attributes with the most substantial effects and highest percentage weights are the accuracy (39.29% in general) and expense of diagnosis (21.69% in general), especially the preferences for the diagnosis “accuracy” attribute, which is constant across classes. For class 1 and class 3, people prefer the AI + clinicians method (class 1: OR 1.247, 95% CI 1.036-1.463, P<.001; class 3: OR 1.958, 95% CI 1.769-2.167, P<.001). For class 2, people prefer the AI method (OR 1.546, 95% CI 0.883-2.707, P=.37). The OR of levels of attributes increases with the increase of accuracy across all classes. Conclusions Latent class analysis was prominent and useful in quantifying preferences for attributes of diagnosis choice. People’s preferences for the “accuracy” and “diagnostic expenses” attributes are palpable. AI will have a potential market. However, accuracy and diagnosis expenses need to be taken into consideration.
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Affiliation(s)
- Taoran Liu
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China.,Faculty of Economics and Business, University of Groningen, Groningen, Netherlands
| | - Winghei Tsang
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Fengqiu Huang
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Oi Ying Lau
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Yanhui Chen
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Jie Sheng
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Yiwei Guo
- School of Finance and Business, Shanghai Normal University, Shanghai, China
| | - Babatunde Akinwunmi
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA, United States.,Center for Genomic Medicine, Massachusetts General Hospital, Harvard Medical School, Harvard University, Boston, MA, United States
| | - Casper Jp Zhang
- School of Public Health, The University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Wai-Kit Ming
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
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Wu L, Wu Y, Zou S, Sun C, Chen J, Li X, Lin Z, Guan L, Zeng Q, Zhao S, Liang J, Chen R, Hu Z, Au K, Xie D, Xiao X, Ming WK. Eliciting women's preference for prenatal testing in China: a discrete choice experiment. BMC Pregnancy Childbirth 2020; 20:604. [PMID: 33032548 PMCID: PMC7542883 DOI: 10.1186/s12884-020-03270-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 09/21/2020] [Indexed: 11/21/2022] Open
Abstract
Background Pregnancy tests can be used for the early diagnosis of fetal problems and can prevent abnormal birth in pregnancies. Yet, testing preferences among Chinese women are poorly investigated. Methods We developed a Discrete Choice Experiment with 5 attributes: test procedure, detection rate, miscarriage rate, time to wait for result, and test cost. By studying the choices that the women make in the hypothetical scenarios and comparing the attributes and levels, we can analyze the women’s preference of prenatal testing in China. Results Ninety-two women completed the study. Respondents considered the test procedure as the most important attribute, followed by detection rate, miscarriage rate, wait time for result, and test cost, respectively. The estimated preference weight for the non-invasive procedure was 0.928 (P < 0.0001). All other attributes being equal, the odds of choosing a non-invasive testing procedure over an invasive one was 2.53 (95% confidence interval, 2.42–2.64; P < 0.001). Participants were willing to pay up to RMB$28,810 (approximately US$4610) for a non-invasive test, RMB$6061(US$970) to reduce the miscarriage rate by 1% and up to RMB$3356 (US$537) to increase the detection rate by 1%. Compared to other DCE (Discrete Choice Experiment) studies regarding Down’s syndrome screening, women in our study place relatively less emphasis on test safety. Conclusions The present study has shown that Chinese women place more emphasis on detection rate than test safety. Chinese women place great preference on noninvasive prenatal testing, which indicate a popular need of incorporating noninvasive prenatal testing into the health insurance coverage in China. This study provided valuable evidence for the decision makers in the Chinese government.
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Affiliation(s)
- Liangzhi Wu
- The Department of Obstetrics and Gynecology, First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China.,The Department of Gynecology, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, China
| | - Yanxin Wu
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Shiqian Zou
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.,School of Medicine, Jinan University, Guangzhou, Guangdong, China
| | - Cong Sun
- Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Junyu Chen
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Xueyan Li
- School of Medicine, Jinan University, Guangzhou, Guangdong, China
| | - Zihang Lin
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Lizhi Guan
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Qing Zeng
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Sihan Zhao
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Jingtong Liang
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Rui Chen
- Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Zhiwen Hu
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Kingyan Au
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Daipeng Xie
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Xiaomin Xiao
- The Department of Obstetrics and Gynecology, First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Wai-Kit Ming
- The Department of Obstetrics and Gynecology, First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China. .,Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China. .,School of Medicine, Jinan University, Guangzhou, Guangdong, China. .,Harvard Medical School, Harvard University, Boston, MA, USA.
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Chitayat D, Langlois S, Wilson RD. No. 261-Prenatal Screening for Fetal Aneuploidy in Singleton Pregnancies. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 39:e380-e394. [PMID: 28859781 DOI: 10.1016/j.jogc.2017.06.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To develop a Canadian consensus document on maternal screening for fetal aneuploidy (e.g., Down syndrome and trisomy 18) in singleton pregnancies. OPTIONS Pregnancy screening for fetal aneuploidy started in the mid 1960s, using maternal age as the screening test. New developments in maternal serum and ultrasound screening have made it possible to offer all pregnant patients a non-invasive screening test to assess their risk of having a fetus with aneuploidy to determine whether invasive prenatal diagnostic testing is necessary. This document reviews the options available for non-invasive screening and makes recommendations for Canadian patients and health care workers. OUTCOMES To offer non-invasive screening for fetal aneuploidy (trisomy 13, 18, 21) to all pregnant women. Invasive prenatal diagnosis would be offered to women who screen above a set risk cut-off level on non-invasive screening or to pregnant women whose personal, obstetrical, or family history places them at increased risk. Currently available non-invasive screening options include maternal age combined with one of the following: (1) first trimester screening (nuchal translucency, maternal age, and maternal serum biochemical markers), (2) second trimester serum screening (maternal age and maternal serum biochemical markers), or (3) 2-step integrated screening, which includes first and second trimester serum screening with or without nuchal translucency (integrated prenatal screen, serum integrated prenatal screening, contingent, and sequential). These options are reviewed, and recommendations are made. EVIDENCE Studies published between 1982 and 2009 were retrieved through searches of PubMed or Medline and CINAHL and the Cochrane Library, using appropriate controlled vocabulary and key words (aneuploidy, Down syndrome, trisomy, prenatal screening, genetic health risk, genetic health surveillance, prenatal diagnosis). Results were restricted to systematic reviews, randomized controlled trials, and relevant observational studies. There were no language restrictions. Searches were updated on a regular basis and incorporated in the guideline to August 2010. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology assessment- related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. The previous Society of Obstetricians and Gynaecologists of Canada guidelines regarding prenatal screening were also reviewed in developing this clinical practice guideline. VALUES The quality of evidence was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care. BENEFITS, HARMS, AND COSTS This guideline is intended to reduce the number of prenatal invasive procedures done when maternal age is the only indication. This will have the benefit of reducing the numbers of normal pregnancies lost because of complications of invasive procedures. Any screening test has an inherent false- positive rate, which may result in undue anxiety. It is not possible at this time to undertake a detailed cost-benefit analysis of the implementation of this guideline, since this would require health surveillance and research and health resources not presently available; however, these factors need to be evaluated in a prospective approach by provincial and territorial initiatives. RECOMMENDATIONS
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Vass CM, Georgsson S, Ulph F, Payne K. Preferences for aspects of antenatal and newborn screening: a systematic review. BMC Pregnancy Childbirth 2019; 19:131. [PMID: 30991967 PMCID: PMC6469127 DOI: 10.1186/s12884-019-2278-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 04/01/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many countries offer screening programmes to unborn and newborn babies (antenatal and newborn screening) to identify those at risk of certain conditions to aid earlier diagnosis and treatment. Technological advances have stimulated the development of screening programmes to include more conditions, subsequently changing the information required and potential benefit-risk trade-offs driving participation. Quantifying preferences for screening programmes can provide programme commissioners with data to understand potential demand, the drivers of this demand, information provision required to support the programmes and the extent to which preferences differ in a population. This study aimed to identify published studies eliciting preferences for antenatal and newborn screening programmes and provide an overview of key methods and findings. METHODS A systematic search of electronic databases for key terms identified eligible studies (discrete choice experiments (DCEs) or best-worst scaling (BWS) studies related to antenatal/newborn testing/screening published between 1990 and October 2018). Data were systematically extracted, tabulated and summarised in a narrative review. RESULTS A total of 19 studies using a DCE or BWS to elicit preferences for antenatal (n = 15; 79%) and newborn screening (n = 4; 21%) programmes were identified. Most of the studies were conducted in Europe (n = 12; 63%) but there were some examples from North America (n = 2; 11%) and Australia (n = 2; 11%). Attributes most commonly included were accuracy of screening (n = 15; 79%) and when screening occurred (n = 13; 68%). Other commonly occurring attributes included information content (n = 11; 58%) and risk of miscarriage (n = 10; 53%). Pregnant women (n = 11; 58%) and healthcare professionals (n = 11; 58%) were the most common study samples. Ten studies (53%) compared preferences across different respondents. Two studies (11%) made comparisons between countries. The most popular analytical model was a standard conditional logit model (n = 11; 58%) and one study investigated preference heterogeneity with latent class analysis. CONCLUSION There is an existing literature identifying stated preferences for antenatal and newborn screening but the incorporation of more sophisticated design and analytical methods to investigate preference heterogeneity could extend the relevance of the findings to inform commissioning of new screening programmes.
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Affiliation(s)
- Caroline M. Vass
- Manchester Centre for Health Economics, The University of Manchester, Oxford Road, Manchester, M13 9PL UK
| | | | - Fiona Ulph
- Division of Psychology & Mental Health, The University of Manchester, Oxford Road, Manchester, M13 9PL UK
| | - Katherine Payne
- Manchester Centre for Health Economics, The University of Manchester, Oxford Road, Manchester, M13 9PL UK
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Cernat A, De Freitas C, Majid U, Trivedi F, Higgins C, Vanstone M. Facilitating informed choice about non-invasive prenatal testing (NIPT): a systematic review and qualitative meta-synthesis of women's experiences. BMC Pregnancy Childbirth 2019; 19:27. [PMID: 30642270 PMCID: PMC6332899 DOI: 10.1186/s12884-018-2168-4] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 12/28/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Non-invasive prenatal testing (NIPT) can be used to accurately detect fetal chromosomal anomalies early in pregnancy by assessing cell-free fetal DNA present in maternal blood. The rapid diffusion of NIPT, as well as the ease and simplicity of the test raises concerns around informed decision-making and the potential for routinization. Introducing NIPT in a way that facilitates informed and autonomous decisions is imperative to the ethical application of this technology. We approach this imperative by systematically reviewing and synthesizing primary qualitative research on women's experiences with and preferences for informed decision-making around NIPT. METHODS We searched multiple bibliographic databases including Ovid MEDLINE, EBSCO Cumulative Index to Nursing & Allied Health Literature (CINAHL), and ISI Web of Science Social Sciences Citation Index (SSCI). Our review was guided by integrative qualitative meta-synthesis, and we used a staged coding process similar to that of grounded theory to conduct our analysis. RESULTS Thirty empirical primary qualitative research studies were eligible for inclusion. Women preferred to learn about NIPT from their clinicians, but they expressed dissatisfaction with the quality and quantity of information provided during counselling and often sought information from a variety of other sources. Women generally had a good understanding of test characteristics, and the factors of accuracy, physical risk, and test timing were the critical information elements that they used to make informed decisions around NIPT. Women often described NIPT as easy or just another blood test, highlighting threats to informed decision-making such as routinization or a pressure to test. CONCLUSIONS Women's unique circumstances modulate the information that they value and require most in the context of making an informed decision. Widened availability of trustworthy information about NIPT as well as careful attention to the facilitation of counselling may help facilitate informed decision-making. TRIAL REGISTRATION PROSPERO 2018 CRD42018086261 .
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Affiliation(s)
- Alexandra Cernat
- Honours Life Sciences BSc Program, McMaster University, Hamilton, ON Canada
| | - Chante De Freitas
- Health Sciences Education Program, McMaster University, Hamilton, ON Canada
| | - Umair Majid
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, ON Canada
| | - Forum Trivedi
- Honours Life Sciences BSc Program, McMaster University, Hamilton, ON Canada
| | | | - Meredith Vanstone
- Department of Family Medicine, McMaster University, DBHSC 5003E, 100 Main St W, Hamilton, ON L8P 1H6 Canada
- Centre for Health Economic and Policy Analysis, McMaster University, Hamilton, ON Canada
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Noordman BJ, de Bekker-Grob EW, Coene PPLO, van der Harst E, Lagarde SM, Shapiro J, Wijnhoven BPL, van Lanschot JJB. Patients' preferences for treatment after neoadjuvant chemoradiotherapy for oesophageal cancer. Br J Surg 2018; 105:1630-1638. [DOI: 10.1002/bjs.10897] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Revised: 05/01/2018] [Accepted: 05/03/2018] [Indexed: 12/20/2022]
Abstract
Abstract
Background
After neoadjuvant chemoradiotherapy (nCRT) plus surgery for oesophageal cancer, 29 per cent of patients have a pathologically complete response in the resection specimen. Active surveillance after nCRT (instead of standard oesophagectomy) may improve health-related quality of life (HRQoL), but patients need to undergo frequent diagnostic tests and it is unknown whether survival is worse than that after standard oesophagectomy. Factors that influence patients' preferences, and trade-offs that patients are willing to make in their choice between surgery and active surveillance were investigated here.
Methods
A prospective discrete-choice experiment was conducted. Patients with oesophageal cancer completed questionnaires 4–6 weeks after nCRT, before surgery. Patients' preferences were quantified using scenarios based on five aspects: 5-year overall survival, short-term HRQoL, long-term HRQoL, the risk that oesophagectomy is still necessary, and the frequency of clinical examinations using endoscopy and PET–CT. Panel latent class analysis was used.
Results
Some 100 of 104 patients (96·2 per cent) responded. All aspects, except the frequency of clinical examinations, influenced patients' preferences. Five-year overall survival, the chance that oesophagectomy is still necessary and long-term HRQoL were the most important attributes. On average, based on calculation of the indifference point between standard surgery and active surveillance, patients were willing to trade off 16 per cent 5-year overall survival to reduce the risk that oesophagectomy is necessary from 100 per cent (standard surgery) to 35 per cent (active surveillance).
Conclusion
Patients are willing to trade off substantial 5-year survival to achieve a reduction in the risk that oesophagectomy is necessary.
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Affiliation(s)
- B J Noordman
- Department of Surgery, Erasmus MC – University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - E W de Bekker-Grob
- Department of Public Health, Erasmus MC – University Medical Centre Rotterdam, Rotterdam, The Netherlands
- Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands
| | - P P L O Coene
- Department of Surgery, Maasstad Hospital, Rotterdam, The Netherlands
| | - E van der Harst
- Department of Surgery, Maasstad Hospital, Rotterdam, The Netherlands
| | - S M Lagarde
- Department of Surgery, Erasmus MC – University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - J Shapiro
- Department of Surgery, Erasmus MC – University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - B P L Wijnhoven
- Department of Surgery, Erasmus MC – University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - J J B van Lanschot
- Department of Surgery, Erasmus MC – University Medical Centre Rotterdam, Rotterdam, The Netherlands
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7
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Vanstone M, Cernat A, Nisker J, Schwartz L. Women's perspectives on the ethical implications of non-invasive prenatal testing: a qualitative analysis to inform health policy decisions. BMC Med Ethics 2018; 19:27. [PMID: 29661182 PMCID: PMC5902938 DOI: 10.1186/s12910-018-0267-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 04/08/2018] [Indexed: 12/13/2022] Open
Abstract
Background Non-Invasive Prenatal Testing (NIPT) is a technology which provides information about fetal genetic characteristics (including sex) very early in pregnancy by examining fetal DNA obtained from a sample of maternal blood. NIPT is a morally complex technology that has advanced quickly to market with a strong push from industry developers, leaving many areas of uncertainty still to be resolved, and creating a strong need for health policy that reflects women’s social and ethical values. We approach the need for ethical policy-making by studying the use of NIPT and emerging policy in the province of Ontario, Canada. Methods Using an adapted version of constructivist grounded theory, we conducted interviews with 38 women who have had personal experiences with NIPT. We used an iterative process of data collection and analysis and a staged coding strategy to conduct a descriptive analysis of ethics issues identified implicitly and explicitly by women who have been affected by this technology. Results The findings of this paper focus on current ethical issues for women seeking NIPT, including place in the prenatal pathway, health care provider counselling about the test, industry influence on the diffusion of NIPT, consequences of availability of test results. Other issues gain relevance in the context of future policy decisions regarding NIPT, including funding of NIPT and principles that may govern the expansion of the scope of NIPT. These findings are not an exhaustive list of all the potential ethical issues related to NIPT, but rather a representation of the issues which concern women who have personal experience with this test. Conclusions Women who have had personal experience with NIPT have concerns and priorities which sometimes contrast dramatically with the theoretical ethics literature. These findings suggest the importance of engaging patients in ethical deliberation about morally complex technologies, and point to the need for more deliberative patient engagement work in this area. Electronic supplementary material The online version of this article (10.1186/s12910-018-0267-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Meredith Vanstone
- Department of Family Medicine, McMaster University, DBHSC 5003E, 100 Main St W, Hamilton, ON, L8P 1H6, Canada. .,Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada.
| | - Alexandra Cernat
- Life Sciences Program, McMaster University, Hamilton, ON, Canada
| | - Jeff Nisker
- Department of Obstetrics and Gynecology, Western University, London, ON, Canada.,Children's Health Research Institute, London, ON, Canada
| | - Lisa Schwartz
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada.,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
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Kibel M, Vanstone M. Reconciling ethical and economic conceptions of value in health policy using the capabilities approach: A qualitative investigation of Non-Invasive Prenatal Testing. Soc Sci Med 2017; 195:97-104. [PMID: 29169104 DOI: 10.1016/j.socscimed.2017.11.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 11/13/2017] [Accepted: 11/15/2017] [Indexed: 01/22/2023]
Abstract
When evaluating new morally complex health technologies, policy decision-makers consider a broad range of different evaluations, which may include the technology's clinical effectiveness, cost effectiveness, and social or ethical implications. This type of holistic assessment is challenging, because each of these evaluations may be grounded in different and potentially contradictory assumptions about the technology's value. One such technology where evaluations conflict is Non-Invasive Prenatal Testing (NIPT). Cost-effectiveness evaluations of NIPT often assess NIPT's ability to deliver on goals (i.e preventing the birth of children with disabilities) that social and ethical analyses suggest it should not have. Thus, cost effectiveness analyses frequently contradict social and ethical assessments of NIPT's value. We use the case of NIPT to explore how economic evaluations using a capabilities approach may be able to capture a broader, more ethical view of the value of NIPT. The capabilities approach is an evaluative framework which bases wellbeing assessments on a person's abilities, rather than their expressed preferences. It is linked to extra-welfarist approaches in health economic assessment. Beginning with Nussbaum's capability framework, we conducted a directed qualitative content analysis of interview data collected in 2014 from 27 Canadian women with personal experience of NIPT. We found that eight of Nussbaum's ten capabilities related to options, states, or choices that women valued in the context of NIPT, and identified one new capability. Our findings suggest that women value NIPT for its ability to provide more and different choices in the prenatal care pathway, and that a capabilities approach can indeed capture the value of NIPT in a way that goes beyond measuring health outcomes of ambiguous social and ethical value. More broadly, the capabilities approach may serve to resolve contradictions between ethical and economic evaluations of health technologies, and contribute to extra-welfarist approaches in the assessment of morally complex health technologies.
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Affiliation(s)
- Mia Kibel
- Arts and Science Program, McMaster University, Commons Building Room 105, 1280 Main Street West, Hamilton, Ontario, L8S 4K1, Canada.
| | - Meredith Vanstone
- Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 100 Main Street West, 5th Floor, Hamilton, Ontario, L8P 1H6, Canada; Centre for Health Economics and Policy Analysis, McMaster University, Canada; McMaster program for Education Research, Innovation & Theory, McMaster University, Canada.
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Archivée: No 261-Dépistage prénatal de l'aneuploïdie fœtale en ce qui concerne les grossesses monofœtales. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 39:e362-e379. [DOI: 10.1016/j.jogc.2017.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Harrison M, Milbers K, Hudson M, Bansback N. Do patients and health care providers have discordant preferences about which aspects of treatments matter most? Evidence from a systematic review of discrete choice experiments. BMJ Open 2017; 7:e014719. [PMID: 28515194 PMCID: PMC5623426 DOI: 10.1136/bmjopen-2016-014719] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES To review studies eliciting patient and healthcare provider preferences for healthcare interventions using discrete choice experiments (DCEs) to (1) review the methodology to evaluate similarities, differences, rigour of designs and whether comparisons are made at the aggregate level or account for individual heterogeneity; and (2) quantify the extent to which they demonstrate concordance of patient and healthcare provider preferences. METHODS A systematic review searching Medline, EMBASE, Econlit, PsycINFO and Web of Science for DCEs using patient and healthcare providers. INCLUSION CRITERIA peer-reviewed; complete empiric text in English from 1995 to 31July 2015; discussing a healthcare-related topic; DCE methodology; comparing patients and healthcare providers. DESIGN Systematic review. RESULTS We identified 38 papers exploring 16 interventions in 26 diseases/indications. Methods to analyse results, determine concordance between patient and physician values, and explore heterogeneity varied considerably between studies. The majority of studies we reviewed found more evidence of mixed concordance and discordance (n=28) or discordance of patient and healthcare provider preferences (n=12) than of concordant preferences (n=4). A synthesis of concordance suggested that healthcare providers rank structure and outcome attributes more highly than patients, while patients rank process attributes more highly than healthcare providers. CONCLUSIONS Discordant patient and healthcare provider preferences for different attributes of healthcare interventions are common. Concordance varies according to whether attributes are processes, structures or outcomes, and therefore determining preference concordance should consider all aspects jointly and not a binary outcome. DCE studies provide excellent opportunities to assess value concordance between patients and providers, but assessment of concordance was limited by a lack of consistency in the approaches used and consideration of heterogeneity of preferences. Future DCEs assessing concordance should fully report the framing of the questions and investigate the heterogeneity of preferences within groups and how these compare.
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Affiliation(s)
- Mark Harrison
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
- Centre for Health Evaluation and Outcome Sciences, St Paul’s Hospital, Vancouver, Canada
| | - Katherine Milbers
- Centre for Health Evaluation and Outcome Sciences, St Paul’s Hospital, Vancouver, Canada
| | - Marie Hudson
- Department of Medicine, McGill University, Montréal, Canada
- Division of Rheumatology, Jewish General Hospital, Montréal, Canada
- Lady Davis Institute for Medical Research, Montréal, Canada
| | - Nick Bansback
- Centre for Health Evaluation and Outcome Sciences, St Paul’s Hospital, Vancouver, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
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11
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Hill M, Oteng-Ntim E, Forya F, Petrou M, Morris S, Chitty LS. Preferences for prenatal diagnosis of sickle-cell disorder: A discrete choice experiment comparing potential service users and health-care providers. Health Expect 2017; 20:1289-1295. [PMID: 28504327 PMCID: PMC5689222 DOI: 10.1111/hex.12568] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2017] [Indexed: 01/29/2023] Open
Abstract
Background Non‐invasive prenatal diagnosis (NIPD) for sickle‐cell disorder (SCD) is moving closer to implementation and studies considering stakeholder preferences are required to underpin strategies for offering NIPD in clinical practice. Objective Determine service user and provider preferences for key attributes of prenatal diagnostic tests for SCD and examine views on NIPD. Method A questionnaire that includes a discrete choice experiment was used to determine the preferences of service users and providers for prenatal tests that varied across three attributes: accuracy, time of test and risk of miscarriage. Results Adults who were carriers of SCD or affected with the condition (N=67) were recruited from haemoglobinopathy clinics at two maternity units. Health professionals, predominately midwives, who offer antenatal care (N=62) were recruited from one maternity unit. No miscarriage risk was a key driver of decision making for both service users and providers. Service providers placed greater emphasis on accuracy than service users. Current uptake of invasive tests was 63%, whilst predicted uptake of NIPD was 93.8%. Many service users (55.4%) and providers (52.5%) think pressure to have prenatal testing will increase when NIPD for SCD becomes available. Conclusions There are clear differences between service users and health professionals’ preferences for prenatal tests for sickle‐cell disorder. The safety of NIPD is welcomed by parents and uptake is likely to be high. To promote informed choice, pretest counselling should be balanced and not exclusively focused on test safety. Counselling strategies that are sensitive to feelings of pressure to test will be essential.
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Affiliation(s)
- Melissa Hill
- Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Eugene Oteng-Ntim
- Directorate of Women's Health, Guy's and St Thomas' Foundation Trust, London, UK.,King's College London, London, UK
| | - Frida Forya
- Fetal Medicine Unit, University College London Hospitals NHS Foundation Trust, London, UK.,Institute of Women's Health, University College London, London, UK
| | - Mary Petrou
- Institute of Women's Health, University College London, London, UK.,Haemoglobinopathy Genetics Service, University College London Hospitals NHS Foundation Trust, London, UK
| | - Stephen Morris
- Department of Applied Health Research, University College London, London, UK
| | - Lyn S Chitty
- Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Fetal Medicine Unit, University College London Hospitals NHS Foundation Trust, London, UK
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12
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Hill M, Johnson JA, Langlois S, Lee H, Winsor S, Dineley B, Horniachek M, Lalatta F, Ronzoni L, Barrett AN, Advani HV, Choolani M, Rabinowitz R, Pajkrt E, van Schendel RV, Henneman L, Rommers W, Bilardo CM, Rendeiro P, Ribeiro MJ, Rocha J, Bay Lund IC, Petersen OB, Becher N, Vogel I, Stefánsdottir V, Ingvarsdottir S, Gottfredsdottir H, Morris S, Chitty LS. Preferences for prenatal tests for Down syndrome: an international comparison of the views of pregnant women and health professionals. Eur J Hum Genet 2015; 24:968-75. [PMID: 26577044 DOI: 10.1038/ejhg.2015.249] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 09/06/2015] [Accepted: 10/23/2015] [Indexed: 12/12/2022] Open
Abstract
Non-invasive prenatal testing is increasingly available worldwide and stakeholder viewpoints are essential to guide implementation. Here we compare the preferences of women and health professionals from nine different countries towards attributes of non-invasive and invasive prenatal tests for Down syndrome. A discrete choice experiment was used to obtain participants' stated preference for prenatal tests that varied according to four attributes: accuracy, time of test, risk of miscarriage, and type of information. Pregnant women and health professionals were recruited from Canada, Denmark, Iceland, Israel, Italy, the Netherlands, Portugal, Singapore, and the United Kingdom. A total of 2666 women's and 1245 health professionals' questionnaires were included in the analysis. Differences in preferences were seen between women and health professionals within and between countries. Overall, women placed greater emphasis on test safety and comprehensive information than health professionals, who emphasised accuracy and early testing. Differences between women's and health professionals' preferences are marked between countries. Varied approaches to implementation and service delivery are therefore needed and individual countries should develop guidelines appropriate for their own social and screening contexts.
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Affiliation(s)
- Melissa Hill
- Genetics and Genomic Medicine, UCL Institute of Child Health and Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Jo-Ann Johnson
- Department of Obstetrics & Gynecology, University of Calgary, Calgary, Alberta, Canada
| | - Sylvie Langlois
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Hyun Lee
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Stephanie Winsor
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
| | - Brigid Dineley
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
| | - Marisa Horniachek
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
| | - Faustina Lalatta
- Clinical Genetics Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Luisa Ronzoni
- Clinical Genetics Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Angela N Barrett
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Henna V Advani
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Mahesh Choolani
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ron Rabinowitz
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Centre, Jerusalem, Israel
| | - Eva Pajkrt
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, The Netherlands
| | - Rachèl V van Schendel
- Department of Clinical Genetics, Section of Community Genetics, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Lidewij Henneman
- Department of Clinical Genetics, Section of Community Genetics, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Wieke Rommers
- Department of Obstetrics and Gynecology, Fetal Medicine Unit, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Caterina M Bilardo
- Department of Obstetrics and Gynecology, Fetal Medicine Unit, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | | | | | - José Rocha
- CGC Genetics, Porto, Portugal.,IINFACTS, CESPU, Porto, Portugal
| | | | - Olav B Petersen
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Naja Becher
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Ida Vogel
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Vigdis Stefánsdottir
- Department of Genetics and Molecular Medicine, Landspitali University Hospital, Reykjavik, Iceland
| | - Sigrun Ingvarsdottir
- Landspitali, National University Hospital, Reykjavik, Iceland.,Department of Midwifery, Faculty of Nursing, University of Iceland, Reykjavik, Iceland
| | - Helga Gottfredsdottir
- Landspitali, National University Hospital, Reykjavik, Iceland.,Department of Midwifery, Faculty of Nursing, University of Iceland, Reykjavik, Iceland
| | - Stephen Morris
- Research Department of Applied Health Research, University College London, London, UK
| | - Lyn S Chitty
- Genetics and Genomic Medicine, UCL Institute of Child Health and Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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13
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Lynn FA, Crealey GE, Alderdice FA, McElnay JC. Preferences for a third-trimester ultrasound scan in a low-risk obstetric population: a discrete choice experiment. Health Expect 2015; 18:892-903. [PMID: 23527851 PMCID: PMC5060810 DOI: 10.1111/hex.12062] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2013] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Establish maternal preferences for a third-trimester ultrasound scan in a healthy, low-risk pregnant population. DESIGN Cross-sectional study incorporating a discrete choice experiment. SETTING A large, urban maternity hospital in Northern Ireland. PARTICIPANTS One hundred and forty-six women in their second trimester of pregnancy. METHODS A discrete choice experiment was designed to elicit preferences for four attributes of a third-trimester ultrasound scan: health-care professional conducting the scan, detection rate for abnormal foetal growth, provision of non-medical information, cost. Additional data collected included age, marital status, socio-economic status, obstetric history, pregnancy-specific stress levels, perceived health and whether pregnancy was planned. Analysis was undertaken using a mixed logit model with interaction effects. MAIN OUTCOME MEASURES Women's preferences for, and trade-offs between, the attributes of a hypothetical scan and indirect willingness-to-pay estimates. RESULTS Women had significant positive preference for higher rate of detection, lower cost and provision of non-medical information, with no significant value placed on scan operator. Interaction effects revealed subgroups that valued the scan most: women experiencing their first pregnancy, women reporting higher levels of stress, an adverse obstetric history and older women. CONCLUSIONS Women were able to trade on aspects of care and place relative importance on clinical, non-clinical outcomes and processes of service delivery, thus highlighting the potential of using health utilities in the development of services from a clinical, economic and social perspective. Specifically, maternal preferences exhibited provide valuable information for designing a randomized trial of effectiveness and insight for clinical and policy decision makers to inform woman-centred care.
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Affiliation(s)
- Fiona A. Lynn
- School of Nursing and MidwiferyQueen's University BelfastBelfastUK
| | - Grainne E. Crealey
- Clinical Research Support CentreBelfast Health and Social Care TrustBelfastUK
| | | | - James C. McElnay
- Clinical and Practice Research GroupSchool of PharmacyQueen's University BelfastBelfastUK
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14
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Dixon S, Nancarrow SA, Enderby PM, Moran AM, Parker SG. Assessing patient preferences for the delivery of different community-based models of care using a discrete choice experiment. Health Expect 2015; 18:1204-14. [PMID: 23809234 PMCID: PMC5060844 DOI: 10.1111/hex.12096] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2013] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES To assess patient preferences for different models of care defined by location of care, frequency of care and principal carer within community-based health-care services for older people. DESIGN Discrete choice experiment administered within a face-to-face interview. SETTING An intermediate care service in a large city within the United Kingdom. PARTICIPANTS The projected sample size was calculated to be 200; however, 77 patients were recruited to the study. The subjects had recently been discharged from hospital and were living at home and were receiving short-term care by a publicly funded intermediate care service. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE The degree of preference, measured using single utility score, for individual service characteristics presented within a series of potential care packages. RESULTS Location of care was the dominant service characteristics with care at home being the strongly stated preference when compared with outpatient care (0.003), hospital care (<0.001) and nursing home care (<0.001) relative to home care, although this was less pronounced among less sick patients. Additionally, the respondents indicated a dislike for very frequent care contacts. No particular type of professional carer background was universally preferred but, unsurprisingly, there was evidence that sick patients showed a preference for nurse-led care. CONCLUSIONS Patients have clear preferences for the location for their care and were able to state preferences between different care packages when their ideal service was not available. Service providers can use this information to assess which models of care are most preferred within resource constraints.
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Affiliation(s)
- Simon Dixon
- School of Health and Related ResearchUniversity of SheffieldSheffieldUK
| | - Susan A. Nancarrow
- School of Health and Human SciencesSouthern Cross UniversityLismoreNSWAustralia
| | - Pamela M. Enderby
- School of Health and Related ResearchUniversity of SheffieldSheffieldUK
| | - Anna M. Moran
- School of Community HealthCharles Sturt UniversityAlburyNSWAustralia
| | - Stuart G. Parker
- School of Health and Related ResearchUniversity of SheffieldSheffieldUK
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15
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Silcock C, Liao L, Hill M, Chitty LS. Will the introduction of non-invasive prenatal testing for Down's syndrome undermine informed choice? Health Expect 2015; 18:1658-71. [PMID: 26039796 PMCID: PMC5060845 DOI: 10.1111/hex.12159] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2013] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE To investigate whether the introduction of non-invasive pre-natal testing for Down's syndrome (DS) has the potential to undermine informed choice. PARTICIPANTS Three hundred and ninety-three health professionals; 523 pregnant women. METHODS A cross-sectional questionnaire study across nine maternity units and three conferences in the UK designed to assess opinions regarding test delivery and how information should be communicated to women when offered Down's syndrome screening (DSS) or diagnosis using invasive (IDT) or non-invasive testing (NIPT). RESULTS Both pregnant women and health professionals in the NIPT and DSS groups were less likely than the IDT group to consider that testing should take place at a return visit or that obtaining written consent was necessary, and more likely to think testing should be carried out routinely. Compared to health professionals, pregnant women expressed a stronger preference for testing to occur on the same day as pre-test counselling (P = 0.000) and for invasive testing to be offered routinely (P = 0.000). They were also more likely to indicate written consent as necessary for DSS (P = 0.000) and NIPT (P < 0.05). CONCLUSIONS Health professionals and pregnant women view the consenting process differently across antenatal test types. These differences suggest that informed choice may be undermined with the introduction of NIPT for DS into clinical practice. To maintain high standards of care, effective professional training programmes and practice guidelines are needed which prioritize informed consent and take into account the views and needs of service users.
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Affiliation(s)
- Caroline Silcock
- University College London Hospitals NHS Foundation Trust & UCL Institute for Women's HealthLondonUK
| | - Lih‐Mei Liao
- University College London Hospitals NHS Foundation Trust & UCL Institute for Women's HealthLondonUK
| | - Melissa Hill
- UCL Institute of Child HealthGreat Ormond Street Hospital for Children NHS Trust, and Fetal Medicine Unit, University College London Hospitals NHS Foundation TrustLondonUK
| | - Lyn S. Chitty
- UCL Institute of Child HealthLondonUK
- Great Ormond Street Hospital for Children NHS Trust and Fetal Medicine UnitUniversity College London Hospitals NHS Foundation TrustLondonUK
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16
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Beulen L, Grutters JPC, Faas BHW, Feenstra I, Groenewoud H, van Vugt JMG, Bekker MN. Women's and healthcare professionals' preferences for prenatal testing: a discrete choice experiment. Prenat Diagn 2015; 35:549-57. [DOI: 10.1002/pd.4571] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 01/29/2015] [Accepted: 01/29/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Lean Beulen
- Department of Obstetrics and Gynecology; Radboud University Medical Center; Nijmegen The Netherlands
| | - Janneke P. C. Grutters
- Department for Health Evidence; Radboud University Medical Center; Nijmegen The Netherlands
| | - Brigitte H. W. Faas
- Department of Human Genetics; Radboud University Medical Center; Nijmegen The Netherlands
| | - Ilse Feenstra
- Department of Human Genetics; Radboud University Medical Center; Nijmegen The Netherlands
| | - Hans Groenewoud
- Department for Health Evidence; Radboud University Medical Center; Nijmegen The Netherlands
| | - John M. G. van Vugt
- Department of Obstetrics and Gynecology; Radboud University Medical Center; Nijmegen The Netherlands
| | - Mireille N. Bekker
- Department of Obstetrics and Gynecology; Radboud University Medical Center; Nijmegen The Netherlands
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17
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Allyse M, Sayres LC, Goodspeed T, Michie M, Cho MK. "Don't Want No Risk and Don't Want No Problems": Public Understandings of the Risks and Benefits of Non-Invasive Prenatal Testing in the United States. AJOB Empir Bioeth 2015; 6:5-20. [PMID: 25932463 DOI: 10.1080/23294515.2014.994722] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The recent availability of new non-invasive prenatal genetic tests for fetal aneuploidy has raised questions concerning whether and how these new tests will be integrated into prenatal medical care. Among the many factors to be considered are public understandings and preferences about prenatal testing mechanisms and the prospect of fetal aneuploidy. METHODS To address these issues, we conducted a nation-wide mixed-method survey of 2,960 adults in the United States to explore justifications for choices among prenatal testing mechanisms. Open responses were qualitatively coded and grouped by theme. RESULTS Respondents cited accuracy, followed by cost, as the most significant aspects of prenatal testing. Acceptance of testing was predicated on differing valuations of knowledge and on personal and religious beliefs. Trust in the medical establishment, attitudes towards risk, and beliefs about health and illness were also considered relevant. CONCLUSIONS Although a significant portion of the sample population valued the additional accuracy provided by the new non-invasive tests, they nevertheless expressed concerns over high costs. Furthermore, participants continued to express reservations about the value of prenatal genetic information per se, regardless of how it was obtained.
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Affiliation(s)
- Megan Allyse
- Institute for Health and Aging, University of California San Francisco
| | | | | | - Marsha Michie
- Institute for Health and Aging, University of California San Francisco
| | - Mildred K Cho
- Stanford Center for Biomedical Ethics and Department of Pediatrics, Stanford Medical School
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18
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Luyten J, Kessels R, Goos P, Beutels P. Public preferences for prioritizing preventive and curative health care interventions: a discrete choice experiment. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2015; 18:224-33. [PMID: 25773558 DOI: 10.1016/j.jval.2014.12.007] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 11/13/2014] [Accepted: 12/01/2014] [Indexed: 05/19/2023]
Abstract
BACKGROUND Setting fair health care priorities counts among the most difficult ethical challenges our societies are facing. OBJECTIVE To elicit through a discrete choice experiment the Belgian adult population's (18-75 years; N = 750) preferences for prioritizing health care and investigate whether these preferences are different for prevention versus cure. METHODS We used a Bayesian D-efficient design with partial profiles, which enables considering a large number of attributes and interaction effects. We included the following attributes: 1) type of intervention (cure vs. prevention), 2) effectiveness, 3) risk of adverse effects, 4) severity of illness, 5) link between the illness and patient's health-related lifestyle, 6) time span between intervention and effect, and 7) patient's age group. RESULTS All attributes were statistically significant contributors to the social value of a health care program, with patient's lifestyle and age being the most influential ones. Interaction effects were found, showing that prevention was preferred to cure for disease in young adults, as well as for severe and lethal disease in people of any age. However, substantial differences were found in the preferences of respondents from different age groups, with different lifestyles and different health states. CONCLUSIONS Our study suggests that according to the Belgian public, contextual factors of health gains such as patient's age and health-related lifestyle should be considered in priority setting decisions. The studies, however, revealed substantial disagreement in opinion between different population subgroups.
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Affiliation(s)
- Jeroen Luyten
- Centre for Health Economics Research & Modelling Infectious Diseases, Vaccine & Infectious Disease Institute, Faculty of Medicine & Health Sciences, University of Antwerp, Antwerpen, Belgium; Centre for Economics and Ethics, Institute of Philosophy, University of Leuven, Leuven, Belgium; Department of Social Policy, London School of Economics and Political Science, London, UK.
| | - Roselinde Kessels
- Faculty of Applied Economics, Department of Economics, University of Antwerp, Antwerpen, Belgium; StatUa Center for Statistics, University of Antwerp, Antwerpen, Belgium
| | - Peter Goos
- Faculty of Applied Economics, Department of Economics, University of Antwerp, Antwerpen, Belgium; StatUa Center for Statistics, University of Antwerp, Antwerpen, Belgium; Department of Econometrics, Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands; Faculty of Bioscience Engineering, Department of Biosystems, University of Leuven, Leuven, Belgium
| | - Philippe Beutels
- Centre for Health Economics Research & Modelling Infectious Diseases, Vaccine & Infectious Disease Institute, Faculty of Medicine & Health Sciences, University of Antwerp, Antwerpen, Belgium; School of Public Health and Community Medicine, The University of New South Wales, Sydney, Australia
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19
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Vanstone M, King C, de Vrijer B, Nisker J. Non-invasive prenatal testing: ethics and policy considerations. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2014; 36:515-526. [PMID: 24927192 DOI: 10.1016/s1701-2163(15)30568-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
New technologies analyzing fetal DNA in maternal blood have led to the wide commercial availability of non-invasive prenatal testing (NIPT). We present here for clinicians the ethical and policy issues related to an emerging practice option. Although NIPT presents opportunities for pregnant women, particularly women who are at increased risk of having a baby with an abnormality or who are otherwise likely to access invasive prenatal testing, NIPT brings significant ethics and policy challenges. The ethical issues include multiple aspects of informed decision-making, such as access to counselling about the possible results of the test in advance of making a decision about participation in NIPT. Policy considerations include issues related to offering and promoting a privately available medical strategy in publicly funded institutions. Ethics and policy considerations merge in NIPT with regard to sex selection and support for persons living with disabilities.
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Affiliation(s)
- Meredith Vanstone
- Department of Clinical Epidemiology and Biostatistics, Centre for Health Economics and Policy Analysis, McMaster University, Hamilton ON
| | - Carol King
- Department of Obstetrics and Gynecology, Schulich School of Medicine and Dentistry, Western University, London ON
| | - Barbra de Vrijer
- Department of Obstetrics and Gynecology, Schulich School of Medicine and Dentistry, Western University, London ON
| | - Jeff Nisker
- Department of Obstetrics and Gynecology, Schulich School of Medicine and Dentistry, Western University, London ON; Children's Health Research Institute, London ON
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20
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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.
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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
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21
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Hofman R, de Bekker-Grob EW, Richardus JH, de Koning HJ, van Ballegooijen M, Korfage IJ. Have preferences of girls changed almost 3 years after the much debated start of the HPV vaccination program in The Netherlands? A discrete choice experiment. PLoS One 2014; 9:e104772. [PMID: 25136919 PMCID: PMC4138034 DOI: 10.1371/journal.pone.0104772] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 07/16/2014] [Indexed: 01/07/2023] Open
Abstract
Objectives To assess how girls' preferences have changed almost 3 years after the much debated start of the human papillomavirus (HPV) vaccination program. Methods A discrete choice experiment (DCE) was conducted among girls aged 11–15 years who were invited, or were not yet invited, to get vaccinated. A panel latent class model was used to determine girls' preferences for vaccination based on five characteristics: degree of protection against cervical cancer; duration of protection; risk of mild side-effects; age of vaccination; and the number of required doses of the vaccine. Results The response rate was 85% (500/592). Most girls preferred vaccination at age 14 years (instead of at age 9 years) and a 2-dose scheme (instead of the current 3-dose scheme). Girls were willing to trade-off 7% (CI: 3.2% to 10.8%) of the degree of protection to have 10% less risk of mild side-effects, and 4% (CI: 1.2% to 5.9%) to receive 2 doses instead of 3 doses. Latent class analyses showed that there was preference heterogeneity among girls, i.e., higher educated girls and HPV vaccinated girls had a higher probability to opt for HPV vaccination at a higher age than lower educated girls or non-vaccinated girls. Conclusions Three years after the start of HPV vaccination program the risk of mild side-effects and age at vaccination seem to have become less important. For the Dutch national immunization program, we recommend not to lower the current target age of 12 years. A 2-dose scheme may result in a higher uptake and we recommend that if this scheme is introduced, it needs to receive adequate publicity.
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Affiliation(s)
- Robine Hofman
- Department of Public Health, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, the Netherlands
- * E-mail:
| | - Esther W. de Bekker-Grob
- Department of Public Health, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Jan Hendrik Richardus
- Department of Public Health, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, the Netherlands
- Municipal Public Health Service Rotterdam-Rijnmond, Rotterdam, the Netherlands
| | - Harry J. de Koning
- Department of Public Health, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Marjolein van Ballegooijen
- Department of Public Health, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Ida J. Korfage
- Department of Public Health, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, the Netherlands
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Hofman R, de Bekker-Grob EW, Raat H, Helmerhorst TJM, van Ballegooijen M, Korfage IJ. Parents' preferences for vaccinating daughters against human papillomavirus in the Netherlands: a discrete choice experiment. BMC Public Health 2014; 14:454. [PMID: 24885861 PMCID: PMC4047770 DOI: 10.1186/1471-2458-14-454] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 05/06/2014] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND To generate knowledge about potential improvements to human papillomavirus (HPV) vaccination information and organization strategies, we assessed how aspects of HPV vaccination are associated with parents' preferences for their daughters' uptake, and which trade-offs parents are willing to make between these aspects. METHODS A discrete choice experiment (DCE) was conducted among parents with a daughter aged 10-12 years. Panel mixed logit regression models were used to determine parents' preferences for vaccination. Trade-offs were quantified between four vaccination programme aspects: degree of protection against cervical cancer, duration of protection, risk of serious side-effects, and age of vaccination. RESULTS Total response rate was 302/983 (31%). All aspects influenced respondents' preferences for HPV vaccination (p < 0.05). Respondents preferred vaccination at age 14 years instead of at a younger age. Respondents were willing to trade-off 11% of the degree of protection to obtain life-time protection instead of 25 years. To obtain a vaccination with a risk of serious side-effects of 1/750,000 instead of 1/150,000, respondents were willing to trade-off 21%. CONCLUSIONS Uptake may rise if the age ranges for free HPV vaccinations are broadened. Based on the trade-offs parents were willing to make, we conclude that uptake would increase if new evidence indicated outcomes are better than are currently understood, particularly for degree and duration of protection.
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Affiliation(s)
- Robine Hofman
- Department of Public Health Erasmus MC, University Medical Centre, Rotterdam, P,O, Box 2040 3000, CA, The Netherlands.
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Harrison M, Rigby D, Vass C, Flynn T, Louviere J, Payne K. Risk as an Attribute in Discrete Choice Experiments: A Systematic Review of the Literature. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2014; 7:151-70. [DOI: 10.1007/s40271-014-0048-1] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Preferences for Prenatal Tests for Cystic Fibrosis: A Discrete Choice Experiment to Compare the Views of Adult Patients, Carriers of Cystic Fibrosis and Health Professionals. J Clin Med 2014; 3:176-90. [PMID: 26237256 PMCID: PMC4449661 DOI: 10.3390/jcm3010176] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Revised: 01/19/2014] [Accepted: 01/20/2014] [Indexed: 12/03/2022] Open
Abstract
As new technologies enable the development of non-invasive prenatal diagnosis (NIPD) for cystic fibrosis (CF), research examining stakeholder views is essential for the preparation of implementation strategies. Here, we compare the views of potential service users with those of health professionals who provide counselling for prenatal tests. A questionnaire incorporating a discrete choice experiment examined preferences for key attributes of NIPD and explored views on NIPD for CF. Adult patients (n = 92) and carriers of CF (n = 50) were recruited from one children’s and one adult NHS specialist CF centre. Health professionals (n = 70) were recruited via an e-mail invitation to relevant professional bodies. The key attribute affecting service user testing preferences was no miscarriage risk, while for health professionals, accuracy and early testing were important. The uptake of NIPD by service users was predicted to be high and includes couples that would currently decline invasive testing. Many service users (47%) and health professionals (55.2%) thought the availability of NIPD for CF would increase the pressure to undergo prenatal testing. Most service users (68.5%) thought NIPD for CF should be offered to all pregnant women, whereas more health professionals (68.2%) thought NIPD should be reserved for known carrier couples. The implications for clinical practice are discussed.
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Masozera M, Erickson JD, Clifford D, Coppolillo P, Sadiki HG, Mazet JK. Integrating the management of Ruaha landscape of Tanzania with local needs and preferences. ENVIRONMENTAL MANAGEMENT 2013; 52:1533-1546. [PMID: 24126572 DOI: 10.1007/s00267-013-0175-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Accepted: 09/21/2013] [Indexed: 06/02/2023]
Abstract
Sustainable management of landscapes with multiple competing demands such as the Ruaha Landscape is complex due to the diverse preferences and needs of stakeholder groups involved. This study uses conjoint analysis to assess the preferences of representatives from three stakeholder groups-local communities, district government officials, and non-governmental organizations-toward potential solutions of conservation and development tradeoffs facing local communities in the Ruaha Landscape of Tanzania. Results demonstrate that there is little consensus among stakeholders about the best development strategies for the Ruaha region. This analysis suggests a need for incorporating issues deemed important by these various groups into a development strategy that aims to promote conservation of the Ruaha Landscape and improve the livelihood of local communities.
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Affiliation(s)
- Michel Masozera
- Widlife Conservation Society - Africa Program, P.o. Box: 1699, Kigali, Rwanda,
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Kobayashi M, Mano T, Yamauchi K. Patients' preference on selecting a medical institution. Int J Health Care Qual Assur 2013; 26:341-52. [PMID: 23795425 DOI: 10.1108/09526861311319564] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this paper is to evaluate the relative importance of attributes for patient selection of a medical institution and to quantitatively evaluate the impact of different types of organizational forms upon the patient's selection of a medical institution. DESIGN/METHODOLOGY/APPROACH By using a conjoint analysis, evaluation criteria in patient selection of a medical institution were examined. The paper assumed the selection of a medical institution under the situation of "being given a diagnosis of suspected diabetes with a physical examination and then visiting a medical institution". The attributes included in the questionnaire were: quality of the medical institution, distance to the hospital, amount paid at the initial visit, amount paid at hospitalization for examinations, and organizational form of the hospital. Relative importance of the attributes and relative importance of organizational form were assessed. A total of 140 people were requested to respond to the questionnaire by way of researchers who have a connection with the authors. Completed responses were obtained from 111 subjects (79 per cent). FINDINGS The results of the conjoint analysis revealed that the most important attribute was quality of the medical institution. Organizational form was the attribute with the lowest importance. The utility value of being a public hospital was the highest within the organizational form attribute for all respondents and being a private hospital was the lowest. The quality of the medical institution was considered the most important factor in selecting a medical institution and the type of organizational form was considered least important. Regarding organizational form, being a public hospital was most preferred and being a hospital managed by a company and a private hospital were least preferred respectively among healthcare professionals and other occupations. ORIGINALITY/VALUE The paper provides a relative evaluation of the factors thought to be important for patients in Japan when selecting a medical institution.
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Affiliation(s)
- Makoto Kobayashi
- Health Economics Research, CRECON Research and Consulting, Tokyo, Japan
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Patients' and urologists' preferences for prostate cancer treatment: a discrete choice experiment. Br J Cancer 2013; 109:633-40. [PMID: 23860533 PMCID: PMC3738130 DOI: 10.1038/bjc.2013.370] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2013] [Revised: 06/19/2013] [Accepted: 06/22/2013] [Indexed: 02/07/2023] Open
Abstract
Background: Patients' preferences are important for shared decision making. Therefore, we investigated patients' and urologists' preferences for treatment alternatives for early prostate cancer (PC). Methods: A discrete choice experiment was conducted among 150 patients who were waiting for their biopsy results, and 150 urologists. Regression analysis was used to determine patients' and urologists' stated preferences using scenarios based on PC treatment modality (radiotherapy, surgery, and active surveillance (AS)), and risks of urinary incontinence and erectile dysfunction. Results: The response rate was 110 out of 150 (73%) for patients and 50 out of 150 (33%) for urologists. Risk of urinary incontinence was an important determinant of both patients' and urologists' stated preferences for PC treatment (P<0.05). Treatment modality also influenced patients' stated preferences (P<0.05), whereas the risk of erectile dysfunction due to radiotherapy was mainly important to urologists (P<0.05). Both patients and urologists preferred AS to radical treatment, with the exception of patients with anxious/depressed feelings who preferred radical treatment to AS. Conclusion: Although patients and urologists generally may prefer similar treatments for PC, they showed different trade-offs between various specific treatment aspects. This implies that urologists need to be aware of potential differences compared with the patient's perspective on treatment decisions in shared decision making on PC treatment.
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Mühlbacher AC, Juhnke C. Patient preferences versus physicians' judgement: does it make a difference in healthcare decision making? APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2013; 11:163-80. [PMID: 23529716 DOI: 10.1007/s40258-013-0023-3] [Citation(s) in RCA: 139] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Clinicians and public health experts make evidence-based decisions for individual patients, patient groups and even whole populations. In addition to the principles of internal and external validity (evidence), patient preferences must also influence decision making. Great Britain, Australia and Germany are currently discussing methods and procedures for valuing patient preferences in regulatory (authorization and pricing) and in health policy decision making. However, many questions remain on how to best balance patient and public preferences with physicians' judgement in healthcare and health policy decision making. For example, how to define evaluation criteria regarding the perceived value from a patient's perspective? How do physicians' fact-based opinions also reflect patients' preferences based on personal values? Can empirically grounded theories explain differences between patients and experts-and, if so, how? This article aims to identify and compare studies that used different preference elicitation methods and to highlight differences between patient and physician preferences. Therefore, studies comparing patient preferences and physician judgements were analysed in a review. This review shows a limited amount of literature analysing and comparing patient and physician preferences for healthcare interventions and outcomes. Moreover, it shows that methodology used to compare preferences is diverse. A total of 46 studies used the following methods-discrete-choice experiments, conjoint analyses, standard gamble, time trade-offs and paired comparisons-to compare patient preferences with doctor judgements. All studies were published between 1985 and 2011. Most studies reveal a disparity between the preferences of actual patients and those of physicians. For most conditions, physicians underestimated the impact of intervention characteristics on patients' decision making. Differentiated perceptions may reflect ineffective communication between the provider and the patient. This in turn may keep physicians from fully appreciating the impact of certain medical conditions on patient preferences. Because differences exist between physicians' judgement and patient preferences, it is important to incorporate the needs and wants of the patient into treatment decisions.
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Affiliation(s)
- Axel C Mühlbacher
- IGM Institut Gesundheitsökonomie und Medizinmanagement, Hochschule Neubrandenburg, Brodaer Straße 2, 17033, Neubrandenburg, Germany.
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Return of incidental findings in genomic medicine: measuring what patients value--development of an instrument to measure preferences for information from next-generation testing (IMPRINT). Genet Med 2013; 15:873-81. [PMID: 23722871 DOI: 10.1038/gim.2013.63] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Accepted: 04/09/2013] [Indexed: 01/03/2023] Open
Abstract
PURPOSE Little is known about the factors that influence patients' preferences for the return of incidental findings from genome sequencing. This study identified attributes of incidental findings that were important to patients and developed a discrete-choice experiment instrument to quantify patient preferences. METHODS An initial set of key attributes and attribute levels was developed from a literature review and in consultation with experts. The attributes' salience and communication were refined using focus group methodology (n = 12) and cognitive interviews (n = 6) with patients who had received conventional genetic testing for familial colorectal cancer or polyposis syndromes. The attributes and levels used in the hypothetical choices presented to participants were identified using validated experimental design techniques. RESULTS The final discrete-choice experiment instrument incorporates the following attributes and levels: lifetime risk of disease (5, 40, 70%); disease treatability (medical, lifestyle, none); disease severity (mild, moderate, severe); carrier status (yes, no); drug response likelihood (high, moderate, none); and test cost ($250, $425, $1,000, $1,900). CONCLUSION Patient preferences for incidental genomic findings are likely influenced by a complex set of diverse attributes. Quantification of patient preferences can inform patient-provider communication by highlighting the attributes of incidental findings that matter most to patients and warrant further discussion.
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Carroll FE, Al-Janabi H, Flynn T, Montgomery AA. Women and their partners' preferences for Down's syndrome screening tests: a discrete choice experiment. Prenat Diagn 2013; 33:449-56. [DOI: 10.1002/pd.4086] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Fran E. Carroll
- School of Social and Community Medicine; University of Bristol; England UK
| | - Hareth Al-Janabi
- Health Economics Unit, School of Health and Population Sciences; University of Birmingham; England UK
| | - Terry Flynn
- Centre for the Study of Choice; University of Technology; Sydney Australia
| | - Alan A. Montgomery
- School of Social and Community Medicine; University of Bristol; England UK
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de Bekker-Grob EW, Rose JM, Donkers B, Essink-Bot ML, Bangma CH, Steyerberg EW. Men's preferences for prostate cancer screening: a discrete choice experiment. Br J Cancer 2013; 108:533-41. [PMID: 23361056 PMCID: PMC3593568 DOI: 10.1038/bjc.2013.5] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Screening for prostate cancer (PC) may save lives, but overdiagnosis and overtreatment are serious drawbacks. We aimed to determine men's preferences for PC screening, and to elicit the trade-offs they make. Methods: A discrete choice experiment (DCE) was conducted among a population-based random sample of 1000 elderly men (55–75-years-old). Trade-offs were quantified with a panel latent class model between five PC screening aspects: risk reduction of PC-related death, screening interval, risk of unnecessary biopsies, risk of unnecessary treatments, and out-of-pocket costs. Results: The response rate was 46% (459/1000). Men were willing to trade-off 2.0% (CI: 1.6%–2.4%) or 1.8% (CI: 1.3%–2.3%) risk reduction of PC-related death to decrease their risk of unnecessary treatment or biopsy with 10%, respectively. They were willing to pay €188 per year (CI: €141–€258) to reduce their relative risk of PC-related death with 10%. Preference heterogeneity was substantial, with men with higher educational levels having a lower probability to opt for PC screening than men with lower educational levels. Conclusion: Men were willing to trade-off some risk reduction of PC-related death to be relieved of the burden of biopsies or unnecessary treatments. Increasing knowledge on overdiagnosis and overtreatment, especially for men with lower educational levels, is warranted to prevent unrealistic expectations from PC screening.
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Affiliation(s)
- E W de Bekker-Grob
- Department of Public Health, Erasmus MC-University Medical Centre Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
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Down Syndrome: what do pregnant women know about their individual risk? A prospective trial. Arch Gynecol Obstet 2013; 287:1119-23. [DOI: 10.1007/s00404-012-2707-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Accepted: 12/31/2012] [Indexed: 11/26/2022]
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Allyse M, Sayres LC, King JS, Norton ME, Cho MK. Cell-free fetal DNA testing for fetal aneuploidy and beyond: clinical integration challenges in the US context. Hum Reprod 2012; 27:3123-31. [PMID: 22863603 PMCID: PMC3472618 DOI: 10.1093/humrep/des286] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The recent release of new, non-invasive prenatal tests for fetal aneuploidy using cell-free fetal DNA (cffDNA) has been hailed as a revolution in prenatal testing and has triggered significant commercial interest in the field. Ongoing research portends the arrival of a wide range of cffDNA tests. However, it is not yet clear how these tests will be integrated into well-established prenatal testing strategies in the USA, as the timing of such testing and the degree to which new non-invasive tests will supplement or replace existing screening and diagnostic tools remain uncertain. We argue that there is an urgent need for policy-makers, regulators and professional societies to provide guidance on the most efficient and ethical manner for such tests to be introduced into clinical practice in the USA.
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Affiliation(s)
- Megan Allyse
- Stanford Center for Biomedical Ethics, Stanford, CA 94305-5417, USA.
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Hill M, Fisher J, Chitty LS, Morris S. Women’s and health professionals’ preferences for prenatal tests for Down syndrome: a discrete choice experiment to contrast noninvasive prenatal diagnosis with current invasive tests. Genet Med 2012; 14:905-13. [DOI: 10.1038/gim.2012.68] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Kinsler JJ, Cunningham WE, Nureña CR, Nadjat-Haiem C, Grinsztejn B, Casapia M, Montoya-Herrera O, Sánchez J, Galea JT. Using conjoint analysis to measure the acceptability of rectal microbicides among men who have sex with men in four South American cities. AIDS Behav 2012; 16:1436-47. [PMID: 21959986 DOI: 10.1007/s10461-011-0045-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Conjoint Analysis (CJA), a statistical market-based technique that assesses the value consumers place on product characteristics, may be used to predict acceptability of hypothetical products. Rectal Microbicides (RM)-substances that would prevent HIV infection during receptive anal intercourse-will require acceptability data from potential users in multiple settings to inform the development process by providing valuable information on desirable product characteristics and issues surrounding potential barriers to product use. This study applied CJA to explore the acceptability of eight different hypothetical RM among 128 MSM in Lima and Iquitos, Peru; Guayaquil, Ecuador; and Rio de Janeiro, Brazil. Overall RM acceptability was highest in Guayaquil and lowest in Rio. Product effectiveness had the greatest impact on acceptability in all four cities, but the impact of other product characteristics varied by city. This study demonstrates that MSM from the same region but from different cities place different values on RM characteristics that could impact uptake of an actual RM. Understanding specific consumer preferences is crucial during RM product development, clinical trials and eventual product dissemination.
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Affiliation(s)
- Janni J Kinsler
- Department of Community Health Sciences, School of Public Health, University of California, Los Angeles, USA.
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Chitty LS, Hill M, White H, Wright D, Morris S. Noninvasive prenatal testing for aneuploidy-ready for prime time? Am J Obstet Gynecol 2012; 206:269-75. [PMID: 22464064 DOI: 10.1016/j.ajog.2012.02.021] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Revised: 02/21/2012] [Accepted: 02/21/2012] [Indexed: 10/28/2022]
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Tischler R, Hudgins L, Blumenfeld YJ, Greely HT, Ormond KE. Noninvasive prenatal diagnosis: pregnant women's interest and expected uptake. Prenat Diagn 2011; 31:1292-9. [PMID: 22028097 PMCID: PMC3225485 DOI: 10.1002/pd.2888] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Revised: 09/07/2011] [Accepted: 09/12/2011] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To investigate pregnant women's level of future interest in noninvasive prenatal diagnosis (NIPD) and what factors might affect expected uptake of this testing. METHOD Written questionnaires were administered to women in their third trimester. RESULTS One hundred fourteen women returned the questionnaire (80.9% response rate). Of these, 71.9% reported interest in NIPD, 22.7% were ambivalent, and 5.4% were uninterested. Safety of the fetus was the single most important factor in 75% of women's decisions. Factors associated with increased interest in NIPD included: older age (p = 0.036), higher education (p = 0.013), Caucasian or Asian ethnicity (p = 0.011), and higher likelihood to terminate an affected pregnancy (p = 0.002). Nearly 20% of women reported that they would do whatever their doctor recommended regarding NIPD, and 94.4% of women wished to meet with a genetic counselor at some point to discuss NIPD. CONCLUSION The majority of pregnant women report hypothetical interest in NIPD, primarily because of increased safety for the fetus, although a significant minority are uninterested or ambivalent. Discussions with healthcare providers regarding NIPD, and their recommendations, are likely to be an important factor in women's decisions about this testing. As such, adequate discussion of the implications of prenatal diagnostic testing will be critical.
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Affiliation(s)
- Reana Tischler
- Department of Genetics, Institutions: Stanford University, Lucile Packard Children’s Hospital
| | - Louanne Hudgins
- Department of Pediatrics, Division of Medical Genetics, Institutions: Stanford University, Lucile Packard Children’s Hospital
| | - Yair J. Blumenfeld
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Institutions: Stanford University, Lucile Packard Children’s Hospital
| | - Henry T. Greely
- Department of Genetics, Institutions: Stanford University, Lucile Packard Children’s Hospital
- Stanford Law School, Institutions: Stanford University, Lucile Packard Children’s Hospital
- Stanford Center for Biomedical Ethics, Institutions: Stanford University, Lucile Packard Children’s Hospital
| | - Kelly E. Ormond
- Department of Genetics, Institutions: Stanford University, Lucile Packard Children’s Hospital
- Stanford Center for Biomedical Ethics, Institutions: Stanford University, Lucile Packard Children’s Hospital
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Chitayat D, Langlois S, Douglas Wilson R. Prenatal screening for fetal aneuploidy in singleton pregnancies. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2011; 33:736-750. [PMID: 21749752 DOI: 10.1016/s1701-2163(16)34961-1] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To develop a Canadian consensus document on maternal screening for fetal aneuploidy (e.g., Down syndrome and trisomy 18) in singleton pregnancies. OPTIONS Pregnancy screening for fetal aneuploidy started in the mid 1960s, using maternal age as the screening test. New developments in maternal serum and ultrasound screening have made it possible to offer all pregnant patients a non-invasive screening test to assess their risk of having a fetus with aneuploidy to determine whether invasive prenatal diagnostic testing is necessary. This document reviews the options available for non-invasive screening and makes recommendations for Canadian patients and health care workers. OUTCOMES To offer non-invasive screening for fetal aneuploidy (trisomy 13, 18, 21) to all pregnant women. Invasive prenatal diagnosis would be offered to women who screen above a set risk cut-off level on non-invasive screening or to pregnant women whose personal, obstetrical, or family history places them at increased risk. Currently available non-invasive screening options include maternal age combined with one of the following: (1) first trimester screening (nuchal translucency, maternal age, and maternal serum biochemical markers), (2) second trimester serum screening (maternal age and maternal serum biochemical markers), or (3) 2-step integrated screening, which includes first and second trimester serum screening with or without nuchal translucency (integrated prenatal screen, serum integrated prenatal screening, contingent, and sequential). These options are reviewed, and recommendations are made. EVIDENCE Studies published between 1982 and 2009 were retrieved through searches of PubMed or Medline and CINAHL and the Cochrane Library, using appropriate controlled vocabulary and key words (aneuploidy, Down syndrome, trisomy, prenatal screening, genetic health risk, genetic health surveillance, prenatal diagnosis). Results were restricted to systematic reviews, randomized controlled trials, and relevant observational studies. There were no language restrictions. Searches were updated on a regular basis and incorporated in the guideline to August 2010. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology assessment-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. The previous Society of Obstetricians and Gynaecologists of Canada guidelines regarding prenatal screening were also reviewed in developing this clinical practice guideline. VALUES The quality of evidence was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care. BENEFITS, HARMS, AND COSTS This guideline is intended to reduce the number of prenatal invasive procedures done when maternal age is the only indication. This will have the benefit of reducing the numbers of normal pregnancies lost because of complications of invasive procedures. Any screening test has an inherent false-positive rate, which may result in undue anxiety. It is not possible at this time to undertake a detailed cost-benefit analysis of the implementation of this guideline, since this would require health surveillance and research and health resources not presently available; however, these factors need to be evaluated in a prospective approach by provincial and territorial initiatives. RECOMMENDATIONS 1. All pregnant women in Canada, regardless of age, should be offered, through an informed counselling process, the option of a prenatal screening test for the most common clinically significant fetal aneuploidies in addition to a second trimester ultrasound for dating, assessment of fetal anatomy, and detection of multiples. (I-A) 2. Counselling must be non-directive and must respect a woman's right to accept or decline any or all of the testing or options offered at any point in the process. (III-A) 3. Maternal age alone is a poor minimum standard for prenatal screening for aneuploidy, and it should not be used a basis for recommending invasive testing when non-invasive prenatal screening for aneuploidy is available. (II-2A) 4. Invasive prenatal diagnosis for cytogenetic analysis should not be performed without multiple marker screening results except for women who are at increased risk of fetal aneuploidy (a) because of ultrasound findings, (b) because the pregnancy was conceived by in vitro fertilization with intracytoplasmic sperm injection, or (c) because the woman or her partner has a history of a previous child or fetus with a chromosomal abnormality or is a carrier of a chromosome rearrangement that increases the risk of having a fetus with a chromosomal abnormality. (II-2E) 5. At minimum, any prenatal screen offered to Canadian women who present for care in the first trimester should have a detection rate of 75% with no more than a 3% false-positive rate. The performance of the screen should be substantiated by annual audit. (III-B) 6. The minimum standard for women presenting in the second trimester should be a screen that has a detection rate of 75% with no more than a 5% false-positive rate. The performance of the screen should be substantiated by annual audit. (III-B) 7. First trimester nuchal translucency should be interpreted for risk assessment only when measured by sonographers or sonologists trained and accredited for this service and when there is ongoing quality assurance (II-2A), and it should not be offered as a screen without biochemical markers in singleton pregnancies. (I-E) 8. Evaluation of the fetal nasal bone in the first trimester should not be incorporated as a screen unless it is performed by sonographers or sonologists trained and accredited for this service and there is ongoing quality assurance. (II-2E) 9. For women who undertake first trimester screening, second trimester serum alpha fetoprotein screening and/or ultrasound examination is recommended to screen for open neural tube defects. (II-1A) 10. Timely referral and access is critical for women and should be facilitated to ensure women are able to undergo the type of screening test they have chosen as first trimester screening. The first steps of integrated screening (with or without nuchal translucency), contingent, or sequential screening are performed in an early and relatively narrow time window. (II-1A) 11. Ultrasound dating should be performed if menstrual or conception dating is unreliable. For any abnormal serum screen calculated on the basis of menstrual dating, an ultrasound should be done to confirm gestational age. (II-1A) 12. The presence or absence of soft markers or anomalies in the 18- to 20-week ultrasound can be used to modify the a priori risk of aneuploidy established by age or prior screening. (II-2B) 13. Information such as gestational dating, maternal weight, ethnicity, insulin-dependent diabetes mellitus, and use of assisted reproduction technologies should be provided to the laboratory to improve accuracy of testing. (II-2A) 14. Health care providers should be aware of the screening modalities available in their province or territory. (III-B) 15. A reliable system needs to be in place ensuring timely reporting of results. (III-C) 16. Screening programs should be implemented with resources that support audited screening and diagnostic laboratory services, ultrasound, genetic counselling services, patient and health care provider education, and high quality diagnostic testing, as well as resources for administration, annual clinical audit, and data management. In addition, there must be the flexibility and funding to adjust the program to new technology and protocols. (II-3B).
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Klein DA. Medical Disparagement of the Disability Experience: Empirical Evidence for the “Expressivist Objection”. ACTA ACUST UNITED AC 2011. [DOI: 10.1080/21507716.2011.594484] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Cost-effectiveness and accuracy of prenatal Down syndrome screening strategies: should the combined test continue to be widely used? Am J Obstet Gynecol 2011; 204:175.e1-8. [PMID: 21074138 DOI: 10.1016/j.ajog.2010.09.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2010] [Revised: 07/19/2010] [Accepted: 09/20/2010] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We analyzed the cost-effectiveness (CE) and performances of commonly used prenatal Down syndrome (DS) screening strategies. STUDY DESIGN We performed computer simulations to compare 8 screening options by applying empirical data from Serum, Urine, and Ultrasound Screening Study trials on the population of 110,948 pregnancies. Screening strategies outcomes, CE ratios, and incremental CE ratios were measured. RESULTS The most CE DS screening strategy was the contingent screening method (CE ratio of Can$26,833 per DS case). Its incremental CE ratio compared to the second-most CE strategy (serum integrated screening) was Can$3815 per DS birth detected. Among the procedures respecting guidelines, our results identified the combined test as the screening strategy with the highest CE ratio (Can$47,358) and the highest number of procedure-related euploid miscarriages (n = 71). CONCLUSION In regard to CE, contingent screening is the best choice. The combined test, which is the most popular screening strategy, shows many limitations.
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van Gils PF, Lambooij MS, Flanderijn MHW, van den Berg M, de Wit GA, Schuit AJ, Struijs JN. Willingness to participate in a lifestyle intervention program of patients with type 2 diabetes mellitus: a conjoint analysis. Patient Prefer Adherence 2011; 5:537-46. [PMID: 22114468 PMCID: PMC3218115 DOI: 10.2147/ppa.s16854] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Several studies suggest that lifestyle interventions can be effective for people with, or at risk for, diabetes. The participation in lifestyle interventions is generally low. Financial incentives may encourage participation in lifestyle intervention programs. OBJECTIVE The main aim of this exploratory analysis is to study empirically potential effects of financial incentives on diabetes patients' willingness to participate in lifestyle interventions. One financial incentive is negative ("copayment") and the other incentive is positive ("bonus"). The key part of this research is to contrast both incentives. The second aim is to investigate the factors that influence participation in a lifestyle intervention program. METHODS Conjoint analysis techniques were used to empirically identify factors that influence willingness to participate in a lifestyle intervention. For this purpose diabetic patients received a questionnaire with descriptions of various forms of hypothetical lifestyle interventions. They were asked if they would be willing to participate in these hypothetical programs. RESULTS In total, 174 observations were rated by 46 respondents. Analysis showed that money was an important factor independently associated with respondents' willingness to participate. Receiving a bonus seemed to be associated with a higher willingness to participate, but having to pay was negatively associated with participation in the lifestyle intervention. CONCLUSION Conjoint analysis results suggest that financial considerations may influence willingness to participate in lifestyle intervention programs. Financial disincentives in the form of copayments might discourage participation. Although the positive impact of bonuses is smaller than the negative impact of copayments, bonuses could still be used to encourage willingness to participate.
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Affiliation(s)
- Paul F van Gils
- Centre for Prevention and Health Services Research, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
- Correspondence: Paul F van Gils, Centre for Prevention and Health Services Research (pb 101), National Institute of Public Health and the Environment, PO Box 1, 3720 BA Bilthoven, The Netherlands, Tel +31 30 274 8581, Fax +31 30 274 4407, Email
| | - Mattijs S Lambooij
- Centre for Prevention and Health Services Research, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Marloes HW Flanderijn
- Centre for Prevention and Health Services Research, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Matthijs van den Berg
- Centre for Public Health Forecasting, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - G Ardine de Wit
- Centre for Prevention and Health Services Research, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Albertine J Schuit
- Centre for Prevention and Health Services Research, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
- Department of Health Sciences, EMGO Institute for Health and Care Research, VU University, Amsterdam, the Netherlands
| | - Jeroen N Struijs
- Centre for Prevention and Health Services Research, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
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Abstract
Down syndrome screening has been offered to pregnant women since the early 1980s. Protocols have changed as research confirmed improvements that result in higher detection rates and lower false-positive rates. Results from 2 clinical trials evaluating screening protocols that include ultrasound measurement of nuchal translucency and biochemical testing in the first and second trimester are now available. First-trimester screening is an option if there are adequate ultrasound, diagnostic, and counseling services available. Regional variation in the availability of these services may limit the implementation of first-trimester screening. Combining screening tests for Down syndrome from both trimesters as an integrated test offers the highest detection rate with the lowest false-positive rate. The possibility of avoiding a positive screen will make this an attractive option for some. Timing, detection rate, false-positive rates, and personal factors influence the decision women make regarding screening versus diagnostic testing. This article reviews the efficacy of current protocols for Down syndrome screening. Accurate information about available screening tests will facilitate informed decisions about screening and testing.
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Affiliation(s)
- Stanley S Grant
- Department Obstetrics and Gynecology, University of Iowa Health Care, Iowa City, IA 52242, USA.
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Seror V, Ville Y. Women's attitudes to the successive decisions possibly involved in prenatal screening for Down syndrome: how consistent with their actual decisions? Prenat Diagn 2010; 30:1086-93. [DOI: 10.1002/pd.2616] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Bahado-Singh RO, Argoti P. An Overview of First-Trimester Screening for Chromosomal Abnormalities. Clin Lab Med 2010; 30:545-55. [DOI: 10.1016/j.cll.2010.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Salomon LJ, Chevret S, Bussieres L, Ville Y, Rozenberg P. Down syndrome screening using first-trimester combined tests and contingent use of femur length at routine anomaly scan. Prenat Diagn 2010; 30:783-9. [DOI: 10.1002/pd.2550] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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de Bekker-Grob EW, Hol L, Donkers B, van Dam L, Habbema JDF, van Leerdam ME, Kuipers EJ, Essink-Bot ML, Steyerberg EW. Labeled versus unlabeled discrete choice experiments in health economics: an application to colorectal cancer screening. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2010; 13:315-23. [PMID: 19912597 DOI: 10.1111/j.1524-4733.2009.00670.x] [Citation(s) in RCA: 115] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVES Discrete choice experiments (DCEs) in health economics commonly present choice sets in an unlabeled form. Labeled choice sets are less abstract and may increase the validity of the results. We empirically compared the feasibility, respondents' trading behavior, and convergent validity between a labeled and an unlabeled DCE for colorectal cancer (CRC) screening programs in The Netherlands. METHODS A labeled DCE version presented CRC screening test alternatives as "fecal occult blood test,""sigmoidoscopy," and "colonoscopy," whereas the unlabeled DCE version presented them as "screening test A" and "screening test B." Questionnaires were sent to participants and nonparticipants in CRC screening. RESULTS Total response rate was 276 (39%) out of 712 and 1033 (46%) out of 2267 for unlabeled and labeled DCEs, respectively (P<0.001). The labels played a significant role in individual choices; approximately 22% of subjects had dominant preferences for screening test labels. The convergent validity was modest to low (participants in CRC screening: r=0.54; P=0.01; nonparticipants: r=0.17; P=0.45) largely because of different preferences for screening frequency. CONCLUSION This study provides important insights in the feasibility and difference in results from labeled and unlabeled DCEs. The inclusion of labels appeared to play a significant role in individual choices but reduced the attention respondents give to the attributes. As a result, unlabeled DCEs may be more suitable to investigate trade-offs between attributes and for respondents who do not have familiarity with the alternative labels, whereas labeled DCEs may be more suitable to explain real-life choices such as uptake of cancer screening.
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Affiliation(s)
- Esther W de Bekker-Grob
- Department of Public Health, Erasmus MC-University Medical Centre Rotterdam, Rotterdam, The Netherlands.
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Grosse SD. What is the value for money of prenatal carrier screening for spinal muscular atrophy? Too soon to say. Am J Obstet Gynecol 2010; 202:209-11. [PMID: 20207235 DOI: 10.1016/j.ajog.2010.01.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2010] [Accepted: 01/14/2010] [Indexed: 11/17/2022]
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van den Heuvel A, Chitty L, Dormandy E, Newson A, Deans Z, Attwood S, Haynes S, Marteau TM. Will the introduction of non-invasive prenatal diagnostic testing erode informed choices? An experimental study of health care professionals. PATIENT EDUCATION AND COUNSELING 2010; 78:24-28. [PMID: 19560305 DOI: 10.1016/j.pec.2009.05.014] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2008] [Revised: 05/18/2009] [Accepted: 05/22/2009] [Indexed: 05/28/2023]
Abstract
OBJECTIVE Informed choice is a fundamental concept within prenatal care. The present study assessed the extent to which the introduction of non-invasive prenatal diagnosis (NIPD) of Down's syndrome may undermine the process of making informed choices to undergo prenatal testing or screening for Down's syndrome by altering the quality and quantity of pre-test counselling. METHODS 231 obstetricians and midwives were randomly allocated one of three vignettes, each describing a different type of test: (a) invasive prenatal diagnosis (IPD), (b) non-invasive prenatal diagnosis (NIPD) or (c) Down's syndrome screening (DSS). Participants were then asked to complete a questionnaire assessing (1) the information considered important to communicate to women, (2) whether test offer and uptake should take place on different days, and (3) whether signed consent forms should be obtained prior to testing. RESULTS Across the three test types, five out of the seven presented topics were considered equally important to communicate, including the information that testing is the woman's choice. Compared with participants receiving the IPD vignette, those receiving the NIPD and DSS vignettes were less likely to report that counselling and testing should occur on different days (IPD 94.7% versus 74.1% and 73.9% for NIPD and DSS respectively, p=.001) and that written consent was a necessity (IPD 96.1% versus 68.3% and 75.4% for NIPD and DSS respectively, p<.001). CONCLUSION This study provides the first empirical evidence to demonstrate that practitioners may view the consent process for NIPD differently to IPD. There is potential for the introduction of NIPD to undermine women making informed choices in the context of prenatal diagnostic testing for conditions like DS. PRACTICE IMPLICATIONS Given the importance of informed choice in reproductive decision-making, implementation of any programme based on NIPD should be designed to facilitate this.
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Affiliation(s)
- Ananda van den Heuvel
- King's College London, IOP, Department of Psychology (at Guy's), Health Psychology Section, 5th floor, Thomas Guy House, London SE1 9RT, UK
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Tapon D. Prenatal testing for Down syndrome: comparison of screening practices in the UK and USA. J Genet Couns 2009; 19:112-30. [PMID: 19885721 DOI: 10.1007/s10897-009-9269-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2009] [Accepted: 10/15/2009] [Indexed: 11/30/2022]
Abstract
Prenatal testing for Down Syndrome is a topic covered in every genetic counselor's training as it constitutes the main workload of genetic counselors in prenatal settings. Most Western countries nowadays offer some type of testing for Down Syndrome. However, practices vary according to country with regards to what tests are offered, insurance coverage and the legal situation concerning the option of terminating an affected pregnancy. In view of the growing interest in international genetic counseling issues, this article aims to compare prenatal testing practices in two English-speaking countries: the United Kingdom and the United States of America. A case will be presented to highlight some of the differences in practice. The topic underlines important implications for genetic counseling practice, such as patients' understanding of testing practices, risk perception, counseling provision and impact of prenatal testing results.
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Affiliation(s)
- Dagmar Tapon
- Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Du Cane Road, London, W12 0HS, Great Britain.
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Regier DA, Friedman JM, Makela N, Ryan M, Marra CA. Valuing the benefit of diagnostic testing for genetic causes of idiopathic developmental disability: willingness to pay from families of affected children. Clin Genet 2009; 75:514-21. [PMID: 19508416 DOI: 10.1111/j.1399-0004.2009.01193.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Idiopathic developmental disability (DD) has been found to put significant psychological distress on families of children with DD. The cause of the disability, however, is unknown for up to one-half of the affected children. Chromosomal abnormalities identified by cytogenetic analysis are the most frequently recognized cause of DD, although they account for less than 10% of cases. Array genomic hybridization (AGH) is a new diagnostic tool that provides a much higher detection rate for chromosomal imbalance than conventional cytogenetic analysis. This increase in diagnostic capability comes at greater monetary costs, which provides an impetus for understanding how individuals value genetic testing for DD. This study estimated the willingness to pay (WTP) for diagnostic testing to find a genetic cause of DD from families of children with DD. A discrete choice experiment was used to obtain WTP values. When it was assumed that AGH resulted in twice as many diagnoses and a 1-week reduction in waiting time compared with conventional cytogenetic analysis, this study found that families were willing to pay up to CDN$1118 (95% confidence interval, $498-1788) for the expected benefit. These results support the conclusion that the introduction of AGH into the Canadian health care system may increase the perceived welfare of society, but future studies should examine the cost-benefit of AGH vs cytogenetic testing.
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Affiliation(s)
- D A Regier
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK.
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