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Martínez-Salazar J, Toledano-Toledano F. Comparative Analysis of Three Predictive Models of Performance Indicators with Results-Based Management: Cancer Data Statistics in a National Institute of Health. Cancers (Basel) 2023; 15:4649. [PMID: 37760617 PMCID: PMC10526912 DOI: 10.3390/cancers15184649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/30/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023] Open
Abstract
Predictive models play a crucial role in RBMs to analyze performance indicator results to manage unexpected events and make timely decisions to resolve them. Their use in Mexico is deficient, and monitoring and evaluation are among the weakest pillars of the model. In response to these needs, the aim of this study was to perform a comparative analysis of three predictive models to analyze 10 medical performance indicators and cancer data related to children with cancer. To accomplish these purposes, a comparative and retrospective study with nonprobabilistic convenience sampling was conducted. The predictive models were exponential smoothing, autoregressive integrated moving average, and linear regression. The lowest mean absolute error was used to identify the best model. Linear regression performed best regarding nine of the ten indicators, with seven showing p < 0.05. Three of their assumptions were checked using the Shapiro-Wilk, Cook's distance, and Breusch-Pagan tests. Predictive models with RBM are a valid and relevant instrument for monitoring and evaluating performance indicator results to support forecasting and decision-making based on evidence and must be promoted for use with cancer data statistics. The place numbers obtained by cancer disease inside the main causes of death, morbidity and hospital outpatients in a National Institute of Health were presented as evidence of the importance of implementing performance indicators associated with children with cancer.
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Affiliation(s)
- Joel Martínez-Salazar
- Unidad de Investigación en Medicina Basada en Evidencias, Hospital Infantil de México Federico Gómez, Instituto Nacional de Salud, Dr. Márquez 162, Doctores, Cuauhtémoc, Mexico City 06720, Mexico;
| | - Filiberto Toledano-Toledano
- Unidad de Investigación en Medicina Basada en Evidencias, Hospital Infantil de México Federico Gómez, Instituto Nacional de Salud, Dr. Márquez 162, Doctores, Cuauhtémoc, Mexico City 06720, Mexico;
- Unidad de Investigación Multidisciplinaria en Salud, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Calzada México-Xochimilco 289, Arenal de Guadalupe, Tlalpan, Mexico City 14389, Mexico
- Dirección de Investigación y Diseminación del Conocimiento, Instituto Nacional de Ciencias e Innovación para la Formación de Comunidad Científica, INDEHUS, Periférico Sur 4860, Arenal de Guadalupe, Tlalpan, Mexico City 14389, Mexico
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Poehler D, Czerniecki J, Norvell D, Henderson A, Dolan J, Devine B. Comparing Patient and Provider Priorities Around Amputation Level Outcomes Using Multiple Criteria Decision Analysis. Ann Vasc Surg 2023; 95:169-177. [PMID: 37263414 PMCID: PMC10782550 DOI: 10.1016/j.avsg.2023.05.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/18/2023] [Accepted: 05/18/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND Patients with chronic limb threatening ischemia may require a transmetatarsal amputation (TMA) or a transtibial amputation. When making an amputation-level decision, these patients face a tradeoff-a TMA preserves more limb and may provide better mobility but has a lower probability of primary wound healing and may therefore result in additional same or higher level amputation surgeries with an associated negative impact on function. Understanding differences in how patients and providers prioritize these tradeoffs and other outcomes may enhance shared decision-making. OBJECTIVES Compare patient priorities with provider perceptions of patient priorities using Multiple Criteria Decision Analysis (MCDA). METHODS The MCDA Analytic Hierarchy Process was chosen due to its low cognitive burden and ease of implementation. We included 5 criteria (outcomes): ability to walk, healing after amputation surgery, rehabilitation program intensity, limb length, and ease of use of prosthetic/orthotic device. A national sample of dysvascular lower-limb amputees and providers were recruited from the Veterans Health Administration with the MCDA administered online to providers and telephonically to patients. RESULTS Twenty-six dysvascular amputees and 38 providers participated. Fifty percent of patients had undergone a TMA; 50%, a transtibial amputation. When compared to providers, patients placed higher value on TMA (72% vs. 63%). Patient versus provider priorities were ability to walk (47% vs. 42%), healing (18% vs. 28%), ease of prosthesis use (17% vs. 13%), limb length (11% vs. 13%), and then rehabilitation intensity (7% vs. 6%). LIMITATIONS Our sample may not generalize to other populations. CONCLUSIONS Provider perceptions aligned with patient values on amputation level but varied around the importance of each outcome. IMPLICATIONS These findings illuminate some differences between patients' values and provider perceptions of patient values, suggesting a role for shared decision-making. Embedding this MCDA framework into a future decision aid may facilitate these discussions.
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Affiliation(s)
- Diana Poehler
- Advanced Methods Development, RTI International, Research Triangle Park, NC; Department of Health Services, University of Washington, Seattle, WA.
| | - Joseph Czerniecki
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | - Daniel Norvell
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA; Veterans Affairs (VA) Center for Limb Loss and Mobility (CLiMB), VA Puget Sound Health Care System, Seattle, WA
| | - Alison Henderson
- Veterans Affairs (VA) Center for Limb Loss and Mobility (CLiMB), VA Puget Sound Health Care System, Seattle, WA
| | - James Dolan
- Department of Public Health Sciences, University of Rochester, Rochester, NY
| | - Beth Devine
- Department of Health Services, The Comparative Health Outcomes, Policy, and Economics Institute, University of Washington, Seattle, WA
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Poehler D, Czerniecki J, Norvell D, Henderson A, Dolan J, Devine B. The Development and Pilot Study of a Multiple Criteria Decision Analysis (MCDA) to Compare Patient and Provider Priorities around Amputation-Level Outcomes. MDM Policy Pract 2022; 7:23814683221143765. [PMID: 36545397 PMCID: PMC9761219 DOI: 10.1177/23814683221143765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 11/11/2022] [Indexed: 12/23/2022] Open
Abstract
Background. Patients with chronic limb-threatening ischemia who are facing a lower-limb amputation often require a transmetatarsal amputation (TMA) or a transtibial amputation (TTA). A TMA preserves more of the patient's limb and may provide better mobility but has a lower probability of primary wound healing relative to a TTA and may result in additional amputation surgeries. Understanding the differences in how patients and providers prioritize key outcomes may enhance the amputation decisional process. Purpose. To develop and pilot test a multiple criteria decision analysis (MCDA) tool to elicit patient values around amputation-level selection and compare those with provider perceptions of patient values. Methods. We conducted literature reviews to identify and measure the performance of criteria important to patients. Because the quantitative literature was sparse, we developed a Sheffield elicitation framework exercise to elicit criteria performance from subject matter experts. We piloted our MCDA among patients and providers to understand tool acceptability and preliminarily assess differences in patient and provider priorities. Results. Five criteria of importance were identified: ability to walk, healing after amputation surgery, rehabilitation intensity, limb length, and prosthetic/orthotic device ease. Patients and providers successfully completed the MCDA and identified challenges in doing so. We propose potential solutions to these challenges. The results of the pilot test suggest differences in patient and provider outcome priorities. Limitations. The pilot test study enrolled a small sample of providers and patients. Conclusions. We successfully implemented the pilot study to patients and providers, received helpful feedback, and identified solutions to improve the tool. Implications. Once modified, our MCDA tool will be suitable for wider rollout. Highlights Patients and providers have successfully completed our MCDA, and patients feel the MCDA may be useful in clinical practice.We encountered several methodologic challenges and identified approaches to ease participant burden.When data are sparse, using the Sheffield elicitation framework is helpful in creating a performance matrix, although patients relied largely on their amputation experiences to complete the exercise. Blinding the alternatives may help patients better understand the process.
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Affiliation(s)
- Diana Poehler
- Diana Poehler, Department of Health
Services, Magnuson Health Sciences Center, University of Washington (UW), 1959
NE Pacific St, Seattle, WA 98195-0005, USA;
()
| | - Joseph Czerniecki
- Department of Rehabilitation Medicine,
University of Washington, Seattle, WA, USA
| | - Daniel Norvell
- VA Puget Sound Health Care System, Veterans
Affairs Center for Limb Loss and Mobility (CLiMB), Seattle, WA, USA,Department of Rehabilitation Medicine,
University of Washington, Seattle, WA, USA
| | - Alison Henderson
- VA Puget Sound Health Care System, Veterans
Affairs Center for Limb Loss and Mobility (CLiMB), Seattle, WA, USA
| | - James Dolan
- Department of Public Health Sciences (Retired),
University of Rochester, Rochester, NY, USA
| | - Beth Devine
- The Comparative Health Outcomes, Policy, and
Economics Institute, University of Washington, Seattle, WA, USA,Department of Health Services, University of
Washington, Seattle, WA, USA
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James LJ, Wong G, Tong A, Craig JC, Howard K, Howell M. Patient preferences for cancer screening in chronic kidney disease: a best-worst scaling survey. Nephrol Dial Transplant 2022; 37:2449-2456. [PMID: 34958393 DOI: 10.1093/ndt/gfab360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Despite an increased cancer risk for patients with chronic kidney disease (CKD), uptake of cancer screening varies due to competing priorities and complex health-related issues. This study aimed to elicit the preferences and important attributes of cancer screening in patients with CKD. METHODS An on-line best-worst scaling survey was used to ascertain the relative importance of 22 screening attributes among CKD patients using an incomplete block design. Preference scores (0-1) were calculated by multinomial logistic regression. Preference heterogeneity was evaluated. RESULTS The survey was completed by 83 patients: 26 not requiring kidney replacement therapy, 20 receiving dialysis and 37 transplant recipients (mean age 59 years, 53% men, 75% prior to cancer screening). The five most important attributes were early detection {preference score 1.0 [95% confidence interval (CI) 0.90-1.10]}, decreased risk of cancer death [0.85 (0.75-0.94)], false negatives [0.71 (0.61-0.80)], reduction in immunosuppression if detected [0.68 (0.59-0.78)] and non-invasive interventions after positive results [0.68 (0.59-0.78)]. Preference heterogeneity reflected the stage of CKD. Immunosuppression reduction [mean difference 0.11 (95% CI 0.02-0.19)] and views of family/friends [0.10 (reference attribute)] were important for transplant recipients. Screening frequency [-0.18 (95% CI -0.26 to -0.10)] and overdiagnosis of harmless cancers [-0.14 (95% CI -0.22 to -0.10)] were important for dialysis patients. CONCLUSION Early detection, risk of cancer-related death, false negatives, immunosuppression reduction and non-invasive interventions following detection are important cancer screening considerations among CKD patients. Patient preferences are key to shared decision-making and individualized cancer screening.
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Affiliation(s)
- Laura J James
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Germaine Wong
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, Children's Hospital at Westmead, Westmead, NSW, Australia.,Centre for Transplant and Renal Research, Westmead Hospital, Westmead, NSW, Australia
| | - Allison Tong
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Jonathan C Craig
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Kirsten Howard
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Martin Howell
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, Children's Hospital at Westmead, Westmead, NSW, Australia
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Ismael J, Díaz MC, Gabay C, Caro LE, Cerisoli C, Figueredo R, Canseco S, Rodriguez P, Criado L, Raffa I, O'Connor J, Kopitowsky K, Adi J, Del Solar CG. Clinical practice guidelines providing new data about CRC screening in argentinian population with average risk based on iFOBT. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2022. [DOI: 10.1016/j.cegh.2022.100997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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6
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Davis TC, Morris JD, Reed EH, Curtis LM, Wolf MS, Davis AB, Arnold CL. Design of a randomized controlled trial to assess the comparative effectiveness of a multifaceted intervention to improve three-year adherence to colorectal cancer screening among patients cared for in rural community health centers. Contemp Clin Trials 2022; 113:106654. [PMID: 34906745 PMCID: PMC8844093 DOI: 10.1016/j.cct.2021.106654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 11/11/2021] [Accepted: 12/08/2021] [Indexed: 02/03/2023]
Abstract
Colorectal cancer (CRC) screening has been shown to decrease CRC mortality, yet significant disparities persist among those living in rural areas, from minority backgrounds, and those having low income. The purpose of this two-arm randomized controlled trial is to test the effectiveness and fidelity of a stepped care (increasing intensity as needed) approach to promoting 3-year adherence to CRC screening via fecal immunochemical testing (FIT) or colonoscopy in rural community clinics serving high rates of low-income and minority patients. We hypothesize that, compared to enhanced usual care (EUC), patients receiving the multifaceted CRC screening intervention will demonstrate higher rates of CRC screening completion over 3 years. Participants from six federally qualified health centers (FQHCs; N = 1200 patients) serving predominately low-income populations in rural Louisiana will be randomized to the intervention or EUC arm. All participants will receive health literacy-directed CRC counseling, simplified materials about both the FIT and colonoscopy procedures, and motivational interviewing to aid in the determination of test preference. Participants in the intervention arm will also receive motivational reminder messages from their primary care provider (via audio recording or tailored text) for either a scheduled colonoscopy or return of a completed FIT. Participants in the EUC arm will receive the standard follow-up provided by their clinic or colonoscopy facility. The primary outcome will be completion of either colonoscopy or annual FIT over 3 years. Results will provide evidence on the effectiveness of the intervention to decrease disparities in CRC screening completion related to health literacy, race, and gender. Trial registration:Clinicaltrials.gov Identifier NCT04313114.
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Affiliation(s)
- Terry C Davis
- Department of Medicine and Feist-Weiller Cancer Center, Louisiana State University Health, 1501 Kings Highway, Shreveport, LA 71130
| | - James D Morris
- Department of Medicine and Feist-Weiller Cancer Center, Louisiana State University Health, 1501 Kings Highway, Shreveport, LA 71130
| | - Elise H Reed
- Grambling State University, 403 Main Street, GSU Box 4267, Grambling, LA 71245
| | - Laura M Curtis
- Division of General Internal Medicine and Geriatrics Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Drive, 10th Floor Chicago, IL 60611 USA
| | - Michael S Wolf
- Division of General Internal Medicine and Geriatrics Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Drive, 10th Floor Chicago, IL 60611 USA
| | - Adrienne B Davis
- Department of Medicine and Feist-Weiller Cancer Center, Louisiana State University Health, 1501 Kings Highway, Shreveport, LA 71130
| | - Connie L Arnold
- Department of Medicine and Feist-Weiller Cancer Center, Louisiana State University Health, 1501 Kings Highway, Shreveport, LA 71130,Corresponding author at: Professor, Department of Medicine, Chief, Division of Health Disparities, LSU Health Shreveport, Feist-Weiller Cancer Center, 1501 Kings Highway, P.O. Box 33932, Shreveport, LA 71130-3932,
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7
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Sava MG, Stanciu A, Dolan JG, May JH, Vargas LG. Implications of the stability analysis of preferences for personalised colorectal cancer screening. JOURNAL OF MULTI-CRITERIA DECISION ANALYSIS 2021. [DOI: 10.1002/mcda.1771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- M. Gabriela Sava
- Department of Management, Wilbur O. and Ann Powers College of Business Clemson University Clemson South Carolina USA
| | - Alia Stanciu
- Freeman College of Management Bucknell University Lewisburg Pennsylvania USA
| | | | - Jerrold H. May
- The Joseph M. Katz Graduate School of Business University of Pittsburgh Pittsburgh Pennsylvania USA
| | - Luis G. Vargas
- The Joseph M. Katz Graduate School of Business University of Pittsburgh Pittsburgh Pennsylvania USA
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Witteman HO, Ndjaboue R, Vaisson G, Dansokho SC, Arnold B, Bridges JFP, Comeau S, Fagerlin A, Gavaruzzi T, Marcoux M, Pieterse A, Pignone M, Provencher T, Racine C, Regier D, Rochefort-Brihay C, Thokala P, Weernink M, White DB, Wills CE, Jansen J. Clarifying Values: An Updated and Expanded Systematic Review and Meta-Analysis. Med Decis Making 2021; 41:801-820. [PMID: 34565196 PMCID: PMC8482297 DOI: 10.1177/0272989x211037946] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Patient decision aids should help people make evidence-informed decisions aligned with their values. There is limited guidance about how to achieve such alignment. Purpose To describe the range of values clarification methods available to patient decision aid developers, synthesize evidence regarding their relative merits, and foster collection of evidence by offering researchers a proposed set of outcomes to report when evaluating the effects of values clarification methods. Data Sources MEDLINE, EMBASE, PubMed, Web of Science, the Cochrane Library, and CINAHL. Study Selection We included articles that described randomized trials of 1 or more explicit values clarification methods. From 30,648 records screened, we identified 33 articles describing trials of 43 values clarification methods. Data Extraction Two independent reviewers extracted details about each values clarification method and its evaluation. Data Synthesis Compared to control conditions or to implicit values clarification methods, explicit values clarification methods decreased the frequency of values-incongruent choices (risk difference, –0.04; 95% confidence interval [CI], –0.06 to –0.02; P < 0.001) and decisional conflict (standardized mean difference, –0.20; 95% CI, –0.29 to –0.11; P < 0.001). Multicriteria decision analysis led to more values-congruent decisions than other values clarification methods (χ2 = 9.25, P = 0.01). There were no differences between different values clarification methods regarding decisional conflict (χ2 = 6.08, P = 0.05). Limitations Some meta-analyses had high heterogeneity. We grouped values clarification methods into broad categories. Conclusions Current evidence suggests patient decision aids should include an explicit values clarification method. Developers may wish to specifically consider multicriteria decision analysis. Future evaluations of values clarification methods should report their effects on decisional conflict, decisions made, values congruence, and decisional regret.
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Affiliation(s)
- Holly O Witteman
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada.,VITAM Research Centre, Quebec City, Quebec, Canada.,CHU de Québec Research Centre, Quebec City, Quebec, Canada
| | - Ruth Ndjaboue
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada.,VITAM Research Centre, Quebec City, Quebec, Canada
| | - Gratianne Vaisson
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada.,CHU de Québec Research Centre, Quebec City, Quebec, Canada
| | - Selma Chipenda Dansokho
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
| | - Bob Arnold
- UPMC Palliative and Supportive Institute, Division of General Internal Medicine, Section of Palliative Care and Medical Ethics, University of Pittsburgh, Pittsburgh, PA, USA
| | - John F P Bridges
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Sandrine Comeau
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
| | - Angela Fagerlin
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Teresa Gavaruzzi
- Department of Developmental Psychology and Socialization, University of Padova, Padova, Italy
| | - Melina Marcoux
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
| | - Arwen Pieterse
- Leiden University Medical Center, Leiden, The Netherlands
| | - Michael Pignone
- Departments of Internal Medicine and Population Health, Dell Medical School, University of Texas, Austin, TX, USA
| | - Thierry Provencher
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
| | - Charles Racine
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
| | - Dean Regier
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Charlotte Rochefort-Brihay
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
| | - Praveen Thokala
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | | | - Douglas B White
- Program on Ethics and Decision Making in Critical Illness, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Celia E Wills
- College of Nursing, Center on Healthy Aging, Self-Management and Complex Care, The Ohio State University, Columbus, OH, USA
| | - Jesse Jansen
- Department of Family Medicine/CAPHRI, Maastricht University, Maastricht, The Netherlands
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Hyams T, Golden B, Sammarco J, Sultan S, King-Marshall E, Wang MQ, Curbow B. Evaluating preferences for colorectal cancer screening in individuals under age 50 using the Analytic Hierarchy Process. BMC Health Serv Res 2021; 21:754. [PMID: 34325701 PMCID: PMC8320058 DOI: 10.1186/s12913-021-06705-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 06/28/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND In 2021, the United States Preventive Services Task Force updated their recommendation, stating that individuals ages 45-49 should initiate screening for colorectal cancer. Since several screening strategies are recommended, making a shared decision involves including an individual's preferences. Few studies have included individuals under age 50. In this study, we use a multicriteria decision analysis technique called the Analytic Hierarchy Process to explore preferences for screening strategies and evaluate whether preferences vary by age. METHODS Participants evaluated a hierarchy with 3 decision alternatives (colonoscopy, fecal immunochemical test, and computed tomography colonography), 3 criteria (test effectiveness, the screening plan, and features of the test) and 7 sub-criteria. We used the linear fit method to calculate consistency ratios and the eigenvector method for group preferences. We conducted sensitivity analysis to assess whether results are robust to change and tested differences in preferences by participant variables using chi-square and analysis of variance. RESULTS Of the 579 individuals surveyed, 556 (96%) provided complete responses to the AHP portion of the survey. Of these, 247 participants gave responses consistent enough (CR < 0.18) to be included in the final analysis. Participants that were either white or have lower health literacy were more likely to be excluded due to inconsistency. Colonoscopy was the preferred strategy in those < 50 and fecal immunochemical test was preferred by those over age 50 (p = 0.002). These results were consistent when we restricted analysis to individuals ages 45-55 (p = 0.011). Participants rated test effectiveness as the most important criteria for making their decision (weight = 0.555). Sensitivity analysis showed our results were robust to shifts in criteria and sub-criteria weights. CONCLUSIONS We reveal potential differences in preferences for screening strategies by age that could influence the adoption of screening programs to include individuals under age 50. Researchers and practitioners should consider at-home interventions using the Analytic Hierarchy Process to assist with the formulation of preferences that are key to shared decision-making. The costs associated with different preferences for screening strategies should be explored further if limited resources must be allocated to screen individuals ages 45-49.
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Affiliation(s)
- Travis Hyams
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, USA. .,Division of Cancer Control and Population Sciences, Office of the Director, National Cancer Institute, Bethesda, USA.
| | - Bruce Golden
- Department of Decision, Operations, and Information Technologies, Robert H. Smith School of Business, University of Maryland, College Park, USA
| | - John Sammarco
- Definitive Business Solutions, Inc., 11921 Freedom Drive, Suite 550, Reston, VA, 20190, USA
| | - Shahnaz Sultan
- Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis, USA
| | - Evelyn King-Marshall
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, USA
| | - Min Qi Wang
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, USA
| | - Barbara Curbow
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, USA
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10
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Salem D, Elwakil E. Expert-based approach to rank critical asset assessment factors for healthcare facilities. FACILITIES 2021. [DOI: 10.1108/f-05-2020-0060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
This research’s main objective is to develop an expert-based approach to rank critical asset assessment factors for health-care facilities. This approach will improve the asset management of health-care buildings. This paper aims to study and prioritize the relative importance of asset criticality factors.
Design/methodology/approach
The research methodology begins with a comprehensive literature review of state-of-the-art health-care facilities management, asset management tools, critical asset assessment and approaches to model techniques. Then, using the expert-based opinion and the collected data through the analytical hierarchy process approach to developing the asset assessment model contains physical, environmental, general safety and revenue loss assessment models.
Findings
Results showed that the general safety factors and the sub-factors of life safety and physical safety contributed to asset condition assessment.
Practical implications
The proposed critical asset assessment ranking will benefit health-care facility organizations by assessing their asset performance according to capital renewal needs.
Originality/value
This study offers a novel conceptual framework to understand and determine rank critical asset assessment factors for health-care facilities.
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11
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Rahimi SA, Dery J, Lamontagne ME, Jamshidi A, Lacroix E, Ruiz A, Ait-Kadi D, Routhier F. Prioritization of patients access to outpatient augmentative and alternative communication services in Quebec: a decision tool. Disabil Rehabil Assist Technol 2020; 17:8-15. [PMID: 32501741 DOI: 10.1080/17483107.2020.1751314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose: A large number of people living with a chronic disability wait a long time to access publicly funded rehabilitation services such as Augmentative and Alternative Communication (AAC) services, and there is no standardized tool to prioritize these patients. We aimed to develop a prioritization tool to improve the organization and access to the care for this population.Methods: In this sequential mixed methods study, we began with a qualitative phase in which we conducted semi-structured interviews with 14 stakeholders including patients, their caregivers, and AAC service providers in Quebec City, Canada to gather their ideas about prioritization criteria. Then, during a half-day consensus group meeting with stakeholders, using a consensus-seeking technique (i.e. Technique for Research of Information by Animation of a Group of Experts), we reached consensus on the most important prioritization criteria. These criteria informed the quantitative phase in which used an electronic questionnaire to collect stakeholders' views regarding the relative weights for each of the selected criteria. We analyzed these data using a hybrid quantitative method called group based fuzzy analytical hierarchy process, to obtain the importance weights of the selected eight criteria.Results: Analyses of the interviews revealed 48 criteria. Collectively, the stakeholders reached consensus on eight criteria, and through the electronic questionnaire they defined the selected criteria's importance weights. The selected eight prioritization criteria and their importance weights are: person's safety (weight: 0.274), risks development potential (weight: 0.144), psychological well-being (weight: 0.140), physical well-being (weight: 0.124), life prognosis (weight: 0.106), possible impact on social environment (weight: 0.085), interpersonal relationships (weight: 0.073), and responsibilities and social role (weight: 0.054).Conclusion: In this study, we co-developed a prioritization decision tool with the key stakeholders for prioritization of patients who are referred to AAC services in rehabilitation settings.IMPLICATIONS FOR REHABILIATIONStudies in Canada have shown that people in Canada with a need for rehabilitation services are not receiving publicly available services in a timely manner.There is no standardized tool for the prioritization of AAC patients.In this mixed methods study, we co-developed a prioritization tool with key stakeholders for prioritization of patients who are referred to AAC services in a rehabilitation center in Quebec, Canada.
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Affiliation(s)
- Samira Abbasgholizadeh Rahimi
- Department of Family Medicine, McGill University, Montreal, Canada.,Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
| | - Julien Dery
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Quebec City, Canada.,Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, Canada
| | - Marie-Eve Lamontagne
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Quebec City, Canada.,Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, Canada
| | - Afshin Jamshidi
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Quebec City, Canada.,Department of Mechanical Engineering, Faculty of Science and Engineering, Université Laval, Quebec City, Canada
| | - Emilie Lacroix
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Quebec City, Canada
| | - Angel Ruiz
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Quebec City, Canada.,Department of Operations and Decision Systems, Faculty of Administration Sciences, Université Laval, Quebec City, Canada
| | - Daoud Ait-Kadi
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Quebec City, Canada.,Department of Mechanical Engineering, Faculty of Science and Engineering, Université Laval, Quebec City, Canada
| | - François Routhier
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Quebec City, Canada.,Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, Canada
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Qaseem A, Crandall CJ, Mustafa RA, Hicks LA, Wilt TJ, Forciea MA, Fitterman N, Horwitch CA, Kansagara D, Maroto M, McLean RM, Roa J, Tufte J. Screening for Colorectal Cancer in Asymptomatic Average-Risk Adults: A Guidance Statement From the American College of Physicians. Ann Intern Med 2019; 171:643-654. [PMID: 31683290 PMCID: PMC8152103 DOI: 10.7326/m19-0642] [Citation(s) in RCA: 101] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
DESCRIPTION The purpose of this guidance statement is to guide clinicians on colorectal cancer screening in average-risk adults. METHODS This guidance statement is derived from a critical appraisal of guidelines on screening for colorectal cancer in average-risk adults and the evidence presented in these guidelines. National guidelines published in English between 1 June 2014 and 28 May 2018 in the National Guideline Clearinghouse or Guidelines International Network library were included. The authors also included 3 guidelines commonly used in clinical practice. Web sites were searched for guideline updates in December 2018. The AGREE II (Appraisal of Guidelines for Research and Evaluation II) instrument was used to evaluate the quality of guidelines. TARGET AUDIENCE AND PATIENT POPULATION The target audience is all clinicians, and the target patient population is adults at average risk for colorectal cancer. GUIDANCE STATEMENT 1 Clinicians should screen for colorectal cancer in average-risk adults between the ages of 50 and 75 years. GUIDANCE STATEMENT 2 Clinicians should select the colorectal cancer screening test with the patient on the basis of a discussion of benefits, harms, costs, availability, frequency, and patient preferences. Suggested screening tests and intervals are fecal immunochemical testing or high-sensitivity guaiac-based fecal occult blood testing every 2 years, colonoscopy every 10 years, or flexible sigmoidoscopy every 10 years plus fecal immunochemical testing every 2 years. GUIDANCE STATEMENT 3 Clinicians should discontinue screening for colorectal cancer in average-risk adults older than 75 years or in adults with a life expectancy of 10 years or less.
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Affiliation(s)
- Amir Qaseem
- American College of Physicians, Philadelphia, Pennsylvania (A.Q.)
| | - Carolyn J Crandall
- David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California (C.J.C.)
| | - Reem A Mustafa
- University of Kansas Medical Center, Kansas City, Kansas (R.A.M.)
| | - Lauri A Hicks
- Centers for Disease Control and Prevention, Atlanta, Georgia (L.A.H.)
| | - Timothy J Wilt
- Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota (T.J.W.)
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Abbasgholizadeh Rahimi S, Archambault PM, Ravitsky V, Lemoine ME, Langlois S, Forest JC, Giguère AMC, Rousseau F, Dolan JG, Légaré F. An Analytical Mobile App for Shared Decision Making About Prenatal Screening: Protocol for a Mixed Methods Study. JMIR Res Protoc 2019; 8:e13321. [PMID: 31596249 PMCID: PMC6913686 DOI: 10.2196/13321] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 05/09/2019] [Accepted: 05/25/2019] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Decisions about prenatal screening to assess the risk of genetic conditions such as Down syndrome are complex and should be well informed. Moreover, the number of available tests is increasing. Shared decision making (SDM) about testing could be facilitated by decision aids powered by mobile technology. OBJECTIVE In this mixed methods study, we aim to (1) assess women's needs and preferences regarding using an app for considering prenatal screening, (2) develop a decision model using the analytical hierarchy process, and (3) develop an analytical app and assess its usability and usefulness. METHODS In phase 1, we will assess the needs of 90 pregnant women and their partners (if available). We will identify eligible participants in 3 clinical sites (a midwife-led birthing center, a family practice clinic, and an obstetrician-led hospital-based clinic) in Quebec City and Montreal, Canada. Using semistructured interviews, we will assess participants' attitudes toward mobile apps for decision making about health, their current use of apps for health purposes, and their expectations of an app for prenatal testing decisions. Self-administered questionnaires will collect sociodemographic information, intentions to use an app for prenatal testing, and perceived importance of decision criteria. Qualitative data will be transcribed verbatim and analyzed thematically. Quantitative data will be analyzed using descriptive statistics and the analytic hierarchy process (AHP) method. In phase 2, we will develop a decision model using the AHP whereby users can assign relative importance to criteria when deciding between options. We will validate the model with potential users and a multidisciplinary team of patients, family physicians, primary care researchers, decision sciences experts, engineers, and experts in SDM, genetics, and bioethics. In phase 3, we will develop a prototype of the app using the results of the first 2 phases, pilot test its usefulness and usability among a sample of 15 pregnant women and their partners (if available), and improve it through 3 iterations. Data will be collected with a self-administered questionnaire. Results will be analyzed using descriptive statistics. RESULTS Recruitment for phase 1 will begin in 2019. We expect results to be available in 2021. CONCLUSIONS This study will result in a validated analytical app that will provide pregnant women and their partners with up-to-date information about prenatal screening options and their risks and benefits. It will help them clarify their values and enable them to weigh the options to make informed choices consistent with their preferences and values before meeting face-to-face with their health care professional. The app will be easy to update with the latest information and will provide women with a user-friendly experience using their smartphones or tablets. This study and the resulting app will contribute to high-quality SDM between pregnant women and their health care team. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/13321.
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Affiliation(s)
- Samira Abbasgholizadeh Rahimi
- Department of Family Medicine, McGill University, Montreal, QC, Canada.,Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
| | - Patrick M Archambault
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Québec, QC, Canada.,Centre de recherche, Centre intégré en santé et services sociaux de Chaudière-Appalaches, Lévis, QC, Canada.,Centre de recherche sur les soins et les services de première ligne de l'Université Laval, Université Laval, Québec, QC, Canada
| | - Vardit Ravitsky
- Programmes de bioéthique, Département de médecine sociale et préventive, École de santé publique de l'Université de Montréal, Université de Montréal, Montréal, QC, Canada
| | - Marie-Eve Lemoine
- Programmes de bioéthique, Département de médecine sociale et préventive, École de santé publique de l'Université de Montréal, Université de Montréal, Montréal, QC, Canada
| | - Sylvie Langlois
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
| | - Jean-Claude Forest
- Centre de recherche, Centre hospitalier universitaire de Québec, Québec, QC, Canada.,Department of Molecular Biology, Medical Biochemistry and Pathology, Faculty of Medicine, Université Laval, Québec, QC, Canada
| | - Anik M C Giguère
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Québec, QC, Canada.,Canadian Research Chair in Shared Decision Making and Knowledge Translation, Québec, QC, Canada
| | - François Rousseau
- Department of Molecular Biology, Medical Biochemistry and Pathology, Faculty of Medicine, Université Laval, Québec, QC, Canada
| | - James G Dolan
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, United States
| | - France Légaré
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Québec, QC, Canada.,Centre de recherche sur les soins et les services de première ligne de l'Université Laval, Université Laval, Québec, QC, Canada
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14
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Davis TC, Rademaker A, Morris J, Ferguson LA, Wiltz G, Arnold CL. Repeat Annual Colorectal Cancer Screening in Rural Community Clinics: A Randomized Clinical Trial to Evaluate Outreach Strategies to Sustain Screening. J Rural Health 2019; 36:307-315. [PMID: 31523848 DOI: 10.1111/jrh.12399] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 07/17/2019] [Accepted: 08/19/2019] [Indexed: 12/14/2022]
Abstract
PURPOSE The majority of colorectal cancer (CRC) research using the fecal immunochemical test (FIT) has studied short-term screening results in predominantly urban areas. The purpose of this study was to evaluate the effectiveness of 2 outreach strategies embedded in a health literacy intervention on repeat CRC screening in rural community clinics. METHODS A 2-arm randomized controlled trial was conducted in 4 rural clinics in Louisiana. During a regularly scheduled clinic visit, participants ages 50-75 received a FIT kit and brief educational intervention. Participants were randomized to receive an automated call or a personal call by a prevention counselor after 4 weeks and 8 weeks if FIT kits were not returned. In year 2, materials were mailed, and follow-up calls were conducted as in year 1. The primary outcome was repeat FIT-the return of the FIT kit in both years. PARTICIPANTS Of 568 eligible participants, 55% were female, 67% were African American, and 39% had low health literacy. FINDINGS Repeat FIT rates were 36.5% for those receiving the automated call and 33.6% for those receiving a personal call (P = .30). No annual FITs were returned in 30% of participants, while only 1 FIT was returned by 35% of participants (31% only year 1 and 4% only year 2). CONCLUSION Sustaining CRC screening with FIT is challenging in rural clinics. A lower cost automated call was just as effective as the personal call in promoting repeat annual screening. However, more intensive strategies are needed to improve long-term FIT screening among rural participants.
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Affiliation(s)
- Terry C Davis
- Department of Medicine, Louisiana State University Health Sciences Center, Shreveport, Louisiana
| | - Alfred Rademaker
- Department of Preventive Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois
| | - James Morris
- Department of Medicine, Louisiana State University Health Sciences Center, Shreveport, Louisiana
| | | | - Gary Wiltz
- Teche Action Clinic, Franklin, Louisiana
| | - Connie L Arnold
- Department of Medicine, Louisiana State University Health Sciences Center, Shreveport, Louisiana
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15
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Sicsic J, Pelletier-Fleury N, Carretier J, Moumjid N. [Eliciting women’s preferences for breast cancer screening]. SANTE PUBLIQUE 2019; 2:7-17. [PMID: 32372583 DOI: 10.3917/spub.197.0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Over the past decade, the balance between the benefits and harms of breast cancer screening (BCS) has been widely debated. To date, no French study has interrogated women's points of view and preferences (in the economic sense) for this controversial screening. This study aims to bridge this gap. We aimed to elicit women's trade-offs between the benefits and harms of BCS. METHODS A discrete choice experiment questionnaire was developed and administered by a survey institute to French women in order to elicit their preferences and trade-offs between the benefits and risks of BCS (i.e., overdiagnosis and false-positive mammography). RESULTS Eight hundred and twelve women, representative of the French general population (age, socioeconomic level, and geographical location), completed the survey. The women would be willing to accept on average 14.1 overdiagnosis cases (median = 9.6) and 47.8 women with a false-positive result (median = 27.2) to avoid one BC-related death. Results from our simulations predict that less than 50% of women would be willing to accept 10 overdiagnosis cases (respectively, 30 women with a false-positive mammography) for one BC-related death avoided. CONCLUSION Women are sensitive to both the benefits and harms of BC screening and their preferences are highly heterogeneous. Providing balanced information on both benefits and harms to women through an informed decision-making process would be more respectful of women's preferences.
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16
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Leddin D, Lieberman DA, Tse F, Barkun AN, Abou-Setta AM, Marshall JK, Samadder NJ, Singh H, Telford JJ, Tinmouth J, Wilkinson AN, Leontiadis GI. Clinical Practice Guideline on Screening for Colorectal Cancer in Individuals With a Family History of Nonhereditary Colorectal Cancer or Adenoma: The Canadian Association of Gastroenterology Banff Consensus. Gastroenterology 2018; 155:1325-1347.e3. [PMID: 30121253 DOI: 10.1053/j.gastro.2018.08.017] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS A family history (FH) of colorectal cancer (CRC) increases the risk of developing CRC. These consensus recommendations developed by the Canadian Association of Gastroenterology and endorsed by the American Gastroenterological Association, aim to provide guidance on screening these high-risk individuals. METHODS Multiple parallel systematic review streams, informed by 10 literature searches, assembled evidence on 5 principal questions around the effect of an FH of CRC or adenomas on the risk of CRC, the age to initiate screening, and the optimal tests and testing intervals. The GRADE (Grading of Recommendation Assessment, Development and Evaluation) approach was used to develop the recommendations. RESULTS Based on the evidence, the Consensus Group was able to strongly recommend CRC screening for all individuals with an FH of CRC or documented adenoma. However, because most of the evidence was very-low quality, the majority of the remaining statements were conditional ("we suggest"). Colonoscopy is suggested (recommended in individuals with ≥2 first-degree relatives [FDRs]), with fecal immunochemical test as an alternative. The elevated risk associated with an FH of ≥1 FDRs with CRC or documented advanced adenoma suggests initiating screening at a younger age (eg, 40-50 years or 10 years younger than age of diagnosis of FDR). In addition, a shorter interval of every 5 years between screening tests was suggested for individuals with ≥2 FDRs, and every 5-10 years for those with FH of 1 FDR with CRC or documented advanced adenoma compared to average-risk individuals. Choosing screening parameters for an individual patient should consider the age of the affected FDR and local resources. It is suggested that individuals with an FH of ≥1 second-degree relatives only, or of nonadvanced adenoma or polyp of unknown histology, be screened according to average-risk guidelines. CONCLUSIONS The increased risk of CRC associated with an FH of CRC or advanced adenoma warrants more intense screening for CRC. Well-designed prospective studies are needed in order to make definitive evidence-based recommendations about the age to commence screening and appropriate interval between screening tests.
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Affiliation(s)
- Desmond Leddin
- Graduate Entry Medical School, University of Limerick, Ireland; Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
| | - David A Lieberman
- Division of Gastroenterology, Oregon Health and Science University, Portland, Oregon
| | - Frances Tse
- Division of Gastroenterology and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Alan N Barkun
- Division of Gastroenterology, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Ahmed M Abou-Setta
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - John K Marshall
- Division of Gastroenterology and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - N Jewel Samadder
- Division of Gastroenterology and Hepatology, Department of Clinical Genomics, Mayo Clinic, Phoenix, Arizona
| | - Harminder Singh
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Section of Gastroenterology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jennifer J Telford
- Division of Gastroenterology, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jill Tinmouth
- Department of Medicine, Sunnybrook and Women's College Health Sciences Centre, Toronto, Ontario, Canada
| | - Anna N Wilkinson
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Grigorios I Leontiadis
- Division of Gastroenterology and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
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17
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Kistler CE, Golin C, Sundaram A, Morris C, Dalton AF, Ferrari R, Lewis CL. Individualized Colorectal Cancer Screening Discussions Between Older Adults and Their Primary Care Providers: A Cross-Sectional Study. MDM Policy Pract 2018; 3:2381468318765172. [PMID: 30288441 PMCID: PMC6157429 DOI: 10.1177/2381468318765172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 02/08/2018] [Indexed: 01/08/2023] Open
Abstract
Introduction. Discussions of colorectal cancer (CRC) screening with older adults should be individualized to maximize appropriate screening. Our aim was to describe CRC screening discussions and explore their associations with patient characteristics and screening intentions. Methods. Cross-sectional survey of 422 primary care patients aged ≥70 years and eligible for CRC screening, including open-ended questions about CRC screening discussions. Primary outcomes were the frequency with which CRC screening discussions occurred, who had those discussions, and the domains that emerged from thematic analysis of participants' brief reports of their discussions. We also examined the associations between 1) patient characteristics and whether a screening discussion occurred and 2) the domains discussed and what screening decisions were made. Results. Of 422 participants, 209 reported having discussions and 201 responded to open-ended questions about CRC discussions. In a regression analysis, several factors were associated with increased odds of having a discussion: participants' preference to pursue screening (odds ratio [OR] 2.3, 95% confidence interval [CI] 1.3, 3.9), good health (OR 2.9, 95% CI 1.7, 4.8), and receipt of the decision aid (OR 2.1, 95% CI 1.4, 3.2). Our thematic analysis identified five domains related to discussion content and three related to discussion process. The CRC screening-related information domain was the most commonly discussed content domain, and the timing/frequency domain was associated with increased odds of intent to pursue screening. Decision-making role, the most commonly discussed process domain, was associated with increased odds of the intent to forgo CRC screening. Conclusions and Relevance. CRC screening discussions varied by type of participant and content. Future work is needed to determine if interventions focused on specific domains alters the appropriateness of participants' colorectal cancer screening intentions.
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Affiliation(s)
- Christine E Kistler
- Department of Family Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Carol Golin
- Department of Medicine, and Department of Health Behavior, Gillings School of Global Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Anupama Sundaram
- School of Medicine, Northeast Ohio Medical University, Rootstown, OH, USA
| | - Carolyn Morris
- Department of Family Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Alexandra F Dalton
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Renee Ferrari
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Carmen L Lewis
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA
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18
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Lehmann HP, Downs SM. Desiderata for sharable computable biomedical knowledge for learning health systems. Learn Health Syst 2018; 2:e10065. [PMID: 31245589 PMCID: PMC6508769 DOI: 10.1002/lrh2.10065] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 07/02/2018] [Accepted: 07/03/2018] [Indexed: 01/02/2023] Open
Abstract
In this commentary, we work out the specific desired functions required for sharing knowledge objects (based on statistical models) presumably to be used for clinical decision support derived from a learning health system, and, in so doing, discuss the implications for novel knowledge architectures. We will demonstrate how decision models, implemented as influence diagrams, satisfy the desiderata. The desiderata include locally validate discrimination, locally validate calibration, locally recalculate thresholds by incorporating local preferences, provide explanation, enable monitoring, enable debiasing, account for generalizability, account for semantic uncertainty, shall be findable, and others as necessary and proper. We demonstrate how formal decision models, especially when implemented as influence diagrams based on Bayesian networks, support both the knowledge artifact itself (the "primary decision") and the "meta-decision" of whether to deploy the knowledge artifact. We close with a research and development agenda to put this framework into place.
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Wolf AMD, Fontham ETH, Church TR, Flowers CR, Guerra CE, LaMonte SJ, Etzioni R, McKenna MT, Oeffinger KC, Shih YCT, Walter LC, Andrews KS, Brawley OW, Brooks D, Fedewa SA, Manassaram-Baptiste D, Siegel RL, Wender RC, Smith RA. Colorectal cancer screening for average-risk adults: 2018 guideline update from the American Cancer Society. CA Cancer J Clin 2018; 68:250-281. [PMID: 29846947 DOI: 10.3322/caac.21457] [Citation(s) in RCA: 1166] [Impact Index Per Article: 194.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 04/23/2018] [Indexed: 12/11/2022] Open
Abstract
In the United States, colorectal cancer (CRC) is the fourth most common cancer diagnosed among adults and the second leading cause of death from cancer. For this guideline update, the American Cancer Society (ACS) used an existing systematic evidence review of the CRC screening literature and microsimulation modeling analyses, including a new evaluation of the age to begin screening by race and sex and additional modeling that incorporates changes in US CRC incidence. Screening with any one of multiple options is associated with a significant reduction in CRC incidence through the detection and removal of adenomatous polyps and other precancerous lesions and with a reduction in mortality through incidence reduction and early detection of CRC. Results from modeling analyses identified efficient and model-recommendable strategies that started screening at age 45 years. The ACS Guideline Development Group applied the Grades of Recommendations, Assessment, Development, and Evaluation (GRADE) criteria in developing and rating the recommendations. The ACS recommends that adults aged 45 years and older with an average risk of CRC undergo regular screening with either a high-sensitivity stool-based test or a structural (visual) examination, depending on patient preference and test availability. As a part of the screening process, all positive results on noncolonoscopy screening tests should be followed up with timely colonoscopy. The recommendation to begin screening at age 45 years is a qualified recommendation. The recommendation for regular screening in adults aged 50 years and older is a strong recommendation. The ACS recommends (qualified recommendations) that: 1) average-risk adults in good health with a life expectancy of more than 10 years continue CRC screening through the age of 75 years; 2) clinicians individualize CRC screening decisions for individuals aged 76 through 85 years based on patient preferences, life expectancy, health status, and prior screening history; and 3) clinicians discourage individuals older than 85 years from continuing CRC screening. The options for CRC screening are: fecal immunochemical test annually; high-sensitivity, guaiac-based fecal occult blood test annually; multitarget stool DNA test every 3 years; colonoscopy every 10 years; computed tomography colonography every 5 years; and flexible sigmoidoscopy every 5 years. CA Cancer J Clin 2018;68:250-281. © 2018 American Cancer Society.
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Affiliation(s)
- Andrew M D Wolf
- Associate Professor and Attending Physician, University of Virginia School of Medicine, Charlottesville, VA
| | - Elizabeth T H Fontham
- Emeritus Professor, Louisiana State University School of Public Health, New Orleans, LA
| | - Timothy R Church
- Professor, University of Minnesota and Masonic Cancer Center, Minneapolis, MN
| | - Christopher R Flowers
- Professor and Attending Physician, Emory University School of Medicine and Winship Cancer Institute, Atlanta, GA
| | - Carmen E Guerra
- Associate Professor of Medicine of the Perelman School of Medicine and Attending Physician, University of Pennsylvania Medical Center, Philadelphia, PA
| | - Samuel J LaMonte
- Independent retired physician and patient advocate, University of Washington and the Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Ruth Etzioni
- Biostatistician, University of Washington and the Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Matthew T McKenna
- Professor and Director, Division of Preventive Medicine, Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, GA
| | - Kevin C Oeffinger
- Professor and Director of the Duke Center for Onco-Primary Care, Durham, NC
| | - Ya-Chen Tina Shih
- Professor, Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Louise C Walter
- Professor and Attending Physician, University of California, San Francisco and San Francisco VA Medical Center, San Francisco, CA
| | - Kimberly S Andrews
- Director, Cancer Control Department, American Cancer Society, Atlanta, GA
| | - Otis W Brawley
- Chief Medical and Scientific Officer and Executive Vice President-Research, American Cancer Society, Atlanta, GA
| | - Durado Brooks
- Vice President, Cancer Control Interventions, Cancer Control Department, American Cancer Society, Atlanta, GA
| | - Stacey A Fedewa
- Strategic Director for Risk Factor Screening and Surveillance, American Cancer Society, Atlanta, GA
| | | | - Rebecca L Siegel
- Strategic Director, Surveillance Information Services, American Cancer Society, Atlanta, GA
| | - Richard C Wender
- Chief Cancer Control Officer, American Cancer Society, Atlanta, GA
| | - Robert A Smith
- Vice President, Cancer Screening, Cancer Control Department, American Cancer Society, Atlanta, GA
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20
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Abstract
BACKGROUND Multicriteria decision-making (MCDM) methods are well-suited to serve as the foundation for clinical decision support systems. To do so, however, they need to be appropriate for use in busy clinical settings. We compared decision-making processes and outcomes of patient-level analyses done with a range of multicriteria methods that vary in ease of use and intensity of decision support, 2 factors that could affect their ease of implementation into practice. METHODS We conducted a series of Internet surveys to compare the effects of 5 multicriteria methods that differ in user interface and required user input format on decisions regarding selection of a preferred method for lowering the risk of cardiovascular disease. The study sample consisted of members of an online Internet panel maintained by Fluidsurveys, an Internet survey company. Study outcomes were changes in preferred option, decision confidence, preparation for decision making, the Values Clarification and Decisional Uncertainty subscales of the Decisional Conflict Scale, and method ease of use. RESULTS The frequency of changes in the preferred option ranged from 9% to 38%, P < 0.001, and rose progressively as the level of decision support provided by the MCDM method increased. The proportion of respondents who rated the method as easy ranged from 57% to 79% and differed significantly among MCDM methods, P = 0.003, but was not consistently related to intensity of decision support or ease of use. CONCLUSION Decision support based on MCDM methods is not necessarily limited by decreases in ease of use. This result suggests that it is possible to develop decision support tools using sophisticated multicriteria techniques suitable for use in routine clinical care settings.
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Affiliation(s)
- James G Dolan
- Department of Public Health Sciences, University of Rochester, Rochester, NY
| | - Peter J Veazie
- Department of Public Health Sciences, University of Rochester, Rochester, NY
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21
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Sava MG, Dolan JG, May JH, Vargas LG. A Personalized Approach of Patient-Health Care Provider Communication Regarding Colorectal Cancer Screening Options. Med Decis Making 2018; 38:601-613. [PMID: 29611458 DOI: 10.1177/0272989x18763802] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Current colorectal cancer screening guidelines by the US Preventive Services Task Force endorse multiple options for average-risk patients and recommend that screening choices should be guided by individual patient preferences. Implementing these recommendations in practice is challenging because they depend on accurate and efficient elicitation and assessment of preferences from patients who are facing a novel task. OBJECTIVE To present a methodology for analyzing the sensitivity and stability of a patient's preferences regarding colorectal cancer screening options and to provide a starting point for a personalized discussion between the patient and the health care provider about the selection of the appropriate screening option. METHODS This research is a secondary analysis of patient preference data collected as part of a previous study. We propose new measures of preference sensitivity and stability that can be used to determine if additional information provided would result in a change to the initially most preferred colorectal cancer screening option. RESULTS Illustrative results of applying the methodology to the preferences of 2 patients, of different ages, are provided. The results show that different combinations of screening options are viable for each patient and that the health care provider should emphasize different information during the medical decision-making process. CONCLUSION Sensitivity and stability analysis can supply health care providers with key topics to focus on when communicating with a patient and the degree of emphasis to place on each of them to accomplish specific goals. The insights provided by the analysis can be used by health care providers to approach communication with patients in a more personalized way, by taking into consideration patients' preferences before adding their own expertise to the discussion.
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Affiliation(s)
| | - James G Dolan
- University of Rochester Medical Center, Rochester, NY, USA
| | - Jerrold H May
- The Joseph M. Katz Graduate School of Business, University of Pittsburgh, Pittsburgh, PA, USA
| | - Luis G Vargas
- The Joseph M. Katz Graduate School of Business, University of Pittsburgh, Pittsburgh, PA, USA
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Wagner M, Samaha D, Khoury H, O'Neil WM, Lavoie L, Bennetts L, Badgley D, Gabriel S, Berthon A, Dolan J, Kulke MH, Goetghebeur M. Development of a Framework Based on Reflective MCDA to Support Patient-Clinician Shared Decision-Making: The Case of the Management of Gastroenteropancreatic Neuroendocrine Tumors (GEP-NET) in the United States. Adv Ther 2018; 35:81-99. [PMID: 29270780 PMCID: PMC5778190 DOI: 10.1007/s12325-017-0653-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Indexed: 01/15/2023]
Abstract
Introduction Well- or moderately differentiated gastroenteropancreatic neuroendocrine tumors (GEP-NETs) are often slow-growing, and some patients with unresectable, asymptomatic, non-functioning tumors may face the choice between watchful waiting (WW), or somatostatin analogues (SSA) to delay progression. We developed a comprehensive multi-criteria decision analysis (MCDA) framework to help patients and physicians clarify their values and preferences, consider each decision criterion, and support communication and shared decision-making. Methods The framework was adapted from a generic MCDA framework (EVIDEM) with patient and clinician input. During a workshop, patients and clinicians expressed their individual values and preferences (criteria weights) and, on the basis of two scenarios (treatment vs WW; SSA-1 [lanreotide] vs SSA-2 [octreotide]) with evidence from a literature review, expressed how consideration of each criterion would impact their decision in favor of either option (score), and shared their knowledge and insights verbally and in writing. Results The framework included benefit-risk criteria and modulating factors, such as disease severity, quality of evidence, costs, and constraints. Overall and progression-free survival being most important, criteria weights ranged widely, highlighting variations in individual values and the need to share them. Scoring and considering each criterion prompted a rich exchange of perspectives and uncovered individual assumptions and interpretations. At the group level, type of benefit, disease severity, effectiveness, and quality of evidence favored treatment; cost aspects favored WW (scenario 1). For scenario 2, most criteria did not favor either option. Conclusions Patients and clinicians consider many aspects in decision-making. The MCDA framework provided a common interpretive frame to structure this complexity, support individual reflection, and share perspectives. Funding Ipsen Pharma. Electronic supplementary material The online version of this article (10.1007/s12325-017-0653-1) contains supplementary material, which is available to authorized users.
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PATIENT-CENTERED DECISION MAKING: LESSONS FROM MULTI-CRITERIA DECISION ANALYSIS FOR QUANTIFYING PATIENT PREFERENCES. Int J Technol Assess Health Care 2017; 34:105-110. [PMID: 29277175 DOI: 10.1017/s0266462317001118] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Patient preferences should be a central consideration in healthcare decision making. However, stories of patients challenging regulatory and reimbursement decisions has led to questions on whether patient voices are being considered sufficiently during those decision making processes. This has led some to argue that it is necessary to quantify patient preferences before they can be adequately considered. METHODS This study considers the lessons from the use of multi-criteria decision analysis (MCDA) for efforts to quantify patient preferences. It defines MCDA and summarizes the benefits it can provide to decision makers, identifies examples of MCDAs that have involved patients, and summarizes good practice guidelines as they relate to quantifying patient preferences. RESULTS The guidance developed to support the use of MCDA in healthcare provide some useful considerations for the quantification of patient preferences, namely that researchers should give appropriate consideration to: the heterogeneity of patient preferences, and its relevance to decision makers; the cognitive challenges posed by different elicitation methods; and validity of the results they produce. Furthermore, it is important to consider how the relevance of these considerations varies with the decision being supported. CONCLUSIONS The MCDA literature holds important lessons for how patient preferences should be quantified to support healthcare decision making.
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Campolina AG, Soárez PCD, Amaral FVD, Abe JM. [Multi-criteria decision analysis for health technology resource allocation and assessment: so far and so near?]. CAD SAUDE PUBLICA 2017; 33:e00045517. [PMID: 29091169 DOI: 10.1590/0102-311x00045517] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 07/17/2017] [Indexed: 11/22/2022] Open
Abstract
Multi-criteria decision analysis (MCDA) is an emerging tool that allows the integration of relevant factors for health technology assessment (HTA). This study aims to present a summary of the methodological characteristics of MCDA: definitions, approaches, applications, and implementation stages. A case study was conducted in the São Paulo State Cancer Institute (ICESP) in order to understand the perspectives of decision-makers in the process of drafting a recommendation for the incorporation of technology in the Brazilian Unified National Health System (SUS), through a report by the Brazilian National Commission for the Incorporation of Technologies in the SUS (CONITEC). Paraconsistent annotated evidential logic Eτ was the methodological approach adopted in the study, since it can serve as an underlying logic for constructs capable of synthesizing objective information (from the scientific literature) and subjective information (from experts' values and preferences in the area of knowledge). It also allows the incorporation of conflicting information (contradictions), as well as vague and even incomplete information in the valuation process, resulting from imperfection of the available scientific evidence. The method has the advantages of allowing explicit consideration of the criteria that influenced the decision, facilitating follow-up and visualization of process stages, allowing assessment of the contribution of each criterion separately, and in aggregate, to the decision's outcome, facilitating the discussion of diverging perspectives by different stakeholder groups, and increasing the understanding of the resulting recommendations. The use of an explicit MCDA approach should facilitate conflict mediation and optimize participation by different stakeholder groups.
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Affiliation(s)
- Alessandro Gonçalves Campolina
- Instituto do Câncer do Estado de São Paulo, São Paulo, Brasil.,Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brasil.,Instituto de Avaliação de Tecnologias em Saúde, São Paulo, Brasil
| | - Patrícia Coelho De Soárez
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brasil.,Instituto de Avaliação de Tecnologias em Saúde, São Paulo, Brasil
| | | | - Jair Minoro Abe
- Pós-graduação em Engenharia de Produção, Universidade Paulista, São Paulo, Brasil.,Instituto de Estudos Avançados, Universidade de São Paulo, São Paulo, Brasil
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Marsh K, Caro JJ, Hamed A, Zaiser E. Amplifying Each Patient's Voice: A Systematic Review of Multi-criteria Decision Analyses Involving Patients. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2017; 15:155-162. [PMID: 27928659 DOI: 10.1007/s40258-016-0299-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Qualitative methods tend to be used to incorporate patient preferences into healthcare decision making. However, for patient preferences to be given adequate consideration by decision makers they need to be quantified. Multi-criteria decision analysis (MCDA) is one way to quantify and capture the patient voice. The objective of this review was to report on existing MCDAs involving patients to support the future use of MCDA to capture the patient voice. METHODS MEDLINE and EMBASE were searched in June 2014 for English-language papers with no date restriction. The following search terms were used: 'multi-criteria decision*', 'multiple criteria decision*', 'MCDA', 'benefit risk assessment*', 'risk benefit assessment*', 'multicriteri* decision*', 'MCDM', 'multi-criteri* decision*'. Abstracts were included if they reported the application of MCDA to assess healthcare interventions where patients were the source of weights. Abstracts were excluded if they did not apply MCDA, such as discussions of how MCDA could be used; or did not evaluate healthcare interventions, such as MCDAs to assess the level of health need in a locality. Data were extracted on weighting method, variation in patient and expert preferences, and discussion on different weighting techniques. RESULTS The review identified ten English-language studies that reported an MCDA to assess healthcare interventions and involved patients as a source of weights. These studies reported 12 applications of MCDA. Different methods of preference elicitation were employed: direct weighting in workshops; discrete choice experiment surveys; and the analytical hierarchy process using both workshops and surveys. There was significant heterogeneity in patient responses and differences between patients, who put greater weight on disease characteristics and treatment convenience, and experts, who put more weight on efficacy. The studies highlighted cognitive challenges associated with some weighting methods, though patients' views on their ability to undertake weighting tasks was positive. CONCLUSION This review identified several recent examples of MCDA used to elicit patient preferences, which support the feasibility of using MCDA to capture the patient voice. Challenges identified included, how best to reflect the heterogeneity of patient preferences in decision making and how to manage the cognitive burden associated with some MCDA tasks.
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Affiliation(s)
- Kevin Marsh
- Evidera, Metro Building 6th Floor, 1 Butterwick, London, W6 8DL, UK.
| | | | | | - Erica Zaiser
- Evidera, Metro Building 6th Floor, 1 Butterwick, London, W6 8DL, UK
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Pauer F, Schmidt K, Babac A, Damm K, Frank M, von der Schulenburg JMG. Comparison of different approaches applied in Analytic Hierarchy Process - an example of information needs of patients with rare diseases. BMC Med Inform Decis Mak 2016; 16:117. [PMID: 27613239 PMCID: PMC5016921 DOI: 10.1186/s12911-016-0346-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 08/03/2016] [Indexed: 11/10/2022] Open
Abstract
Background The Analytic Hierarchy Process (AHP) is increasingly used to measure patient priorities. Studies have shown that there are several different approaches to data acquisition and data aggregation. The aim of this study was to measure the information needs of patients having a rare disease and to analyze the effects of these different AHP approaches. The ranking of information needs is then used to display information categories on a web-based information portal about rare diseases according to the patient’s priorities. Methods The information needs of patients suffering from rare diseases were identified by an Internet research study and a preliminary qualitative study. Hence, we designed a three-level hierarchy containing 13 criteria. For data acquisition, the differences in outcomes were investigated using individual versus group judgements separately. Furthermore, we analyzed the different effects when using the median and arithmetic and geometric means for data aggregation. A consistency ratio ≤0.2 was determined to represent an acceptable consistency level. Results Forty individual and three group judgements were collected from patients suffering from a rare disease and their close relatives. The consistency ratio of 31 individual and three group judgements was acceptable and thus these judgements were included in the study. To a large extent, the local ranks for individual and group judgements were similar. Interestingly, group judgements were in a significantly smaller range than individual judgements. According to our data, the ranks of the criteria differed slightly according to the data aggregation method used. Conclusions It is important to explain and justify the choice of an appropriate method for data acquisition because response behaviors differ according to the method. We conclude that researchers should select a suitable method based on the thematic perspective or investigated topics in the study. Because the arithmetic mean is very vulnerable to outliers, the geometric mean and the median seem to be acceptable alternatives for data aggregation. Overall, using the AHP to identify patient priorities and enhance the user-friendliness of information websites offers an important contribution to medical informatics. Electronic supplementary material The online version of this article (doi:10.1186/s12911-016-0346-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Frédéric Pauer
- Center for Health Economics Research Hannover (CHERH), Leibniz University of Hannover, Otto-Brenner-Straße 1, Hannover, 30159, Germany.
| | - Katharina Schmidt
- Center for Health Economics Research Hannover (CHERH), Leibniz University of Hannover, Otto-Brenner-Straße 1, Hannover, 30159, Germany
| | - Ana Babac
- Center for Health Economics Research Hannover (CHERH), Leibniz University of Hannover, Otto-Brenner-Straße 1, Hannover, 30159, Germany
| | - Kathrin Damm
- Center for Health Economics Research Hannover (CHERH), Leibniz University of Hannover, Otto-Brenner-Straße 1, Hannover, 30159, Germany
| | - Martin Frank
- Center for Health Economics Research Hannover (CHERH), Leibniz University of Hannover, Otto-Brenner-Straße 1, Hannover, 30159, Germany
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How Well Can Analytic Hierarchy Process be Used to Elicit Individual Preferences? Insights from a Survey in Patients Suffering from Age-Related Macular Degeneration. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2016; 9:481-92. [DOI: 10.1007/s40271-016-0179-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Thill M, Pisa G, Isbary G. Targets for Neoadjuvant Therapy - The Preferences of Patients with Early Breast Cancer. Geburtshilfe Frauenheilkd 2016; 76:551-556. [PMID: 27239064 DOI: 10.1055/s-0042-101025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Background: Therapists and administrative bodies consider a pathological complete remission as an independent and relevant endpoint in evaluations of the clinical utility of neoadjuvant therapy for early breast cancer. The present study aims to investigate which treatment outcomes of a neoadjuvant therapy are considered by the patients themselves to be relevant. Materials and Methods: With the help of analytic hierarchy process (AHP) methods patient preferences about the treatment targets of neoadjuvant therapy were assessed quantitatively. All participants had undergone a neoadjuvant therapy in the form of chemotherapy and, in HER2-positive cases, as a targeted antibody therapy against HER2 for the primary diagnosis of early breast cancer 12-36 months prior to the interview. The criteria for the hierarchy model were identified in an earlier qualitative survey. The patient interviews were conducted by 4 experienced female interviewers. Results: Forty-one patients participated in the quantitative survey, of these 15 (36.6 %) had suffered from HER2-positive disease. The achievement of pCR was the most important therapeutic target for the patients, even before disease-free survival, overall survival and the option for breast-preserving operation. Avoidance of side effects was considered to be the least important. In a comparison of the side effects the patients judged fatigue to be most important before nausea and loss of hair. Conclusion: For the patients the achievement of a pathological complete remission is considered to be an independent, relevant and highly desired target of neoadjuvant therapy.
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Affiliation(s)
- M Thill
- Klinik für Gynäkologie und Geburtshilfe, Agaplesion Markus-Krankenhaus Frankfurt, Frankfurt am Main
| | | | - G Isbary
- Roche Pharma AG, Grenzach-Wyhlen
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Marsh K, IJzerman M, Thokala P, Baltussen R, Boysen M, Kaló Z, Lönngren T, Mussen F, Peacock S, Watkins J, Devlin N. Multiple Criteria Decision Analysis for Health Care Decision Making--Emerging Good Practices: Report 2 of the ISPOR MCDA Emerging Good Practices Task Force. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2016; 19:125-137. [PMID: 27021745 DOI: 10.1016/j.jval.2015.12.016] [Citation(s) in RCA: 278] [Impact Index Per Article: 34.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 12/22/2015] [Indexed: 06/05/2023]
Abstract
Health care decisions are complex and involve confronting trade-offs between multiple, often conflicting objectives. Using structured, explicit approaches to decisions involving multiple criteria can improve the quality of decision making. A set of techniques, known under the collective heading, multiple criteria decision analysis (MCDA), are useful for this purpose. In 2014, ISPOR established an Emerging Good Practices Task Force. The task force's first report defined MCDA, provided examples of its use in health care, described the key steps, and provided an overview of the principal methods of MCDA. This second task force report provides emerging good-practice guidance on the implementation of MCDA to support health care decisions. The report includes: a checklist to support the design, implementation and review of an MCDA; guidance to support the implementation of the checklist; the order in which the steps should be implemented; illustrates how to incorporate budget constraints into an MCDA; provides an overview of the skills and resources, including available software, required to implement MCDA; and future research directions.
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Affiliation(s)
| | - Maarten IJzerman
- Department of Health Technology & Services Research, University of Twente, Enschede, The Netherlands
| | | | - Rob Baltussen
- Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Meindert Boysen
- National Institute for Health and Care Excellence, Manchester, UK
| | - Zoltán Kaló
- Department of Health Policy and Health Economics, Eötvös Loránd University (ELTE), Budapest, Hungary; Syreon Research Institute, Budapest, Hungary
| | | | - Filip Mussen
- Janssen Pharmaceutical Companies of Johnson & Johnson, Antwerp, Belgium
| | - Stuart Peacock
- Canadian Centre for Applied Research in Cancer Control, British Columbia Cancer Agency, Vancouver, BC, Canada; Leslie Diamond Chair in Cancer Survivorship, Simon Fraser University, Vancouver, Canada
| | - John Watkins
- Premera Blue Cross, Bothell, WA, USA; University of Washington, Seattle, WA, USA
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Thokala P, Devlin N, Marsh K, Baltussen R, Boysen M, Kalo Z, Longrenn T, Mussen F, Peacock S, Watkins J, Ijzerman M. Multiple Criteria Decision Analysis for Health Care Decision Making--An Introduction: Report 1 of the ISPOR MCDA Emerging Good Practices Task Force. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2016; 19:1-13. [PMID: 26797229 DOI: 10.1016/j.jval.2015.12.003] [Citation(s) in RCA: 356] [Impact Index Per Article: 44.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 12/01/2015] [Indexed: 05/23/2023]
Abstract
Health care decisions are complex and involve confronting trade-offs between multiple, often conflicting, objectives. Using structured, explicit approaches to decisions involving multiple criteria can improve the quality of decision making and a set of techniques, known under the collective heading multiple criteria decision analysis (MCDA), are useful for this purpose. MCDA methods are widely used in other sectors, and recently there has been an increase in health care applications. In 2014, ISPOR established an MCDA Emerging Good Practices Task Force. It was charged with establishing a common definition for MCDA in health care decision making and developing good practice guidelines for conducting MCDA to aid health care decision making. This initial ISPOR MCDA task force report provides an introduction to MCDA - it defines MCDA; provides examples of its use in different kinds of decision making in health care (including benefit risk analysis, health technology assessment, resource allocation, portfolio decision analysis, shared patient clinician decision making and prioritizing patients' access to services); provides an overview of the principal methods of MCDA; and describes the key steps involved. Upon reviewing this report, readers should have a solid overview of MCDA methods and their potential for supporting health care decision making.
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Affiliation(s)
- Praveen Thokala
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK.
| | | | | | - Rob Baltussen
- Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Meindert Boysen
- National Institute for Health and Clinical Excellence (NICE), Manchester, UK
| | - Zoltan Kalo
- Department of Health Policy and Health Economics, Eötvös Loránd University (ELTE); Syreon Research Institute, Budapest, Hungary
| | | | - Filip Mussen
- Regional Regulatory Affairs, Janssen Pharmaceutical Companies of Johnson & Johnson, Antwerp, Belgium
| | - Stuart Peacock
- Canadian Centre for Applied Research in Cancer Control (ARCC), British Columbia Cancer Agency, Vancouver, WA, USA; Leslie Diamond Chair in Cancer Survivorship, Simon Fraser University, Vancouver, WA, USA
| | - John Watkins
- Formulary Development, Premera Blue Cross, Bothell, WA, USA; University of Washington, Seattle, WA, USA
| | - Maarten Ijzerman
- Department of Health Technology & Services Research, University of Twente, Enschede, The Netherlands
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Schmidt K, Aumann I, Hollander I, Damm K, von der Schulenburg JMG. Applying the Analytic Hierarchy Process in healthcare research: A systematic literature review and evaluation of reporting. BMC Med Inform Decis Mak 2015; 15:112. [PMID: 26703458 PMCID: PMC4690361 DOI: 10.1186/s12911-015-0234-7] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 12/15/2015] [Indexed: 01/12/2023] Open
Abstract
Background The Analytic Hierarchy Process (AHP), developed by Saaty in the late 1970s, is one of the methods for multi-criteria decision making. The AHP disaggregates a complex decision problem into different hierarchical levels. The weight for each criterion and alternative are judged in pairwise comparisons and priorities are calculated by the Eigenvector method. The slowly increasing application of the AHP was the motivation for this study to explore the current state of its methodology in the healthcare context. Methods A systematic literature review was conducted by searching the Pubmed and Web of Science databases for articles with the following keywords in their titles or abstracts: “Analytic Hierarchy Process,” “Analytical Hierarchy Process,” “multi-criteria decision analysis,” “multiple criteria decision,” “stated preference,” and “pairwise comparison.” In addition, we developed reporting criteria to indicate whether the authors reported important aspects and evaluated the resulting studies’ reporting. Results The systematic review resulted in 121 articles. The number of studies applying AHP has increased since 2005. Most studies were from Asia (almost 30 %), followed by the US (25.6 %). On average, the studies used 19.64 criteria throughout their hierarchical levels. Furthermore, we restricted a detailed analysis to those articles published within the last 5 years (n = 69). The mean of participants in these studies were 109, whereas we identified major differences in how the surveys were conducted. The evaluation of reporting showed that the mean of reported elements was about 6.75 out of 10. Thus, 12 out of 69 studies reported less than half of the criteria. Conclusion The AHP has been applied inconsistently in healthcare research. A minority of studies described all the relevant aspects. Thus, the statements in this review may be biased, as they are restricted to the information available in the papers. Hence, further research is required to discover who should be interviewed and how, how inconsistent answers should be dealt with, and how the outcome and stability of the results should be presented. In addition, we need new insights to determine which target group can best handle the challenges of the AHP.
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Affiliation(s)
- Katharina Schmidt
- Center for Health Economics Research Hannover (CHERH), Leibniz University of Hanover, Otto-Brenner-Str. 1, 30159, Hannover, Germany.
| | - Ines Aumann
- Center for Health Economics Research Hannover (CHERH), Leibniz University of Hanover, Otto-Brenner-Str. 1, 30159, Hannover, Germany.
| | - Ines Hollander
- Institute for Risk and Insurance, Leibniz University of Hanover, Otto-Brenner-Str. 1, 30159, Hannover, Germany.
| | - Kathrin Damm
- Center for Health Economics Research Hannover (CHERH), Leibniz University of Hanover, Otto-Brenner-Str. 1, 30159, Hannover, Germany.
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Dolan JG, Cherkasky OA, Chin N, Veazie PJ. Decision Aids: The Effect of Labeling Options on Patient Choices and Decision Making. Med Decis Making 2015; 35:979-86. [PMID: 26229084 PMCID: PMC4592400 DOI: 10.1177/0272989x15598532] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 06/23/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Conscious and unconscious biases can influence how people interpret new information and make decisions. Current standards for creating decision aids, however, do not address this issue. METHOD Using a 2×2 factorial design, we developed surveys that contained a decision scenario (involving a choice between aspirin or a statin drug to lower risk of heart attack) and a decision aid. Each aid presented identical information about reduction in heart attack risk and likelihood of a major side effect. They differed in whether the options were labeled and the amount of decisional guidance: information only (a balance sheet) versus information plus values clarification (a multicriteria decision analysis). We sent the surveys to members of 2 Internet survey panels. After using the decision aid, participants indicated their preferred medication. Those using a multicriteria decision aid also judged differences in the comparative outcome data provided for the 2 options and the relative importance of achieving benefits versus avoiding risks in making the decision. RESULTS The study sample size was 536. Participants using decision aids with unlabeled options were more likely to choose a statin: 56% versus 25% (P < 0.001). The type of decision aid made no difference. This effect persisted after adjustment for differences in survey company, age, gender, education level, health literacy, and numeracy. Participants using unlabeled decision aids were also more likely to interpret the data presented as favoring a statin with regard to both treatment benefits and risk of side effects (P ≤ 0.01). There were no significant differences in decision priorities (P = 0.21). CONCLUSION Identifying the options in patient decision aids can influence patient preferences and change how they interpret comparative outcome data.
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Affiliation(s)
- James G Dolan
- Department of Public Health Sciences, University of Rochester, Rochester, NY (JGD, OAC, NC, PJV)
| | - Olena A Cherkasky
- Department of Public Health Sciences, University of Rochester, Rochester, NY (JGD, OAC, NC, PJV)
| | - Nancy Chin
- Department of Public Health Sciences, University of Rochester, Rochester, NY (JGD, OAC, NC, PJV)
| | - Peter J Veazie
- Department of Public Health Sciences, University of Rochester, Rochester, NY (JGD, OAC, NC, PJV)
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Dowie J, Kjer Kaltoft M, Salkeld G, Cunich M. Towards generic online multicriteria decision support in patient-centred health care. Health Expect 2015; 18:689-702. [PMID: 23910715 PMCID: PMC5060847 DOI: 10.1111/hex.12111] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2013] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To introduce a new online generic decision support system based on multicriteria decision analysis (MCDA), implemented in practical and user-friendly software (Annalisa©). BACKGROUND All parties in health care lack a simple and generic way to picture and process the decisions to be made in pursuit of improved decision making and more informed choice within an overall philosophy of person- and patient-centred care. METHODS The MCDA-based system generates patient-specific clinical guidance in the form of an opinion as to the merits of the alternative options in a decision, which are all scored and ranked. The scores for each option combine, in a simple expected value calculation, the best estimates available now for the performance of those options on patient-determined criteria, with the individual patient's preferences, expressed as importance weightings for those criteria. The survey software within which the Annalisa file is embedded (Elicia©) customizes and personalizes the presentation and inputs. Principles relevant to the development of such decision-specific MCDA-based aids are noted and comparisons with alternative implementations presented. The necessity to trade-off practicality (including resource constraints) with normative rigour and empirical complexity, in both their development and delivery, is emphasized. CONCLUSION The MCDA-/Annalisa-based decision support system represents a prescriptive addition to the portfolio of decision-aiding tools available online to individuals and clinicians interested in pursuing shared decision making and informed choice within a commitment to transparency in relation to both the evidence and preference bases of decisions. Some empirical data establishing its usability are provided.
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Affiliation(s)
- Jack Dowie
- London School of Hygiene and Tropical MedicineLondonUK
| | | | - Glenn Salkeld
- Sydney School of Public HealthUniversity of SydneySydneyNSWAustralia
| | - Michelle Cunich
- NHMRC Clinical Trials CentreUniversity of SydneySydneyNSWAustralia
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Kaltoft MK, Turner R, Cunich M, Salkeld G, Nielsen JB, Dowie J. Addressing preference heterogeneity in public health policy by combining Cluster Analysis and Multi-Criteria Decision Analysis: Proof of Method. HEALTH ECONOMICS REVIEW 2015; 5:10. [PMID: 25992305 PMCID: PMC4429422 DOI: 10.1186/s13561-015-0048-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 04/08/2015] [Indexed: 05/31/2023]
Abstract
The use of subgroups based on biological-clinical and socio-demographic variables to deal with population heterogeneity is well-established in public policy. The use of subgroups based on preferences is rare, except when religion based, and controversial. If it were decided to treat subgroup preferences as valid determinants of public policy, a transparent analytical procedure is needed. In this proof of method study we show how public preferences could be incorporated into policy decisions in a way that respects both the multi-criterial nature of those decisions, and the heterogeneity of the population in relation to the importance assigned to relevant criteria. It involves combining Cluster Analysis (CA), to generate the subgroup sets of preferences, with Multi-Criteria Decision Analysis (MCDA), to provide the policy framework into which the clustered preferences are entered. We employ three techniques of CA to demonstrate that not only do different techniques produce different clusters, but that choosing among techniques (as well as developing the MCDA structure) is an important task to be undertaken in implementing the approach outlined in any specific policy context. Data for the illustrative, not substantive, application are from a Randomized Controlled Trial of online decision aids for Australian men aged 40-69 years considering Prostate-specific Antigen testing for prostate cancer. We show that such analyses can provide policy-makers with insights into the criterion-specific needs of different subgroups. Implementing CA and MCDA in combination to assist in the development of policies on important health and community issues such as drug coverage, reimbursement, and screening programs, poses major challenges -conceptual, methodological, ethical-political, and practical - but most are exposed by the techniques, not created by them.
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Affiliation(s)
- Mette Kjer Kaltoft
- Research Unit for General Practice, Department of Public Health University of Southern Denmark, J.B. Winsløws Vej 9 B, 5000 Odense C, Denmark
| | - Robin Turner
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW 2052 Australia
| | - Michelle Cunich
- NHMRC Clinical Trials Centre, Sydney Medical School, Charles Perkins Centre, Johns Hopkins Drive, Camperdown, NSW 2050 Australia
| | - Glenn Salkeld
- Faculty of Medicine, School of Public Health University of Sydney, Edward Ford Building (A27), Sydney, NSW 2006 Australia
| | - Jesper Bo Nielsen
- Research Unit for General Practice, Department of Public Health University of Southern Denmark, J.B. Winsløws Vej 9 B, 5000 Odense C, Denmark
| | - Jack Dowie
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH UK
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Xu Y, Levy BT, Daly JM, Bergus GR, Dunkelberg JC. Comparison of patient preferences for fecal immunochemical test or colonoscopy using the analytic hierarchy process. BMC Health Serv Res 2015; 15:175. [PMID: 25902770 PMCID: PMC4411789 DOI: 10.1186/s12913-015-0841-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 04/10/2015] [Indexed: 12/24/2022] Open
Abstract
Background In average-risk individuals aged 50 to 75 years, there is no difference in life-years gained when comparing colonoscopy every 10 years vs. annual fecal immunochemical testing (FIT) for colorectal cancer screening. Little is known about the preferences of patients when they have experienced both tests. Methods The study was conducted with 954 patients from the University of Iowa Hospital and Clinics during 2010 to 2011. Patients scheduled for a colonoscopy were asked to complete a FIT before the colonoscopy preparation. Following both tests, patients completed a questionnaire which was based on an analytic hierarchy process (AHP) decision-making model. Results In the AHP analysis, the test accuracy was given the highest priority (0.457), followed by complications (0.321), and test preparation (0.223). Patients preferred colonoscopy (0.599) compared with FIT (0.401) when considering accuracy; preferred FIT (0.589) compared with colonoscopy (0.411) when considering avoiding complications; and preferred FIT (0.650) compared with colonoscopy (0.350) when considering test preparation. The overall aggregated priorities were 0.517 for FIT, and 0.483 for colonoscopy, indicating patients slightly preferred FIT over colonoscopy. Patients’ preferences were significantly different before and after provision of detailed information on test features (p < 0.0001). Conclusions AHP analysis showed that patients slightly preferred FIT over colonoscopy. The information provided to patients strongly affected patient preference. Patients’ test preferences should be considered when ordering a colorectal cancer screening test.
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Affiliation(s)
- Yinghui Xu
- Department of Family Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, 52242, USA.
| | - Barcey T Levy
- Department of Family Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, 52242, USA. .,Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, 52242, USA.
| | - Jeanette M Daly
- Department of Family Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, 52242, USA.
| | - George R Bergus
- Department of Family Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, 52242, USA.
| | - Jeffrey C Dunkelberg
- Department of Internal Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, 52242, USA.
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Diaz-Ledezma C, Lichstein PM, Dolan JG, Parvizi J. Diagnosis of periprosthetic joint infection in Medicare patients: multicriteria decision analysis. Clin Orthop Relat Res 2014; 472:3275-84. [PMID: 24522385 PMCID: PMC4182413 DOI: 10.1007/s11999-014-3492-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND In the setting of finite healthcare resources, developing cost-efficient strategies for periprosthetic joint infection (PJI) diagnosis is paramount. The current levels of knowledge allow for PJI diagnostic recommendations based on scientific evidence but do not consider the benefits, opportunities, costs, and risks of the different diagnostic alternatives. QUESTIONS/PURPOSES We determined the best diagnostic strategy for knee and hip PJI in the ambulatory setting for Medicare patients, utilizing benefits, opportunities, costs, and risks evaluation through multicriteria decision analysis (MCDA). METHODS The PJI diagnostic definition supported by the Musculoskeletal Infection Society was employed for the MCDA. Using a preclinical model, we evaluated three diagnostic strategies that can be conducted in a Medicare patient seen in the outpatient clinical setting complaining of a painful TKA or THA. Strategies were (1) screening with serum markers (erythrocyte sedimentation rate [ESR]/C-reactive protein [CRP]) followed by arthrocentesis in positive cases, (2) immediate arthrocentesis, and (3) serum markers requested simultaneously with arthrocentesis. MCDA was conducted through the analytic hierarchy process, comparing the diagnostic strategies in terms of benefits, opportunities, costs, and risks. RESULTS Strategy 1 was the best alternative to diagnose knee PJI among Medicare patients (normalized value: 0.490), followed by Strategy 3 (normalized value: 0.403) and then Strategy 2 (normalized value: 0.106). The same ranking of alternatives was observed for the hip PJI model (normalized value: 0.487, 0.405, and 0.107, respectively). The sensitivity analysis found this sequence to be robust with respect to benefits, opportunities, and risks. However, if during the decision-making process, cost savings was given a priority of higher than 54%, the ranking for the preferred diagnostic strategy changed. CONCLUSIONS After considering the benefits, opportunities, costs, and risks of the different available alternatives, our preclinical model supports the American Academy of Orthopaedic Surgeons recommendations regarding the use of serum markers (ESR/CRP) before arthrocentesis as the best diagnostic strategy for PJI among Medicare patients. LEVEL OF EVIDENCE Level II, economic and decision analysis. See Instructions to Authors for a complete description of levels of evidence.
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Affiliation(s)
| | - Paul M. Lichstein
- />The Rothman Institute at Thomas Jefferson University, Philadelphia, PA USA
| | - James G. Dolan
- />Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY USA
| | - Javad Parvizi
- />The Rothman Institute at Thomas Jefferson University, The Sheridan Building, 125th South 9th Street, Suite 1000, Philadelphia, PA 19107 USA
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Group decision making with the analytic hierarchy process in benefit-risk assessment: a tutorial. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2014; 7:129-40. [PMID: 24623191 DOI: 10.1007/s40271-014-0050-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The analytic hierarchy process (AHP) has been increasingly applied as a technique for multi-criteria decision analysis in healthcare. The AHP can aid decision makers in selecting the most valuable technology for patients, while taking into account multiple, and even conflicting, decision criteria. This tutorial illustrates the procedural steps of the AHP in supporting group decision making about new healthcare technology, including (1) identifying the decision goal, decision criteria, and alternative healthcare technologies to compare, (2) structuring the decision criteria, (3) judging the value of the alternative technologies on each decision criterion, (4) judging the importance of the decision criteria, (5) calculating group judgments, (6) analyzing the inconsistency in judgments, (7) calculating the overall value of the technologies, and (8) conducting sensitivity analyses. The AHP is illustrated via a hypothetical example, adapted from an empirical AHP analysis on the benefits and risks of tissue regeneration to repair small cartilage lesions in the knee.
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Padilla-Garrido N, Aguado-Correa F, Cortijo-Gallego V, López-Camacho F. Multicriteria decision making in health care using the analytic hierarchy process and Microsoft Excel. Med Decis Making 2014; 34:931-5. [PMID: 24829275 DOI: 10.1177/0272989x14534533] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Nuria Padilla-Garrido
- Department of Quantitative Methods and Statistics, University of Huelva, Spain (NP-G)
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Mühlbacher AC, Kaczynski A. Der Analytic Hierarchy Process (AHP): Eine Methode zur Entscheidungsunterstützung im Gesundheitswesen. ACTA ACUST UNITED AC 2014. [DOI: 10.1007/s40275-014-0011-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Yuen KKF. The Primitive Cognitive Network Process in healthcare and medical decision making: Comparisons with the Analytic Hierarchy Process. Appl Soft Comput 2014. [DOI: 10.1016/j.asoc.2013.06.028] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Dolan JG, Boohaker E, Allison J, Imperiale TF. Can Streamlined Multicriteria Decision Analysis Be Used to Implement Shared Decision Making for Colorectal Cancer Screening? Med Decis Making 2013; 34:746-55. [PMID: 24300851 DOI: 10.1177/0272989x13513338] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Accepted: 10/26/2013] [Indexed: 02/02/2023]
Abstract
BACKGROUND Current US colorectal cancer screening guidelines that call for shared decision making regarding the choice among several recommended screening options are difficult to implement. Multicriteria decision analysis (MCDA) is an established method well suited for supporting shared decision making. Our study goal was to determine whether a streamlined form of MCDA using rank-order-based judgments can accurately assess patients' colorectal cancer screening priorities. METHODS We converted priorities for 4 decision criteria and 3 subcriteria regarding colorectal cancer screening obtained from 484 average-risk patients using the analytic hierarchy process (AHP) in a prior study into rank-order-based priorities using rank order centroids. We compared the 2 sets of priorities using Spearman rank correlation and nonparametric Bland-Altman limits of agreement analysis. We assessed the differential impact of using the rank-order-based versus the AHP-based priorities on the results of a full MCDA comparing 3 currently recommended colorectal cancer screening strategies. Generalizability of the results was assessed using Monte Carlo simulation. RESULTS Correlations between the 2 sets of priorities for the 7 criteria ranged from 0.55 to 0.92. The proportions of differences between rank-order-based and AHP-based priorities that were more than ±0.15 ranged from 1% to 16%. Differences in the full MCDA results were minimal, and the relative rankings of the 3 screening options were identical more than 88% of the time. The Monte Carlo simulation results were similar. CONCLUSIONS Rank-order-based MCDA could be a simple, practical way to guide individual decisions and assess population decision priorities regarding colorectal cancer screening strategies. Additional research is warranted to further explore the use of these methods for promoting shared decision making.
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Affiliation(s)
- James G Dolan
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY (JGD)
| | - Emily Boohaker
- University of Alabama at Birmingham, Birmingham, AL (EB)
| | | | - Thomas F Imperiale
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine; Regenstrief Institute, Inc.; and Center of Excellence for Implementation of Evidence-based Medicine, Roudebush VA Medical Center, Indianapolis, IN (TFI)
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Hummel JM, Steuten LGM, Groothuis-Oudshoorn CJM, Mulder N, Ijzerman MJ. Preferences for colorectal cancer screening techniques and intention to attend: a multi-criteria decision analysis. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2013; 11:499-507. [PMID: 23979875 DOI: 10.1007/s40258-013-0051-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Despite the expected health benefits of colorectal cancer screening programs, participation rates remain low in countries that have implemented such a screening program. The perceived benefits and risks of the colorectal cancer screening technique are likely to influence the decision to attend the screening program. Besides the diagnostic accuracy and the risks of the screening technique, which can affect the health of the participants, additional factors, such as the burden of the test, may impact the individuals' decisions to participate. To maximise the participation rate of a screening program for a new colorectal cancer program in the Netherlands, it is important to know the preferences of the screening population for alternative screening techniques. OBJECTIVE The aim of this study was to explore the impact of preferences for particular attributes of the screening tests on the intention to attend a colorectal cancer screening program. METHODS We used a web-based questionnaire to elicit the preferences of the target population for a selection of colon-screening techniques. The target population consisted of Dutch men and women aged 55-75 years. The analytic hierarchy process (AHP), a technique for multi-criteria analysis, was used to estimate the colorectal cancer screening preferences. Respondents weighted the relevance of five criteria, i.e. the attributes of the screening techniques: sensitivity, specificity, safety, inconvenience, and frequency of the test. With regard to these criteria, preferences were estimated between four alternative screening techniques, namely, immunochemical fecal occult blood test (iFOBT), colonoscopy, sigmoidoscopy, and computerized tomographic (CT) colonography. A five-point ordinal scale was used to estimate the respondents' intention to attend the screening. We conducted a correlation analysis on the preferences for the screening techniques and the intention to attend. RESULTS We included 167 respondents who were consistent in their judgments of the relevance of the criteria and their preferences for the screening techniques. The most preferred screening method for the national screening program was CT colonography. Sensitivity (weight = 0.26) and safety (weight = 0.26) were the strongest determinants of the overall preferences for the screening techniques. However, the screening test with the highest intention to attend was iFOBT. Inconvenience (correlation [r] = 0.69), safety (r = 0.58), and the frequency of the test (r = 0.58) were most strongly related to intention to attend. CONCLUSIONS The multi-criteria decision analysis revealed the attributes of the screening techniques that are most important so as to increase intention to participate in a screening program. Even though the respondents may recognize the high importance of diagnostic effectiveness in the long term, their short-term decision to attend the screening tests may be less driven by this consideration. Our analysis suggests that inconvenience, safety, and frequency of the test are the strongest technique-related determinants of the respondents' intention to participate in colorectal screening programs.
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Affiliation(s)
- J Marjan Hummel
- Department of Health Technology and Services Research, MIRA, University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands,
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Bowyer HL, Vart G, Kralj-Hans I, Atkin W, Halloran SP, Seaman H, Wardle J, Wagner CV. Patient attitudes towards faecal immunochemical testing for haemoglobin as an alternative to colonoscopic surveillance of groups at increased risk of colorectal cancer. J Med Screen 2013; 20:149-56. [PMID: 24045920 DOI: 10.1177/0969141313503953] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To examine attitudes towards an annual faecal immunochemical test for haemoglobin (FIT) versus three-yearly colonoscopic surveillance of individuals at intermediate risk of colorectal cancer (CRC). SETTING A London hospital. METHODS Five semi-structured discussion groups were conducted with 28 adults (aged 60-74, 61% female) with different levels of CRC risk and experience of colonoscopy or colonoscopic surveillance. Information was presented sequentially using a step-by-step discussion guide. Results were analyzed using thematic analysis. RESULTS When evaluating FIT in the context of a surveillance programme, all respondents readily made comparisons with related tests that they had been exposed to previously. Those with no experience of surveillance were enthusiastic about an annual FIT to replace three-yearly colonoscopy, because they felt that the higher testing frequency could improve detection of advanced lesions. Those with experience of colonoscopic surveillance did not perceive FIT to be as accurate as colonoscopy, and therefore either preferred colonoscopy on its own or wanted an annual FIT in addition to three-yearly colonoscopy. CONCLUSIONS FIT may be well-received as an additional method of surveillance for new patients at intermediate risk of CRC. More research is required to better understand potential barriers associated with FIT surveillance for patients with experience of colonoscopic surveillance.
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Affiliation(s)
- Harriet L Bowyer
- Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, UCL, Gower Street, London, WC1E 6BT, United Kingdom
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Diaz-Ledezma C, Parvizi J. Surgical approaches for cam femoroacetabular impingement: the use of multicriteria decision analysis. Clin Orthop Relat Res 2013; 471:2509-16. [PMID: 23532552 PMCID: PMC3705078 DOI: 10.1007/s11999-013-2934-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Currently, three surgical approaches are available for the treatment of cam femoroacetabular impingement (FAI), namely surgical hip dislocation (SHD), hip arthroscopy (HA), and the miniopen anterior approach of the hip (MO). Although previous systematic reviews have compared these different approaches, an overall assessment of their performance is not available. QUESTIONS/PURPOSES We therefore executed a multidimensional structured comparison considering the benefits, opportunities, costs, and risk (BOCR) of the different approaches using multicriteria decision analysis (MCDA). METHODS A MCDA using analytic hierarchical process (AHP) was conducted to compare SHD, HA, and MO in terms of BOCR on the basis of available evidence, institutional experience, costs, and our understanding of pathophysiology of FAI. A preclinical decision-making model was created for cam FAI to establish the surgical approach that better accomplishes our objectives regarding the surgical treatment. A total score of an alternative's utility and sensitivity analysis was established using commercially available AHP software. RESULTS The AHP model based on BOCR showed that MO is the best surgical approach for cam FAI (normalized score: 0.38) followed by HA (normalized score: 0.36) and SHD (normalized score: 0.25). The sensitivity analysis showed that HA would turn into the best alternative if the variable risks account for more than 61.8% of the priority during decision-making. In any other decision-making scenario, MO remains as the best alternative. CONCLUSIONS Using a recognized method for decision-making, this study provides supportive data for the use of MO approach as our preferred surgical approach for cam FAI. The latter is predominantly derived from the lower cost of this approach. Our data may be considered a proxy performance measurement for surgical approaches in cam FAI.
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Affiliation(s)
- Claudio Diaz-Ledezma
- The Rothman Institute of Orthopaedics at Thomas Jefferson University Hospital, Sheridan Building, 10th Floor, 125 South 9th Street, Philadelphia, PA 19107 USA
| | - Javad Parvizi
- The Rothman Institute of Orthopaedics at Thomas Jefferson University Hospital, Sheridan Building, 10th Floor, 125 South 9th Street, Philadelphia, PA 19107 USA
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Maruthur NM, Joy S, Dolan J, Segal JB, Shihab HM, Singh S. Systematic assessment of benefits and risks: study protocol for a multi-criteria decision analysis using the Analytic Hierarchy Process for comparative effectiveness research. F1000Res 2013; 2:160. [PMID: 24555077 PMCID: PMC3886795 DOI: 10.12688/f1000research.2-160.v1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/23/2013] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Regulatory decision-making involves assessment of risks and benefits of medications at the time of approval or when relevant safety concerns arise with a medication. The Analytic Hierarchy Process (AHP) facilitates decision-making in complex situations involving tradeoffs by considering risks and benefits of alternatives. The AHP allows a more structured method of synthesizing and understanding evidence in the context of importance assigned to outcomes. Our objective is to evaluate the use of an AHP in a simulated committee setting selecting oral medications for type 2 diabetes. METHODS This study protocol describes the AHP in five sequential steps using a small group of diabetes experts representing various clinical disciplines. The first step will involve defining the goal of the decision and developing the AHP model. In the next step, we will collect information about how well alternatives are expected to fulfill the decision criteria. In the third step, we will compare the ability of the alternatives to fulfill the criteria and judge the importance of eight criteria relative to the decision goal of the optimal medication choice for type 2 diabetes. We will use pairwise comparisons to sequentially compare the pairs of alternative options regarding their ability to fulfill the criteria. In the fourth step, the scales created in the third step will be combined to create a summary score indicating how well the alternatives met the decision goal. The resulting scores will be expressed as percentages and will indicate the alternative medications' relative abilities to fulfill the decision goal. The fifth step will consist of sensitivity analyses to explore the effects of changing the estimates. We will also conduct a cognitive interview and process evaluation. DISCUSSION Multi-criteria decision analysis using the AHP will aid, support and enhance the ability of decision makers to make evidence-based informed decisions consistent with their values and preferences.
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Affiliation(s)
- Nisa M Maruthur
- Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore MD, 21205, USA ; Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore MD, 21205, USA ; The Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore MD, 21205, USA
| | - Susan Joy
- Department of Health Policy and Management, The Johns Hopkins University Bloomberg School of Public Health, Baltimore MD, 21205, USA
| | - James Dolan
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester NY, 14642, USA
| | - Jodi B Segal
- Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore MD, 21205, USA ; Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore MD, 21205, USA ; Department of Health Policy and Management, The Johns Hopkins University Bloomberg School of Public Health, Baltimore MD, 21205, USA
| | - Hasan M Shihab
- Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore MD, 21205, USA
| | - Sonal Singh
- Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore MD, 21205, USA ; Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore MD, 21205, USA ; Department of Health Policy and Management, The Johns Hopkins University Bloomberg School of Public Health, Baltimore MD, 21205, USA
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