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Corvin JA, Chan I, Aguado Loi CX, Dollman I, Gonzales J. Analytic hierarchy process: An innovative technique for culturally tailoring evidence-based interventions to reduce health disparities. Health Expect 2021; 24 Suppl 1:70-81. [PMID: 31908082 PMCID: PMC8137498 DOI: 10.1111/hex.13022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 11/09/2019] [Accepted: 12/14/2019] [Indexed: 12/02/2022] Open
Abstract
Latinos in the United States represent a disproportionate burden of illness and disease and face barriers to accessing health care and related resources. Culturally tailored, evidence-based interventions hold promise in addressing many of these challenges. Yet, ensuring patient voice is vital in the successful development and implementation of such interventions. Thus, this paper examines the application of analytic hierarchy process (AHP) to inform the augmentation and implementation of an evidence-based chronic disease self-management programme for underserved Latinos living with both minor depression and chronic illness. The process of AHP allows for direct input from the individuals that would utilize such a programme, including afflicted individuals, their family members and the health educators/promotores that would be responsible for implementation. Specifically, 45 participants, including 15 individuals with chronic disease, 15 family members/caregivers and 15 promotores, partook in the Stakeholder Values Questionnaire, which elicited preferences and values regarding major goals, processes and content for the intervention. AHP was employed to analyse pairwise comparison ratings and to determine differences and similarities across stakeholder groups. This analytical technique allowed for the adaptation of the EBI to stakeholders' specific priorities and preferences and facilitated complex decision-making. Findings not only shed light on similarities and differences between stakeholder groups, but also the magnitude of these priorities and preferences and allowed the intervention to be driven by the participants, themselves. Applying AHP was a unique opportunity to optimize the decision-making process to inform cultural adaptation of an EBI while considering multiple viewpoints systematically.
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Affiliation(s)
- Jaime A. Corvin
- Department of Global HealthCollege of Public HealthUniversity of South FloridaTampaFLUSA
| | - Isabella Chan
- Department of Global HealthCollege of Public HealthUniversity of South FloridaTampaFLUSA
| | | | - Ian Dollman
- Department of Global HealthCollege of Public HealthUniversity of South FloridaTampaFLUSA
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Garcia-Alonso FJ, Tejero MH, Cambrodón DB, Bermejo F. Knowledge acquired, satisfaction attained and attitudes towards shared decision making in colorectal cancer screening. Ann Gastroenterol 2016; 30:76-82. [PMID: 28042241 PMCID: PMC5198251 DOI: 10.20524/aog.2016.0090] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 08/23/2016] [Indexed: 01/08/2023] Open
Abstract
Background Introducing shared decision making (SDM) in colorectal cancer (CRC) screening requires patients to acquire appropriate knowledge. We aimed to describe the knowledge attained by subjects with a family history of CRC. Methods Consecutive patients attending the gastroenterology clinic for a CRC family history were invited to take part in a cross-sectional survey. Attitudes towards SDM, satisfaction with the information received, knowledge currently achieved, and relevant influencing factors were evaluated. Satisfaction and attitudes towards SDM were evaluated with Likert scale questions. Knowledge was surveyed with closed (80%) and open (20%) questions. Results Of the 160 patients, 42.7% were male and the median age was 51.8 years (interquartile range: 43.9-58.5). Most subjects favored SDM; only 12.8% (8.4-19.1%) favored passive attitudes. Satisfaction with the information received about what a colonoscopy is and why it is recommended was adequate in 83.1% (76.4-88.2%). Information about risks satisfied 62.9% (55-70.1%) and about alternatives to colonoscopy only 30.6% (23.8-38.3%). The benefits of screening were better known than its risks and alternatives. The CRC decrease associated with screening was known to 71.3% (63.7-77.8%), but only 38.5% (31.1-46.4%) knew that a reduced risk still exists. Just 21.2% (15.5-26.9%) could mention an alternative screening method to colonoscopy and only 42.5% (35-50.4%) were aware of any associated harm. On multivariate analysis, higher educational level and younger age of the attending physician were associated with higher knowledge scores. Conclusion SDM is considered favorably by most patients. Although information about the benefits of CRC screening is transmitted adequately, risks and alternatives should be better addressed.
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Affiliation(s)
| | | | | | - Fernando Bermejo
- Gastroenterology Department, Fuenlabrada University Hospital, Fuenlabrada, Spain
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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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Hsu JC, Tang DH, Lu CY. Risk-benefit assessment of oral phosphodiesterase type 5 inhibitors for treatment of erectile dysfunction: a multiple criteria decision analysis. Int J Clin Pract 2015; 69:436-43. [PMID: 25311239 DOI: 10.1111/ijcp.12548] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2014] [Accepted: 08/25/2014] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Erectile dysfunction (ED) is a common male sexual disorder worldwide. Three oral phosphodiesterase type 5 inhibitors (PDE5Is) - sildenafil, tadalafil and vardenafil - are available for treatment of ED. This study quantitatively evaluated the therapeutic efficacy and safety of these medications to assist treatment decision making. METHODS We used multiple criteria decision analysis (MCDA) to assess the totality of risk-benefit of PDE5Is. We created two models: (i) the overall model included 'overall improvement in erections' and 'any adverse events' and (ii) the detailed model included 'erectile function domain', 'ability for sexual intercourse', 'duration of erection last', 'serious adverse events', 'headache', 'flushing' and 'dyspepsia'. We calculated a synthetic utility for each drug accounting for all of its benefits and risks. RESULTS Considering the overall risk-benefit, vardenafil had the highest synthetic utility among three medications; in the order of synthetic utilities: vardenafil (0.568), tadalafil (0.478) and sildenafil (0.437). However, when specific risk and benefit criteria were assessed, tadalafil had the highest synthetic utility (0.602) according to the conjoint evaluation (synthetic utility for vardenafil is 0.491 and sildenafil is 0.442, respectively). The sensitivity analysis based on the uncertainties of weight on risks of any adverse events (including serious adverse events and headache) suggested our results were robust. CONCLUSIONS This study provides a useful approach that comprehensively and systematically assesses and compares the risk-benefit of several treatment alternatives. Our study not only rank treatment alternatives by synthetic utilities based on the risk-benefit balance but also compare specific risk and benefit criteria between these medicines. Our results provide valuable evidence that can guide clinicians and patients in making treatment decisions.
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Affiliation(s)
- J C Hsu
- School of Pharmacy and Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
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5
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Suner A, Karakülah G, Dicle O, Sökmen S, Çelikoğlu C. CorRECTreatment: a web-based decision support tool for rectal cancer treatment that uses the analytic hierarchy process and decision tree. Appl Clin Inform 2015; 6:56-74. [PMID: 25848413 PMCID: PMC4377560 DOI: 10.4338/aci-2014-10-ra-0087] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 12/22/2014] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The selection of appropriate rectal cancer treatment is a complex multi-criteria decision making process, in which clinical decision support systems might be used to assist and enrich physicians' decision making. OBJECTIVE The objective of the study was to develop a web-based clinical decision support tool for physicians in the selection of potentially beneficial treatment options for patients with rectal cancer. METHODS The updated decision model contained 8 and 10 criteria in the first and second steps respectively. The decision support model, developed in our previous study by combining the Analytic Hierarchy Process (AHP) method which determines the priority of criteria and decision tree that formed using these priorities, was updated and applied to 388 patients data collected retrospectively. Later, a web-based decision support tool named corRECTreatment was developed. The compatibility of the treatment recommendations by the expert opinion and the decision support tool was examined for its consistency. Two surgeons were requested to recommend a treatment and an overall survival value for the treatment among 20 different cases that we selected and turned into a scenario among the most common and rare treatment options in the patient data set. RESULTS In the AHP analyses of the criteria, it was found that the matrices, generated for both decision steps, were consistent (consistency ratio<0.1). Depending on the decisions of experts, the consistency value for the most frequent cases was found to be 80% for the first decision step and 100% for the second decision step. Similarly, for rare cases consistency was 50% for the first decision step and 80% for the second decision step. CONCLUSIONS The decision model and corRECTreatment, developed by applying these on real patient data, are expected to provide potential users with decision support in rectal cancer treatment processes and facilitate them in making projections about treatment options.
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Affiliation(s)
- A. Suner
- Ege University, School of Medicine, Department of Biostatistics and Medical Informatics, Bornova-Izmir, 35040, Turkey
| | - G. Karakülah
- Neurobiology-Neurodegeneration and Repair Laboratory, National Eye Institute, National Institutes of Health, Bethesda, Maryland, 20892, USA
- Dokuz Eylül University, Health Sciences Institute, Department of Medical Informatics, Inciraltı-Izmir, 35340, Turkey
| | - O. Dicle
- Dokuz Eylül University, Health Sciences Institute, Department of Medical Informatics, Inciraltı-Izmir, 35340, Turkey
- Dokuz Eylül University, School of Medicine, Department of Radiology, Inciraltı-Izmir, 35340, Turkey
| | - S. Sökmen
- FACS, FASCRS, FASPSM Member from Dokuz Eylül University, School of Medicine, Department of General Surgery, Colorectal and Pelvic Surgery Unit, Inciraltı-Izmir, 35340, Turkey
| | - C.C. Çelikoğlu
- Dokuz Eylül University, Faculty of Science, Department of Statistics, Buca-Izmir, 35160, Turkey
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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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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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Jimbo M, Rana GK, Hawley S, Holmes-Rovner M, Kelly-Blake K, Nease DE, Ruffin MT. What is lacking in current decision aids on cancer screening? CA Cancer J Clin 2013; 63:193-214. [PMID: 23504675 PMCID: PMC3644368 DOI: 10.3322/caac.21180] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Recent guidelines on cancer screening have provided not only more screening options but also conflicting recommendations. Thus, patients, with their clinicians' support, must decide whether to get screened, which modality to use, and how often to undergo screening. Decision aids could potentially lead to better shared decision-making regarding screening between the patient and the clinician. A total of 73 decision aids concerning screening for breast, cervical, colorectal, and prostate cancers were reviewed. The goal of this review was to assess the effectiveness of such decision aids, examine areas in need of more research, and determine how the decision aids can be currently applied in the real-world setting. Most studies used sound study designs. Significant variation existed in the setting, theoretical framework, and measured outcomes. Just over one-third of the decision aids included an explicit values clarification. Other than knowledge, little consistency was noted with regard to which patient attributes were measured as outcomes. Few studies actually measured shared decision-making. Little information was available regarding the feasibility and outcomes of integrating decision aids into practice. In this review, the implications for future research, as well as what clinicians can do now to incorporate decision aids into their practice, are discussed.
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Affiliation(s)
- Masahito Jimbo
- Departments of Family Medicine and Urology, University of Michigan, 1018 Fuller Street, Ann Arbor, MI 48109-0708, Phone: (734) 998-7120 Ext 334, Fax: (734) 998-7335
| | - Gurpreet K. Rana
- Taubman Health Sciences Library, University of Michigan, 1135 E. Catherine, Ann Arbor, MI 48109-0726, Phone: (734) 936-1399, Fax: (734) 763-1473
| | - Sarah Hawley
- Departments of Internal Medicine and Health Management and Policy, University of Michigan, NCRC 2800 Plymouth Road Building, 16/406E, Ann Arbor, MI 48109-2800, Phone: (734) 936-8816
| | - Margaret Holmes-Rovner
- Health Services Research, Center for Ethics and Department of Medicine, Michigan State University College of Human Medicine, 965 Fee Road Rm C203, East Lansing, MI, 48824-1316, Phone: (517) 353-5197
| | - Karen Kelly-Blake
- Center for Ethics and Humanities in the Life Sciences, Michigan State University College of Human Medicine, East Fee Hall, 965 Fee Road Room C215, East Lansing, MI 48824, Phone: (517) 353-8582, Fax: (517) 353-3289
| | - Donald E. Nease
- Department of Family Medicine and Colorado Health Outcomes Program, University of Colorado – Denver, 13199 E. Montview Blvd, Suite 300, Mail Stop F443, Aurora, CO 80045, Phone: (303) 724-6270, Fax: (303) 724-1839
| | - Mack T. Ruffin
- Associate Chair for Research Programs, Department of Family Medicine, University of Michigan, 1018 Fuller Street, Ann Arbor, MI 48109-0708, Phone: (734) 998-7120 Ext 310, Fax: (734) 998-7335
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Fujiya M, Kohgo Y. Image-enhanced endoscopy for the diagnosis of colon neoplasms. Gastrointest Endosc 2013; 77:111-118.e5. [PMID: 23148965 DOI: 10.1016/j.gie.2012.07.031] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Accepted: 07/18/2012] [Indexed: 02/08/2023]
Affiliation(s)
- Mikihiro Fujiya
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Hokkaido, Japan
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Dolan JG, Boohaker E, Allison J, Imperiale TF. Patients' preferences and priorities regarding colorectal cancer screening. Med Decis Making 2012; 33:59-70. [PMID: 22895558 DOI: 10.1177/0272989x12453502] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND US colorectal cancer screening guidelines for people at average risk for colorectal cancer endorse multiple screening options and recommend that screening decisions reflect individual patient preferences. METHODS The authors used the analytic hierarchy process (AHP) to ascertain decision priorities of people at average risk for colorectal cancer attending primary care practices in Rochester, New York; Birmingham, Alabama; and Indianapolis, Indiana. The analysis included 4 decision criteria, 3 subcriteria, and 10 options. RESULTS Four hundred eighty-four people completed the study; 66% were female, 49% were African American, 9% had low literacy skills, and 27% had low numeracy skills. Overall, preventing cancer was given the highest priority (mean priority 55%), followed by avoiding screening test side effects (mean priority 17%), minimizing false-positive test results (mean priority 15%), and the combined priority of screening frequency, test preparation, and the test procedure(s) (mean priority 14%). Hierarchical cluster analysis revealed 6 distinct priority groupings containing multiple instances of decision priorities that differed from the average value by a factor of 4 or more. More than 90% of the study participants fully understood the concepts involved, 79% met AHP analysis quality standards, and 88% were willing to use similar methods to help make important health care decisions. CONCLUSION These results highlight the need to facilitate incorporation of patient preferences into colorectal cancer screening decisions. The large number of study participants able and willing to perform the complex AHP analysis used for this study suggests that the AHP is a useful tool for identifying the patient-specific priorities needed to ensure that screening decisions appropriately reflect individual patient preferences.
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Affiliation(s)
- James G Dolan
- Department of Community & Preventive Medicine, University of Rochester Medical Center, Rochester, New York (JGD)
| | - Emily Boohaker
- University of Alabama at Birmingham, Birmingham, Alabama (EB)
| | - Jeroan Allison
- University of Massachusetts, Worcester, Massachusetts (JA)
| | - Thomas F Imperiale
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana (TFI),Regenstrief Institute, Inc., Indianapolis, Indiana (TFI)
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Suner A, Çelikoğlu CC, Dicle O, Sökmen S. Sequential decision tree using the analytic hierarchy process for decision support in rectal cancer. Artif Intell Med 2012; 56:59-68. [PMID: 22776889 DOI: 10.1016/j.artmed.2012.05.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Revised: 05/08/2012] [Accepted: 05/13/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE The aim of the study is to determine the most appropriate method for construction of a sequential decision tree in the management of rectal cancer, using various patient-specific criteria and treatments such as surgery, chemotherapy, and radiotherapy. METHODS An analytic hierarchy process (AHP) was used to determine the priorities of variables. Relevant criteria used in two decision steps and their relative priorities were established by a panel of five general surgeons. Data were collected via a web-based application and analyzed using the "Expert Choice" software specifically developed for the AHP. Consistency ratios in the AHP method were calculated for each set of judgments, and the priorities of sub-criteria were determined. A sequential decision tree was constructed for the best treatment decision process, using priorities determined by the AHP method. RESULTS Consistency ratios in the AHP method were calculated for each decision step, and the judgments were considered consistent. The tumor-related criterion "presence of perforation" (0.331) and the patient-surgeon-related criterion "surgeon's experience" (0.630) had the highest priority in the first decision step. In the second decision step, the tumor-related criterion "the stage of the disease" (0.230) and the patient-surgeon-related criterion "surgeon's experience" (0.281) were the paramount criteria. The results showed some variation in the ranking of criteria between the decision steps. In the second decision step, for instance, the tumor-related criterion "presence of perforation" was just the fifth. CONCLUSION The consistency of decision support systems largely depends on the quality of the underlying decision tree. When several choices and variables have to be considered in a decision, it is very important to determine priorities. The AHP method seems to be effective for this purpose. The decision algorithm developed by this method is more realistic and will improve the quality of the decision tree.
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Affiliation(s)
- Aslı Suner
- Dokuz Eylül University, Faculty of Science, Department of Statistics, 35160 Tınaztepe, Buca, İzmir, Turkey.
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12
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Gomez DE, Vázquez AM, Alonso DF. Cancer antigen prioritization: a road map to work in defining vaccines against specific targets. A point of view. Front Oncol 2012; 2:66. [PMID: 22754871 PMCID: PMC3384841 DOI: 10.3389/fonc.2012.00066] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Accepted: 06/11/2012] [Indexed: 11/13/2022] Open
Affiliation(s)
- Daniel E Gomez
- Laboratory of Molecular Oncology, Quilmes National University Buenos Aires, Argentina
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Kobayashi Y, Hayashino Y, Jackson JL, Takagaki N, Hinotsu S, Kawakami K. Diagnostic performance of chromoendoscopy and narrow band imaging for colonic neoplasms: a meta-analysis. Colorectal Dis 2012; 14:18-28. [PMID: 20955514 DOI: 10.1111/j.1463-1318.2010.02449.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AIM We conducted a meta-analysis to compare the diagnostic test performance of chromoendoscopy and narrow band imaging (NBI) for colonic neoplasms. METHOD MEDLINE, EMBASE and the Cochrane Library were searched (1966 to March 2009). Articles were included if: (i) chromoendoscopy or NBI was used, (ii) sensitivity and specificity were reported; (iii) absolute numbers of true-positive, false-positive, true-negative and false-negative results were provided or could be calculated; and (iv) pathology was used as the reference standard. Sensitivity and specificity were pooled using random effects model. Secondary analyses were conducted by limiting the studies in which magnifying endoscopy was used alone as a diagnostic modality, and polyp size and macroscopic appearance of lesions were not considered. RESULTS Of 1342 screened articles, 27 met the inclusion criteria. Pooled sensitivity for chromoendoscopy and NBI was 0.94 (95% CI, 0.92-0.95) and 0.94 (0.91-0.97), and specificity was 0.82 (0.77-0.88) and 0.86 (0.83-0.89), respectively. There were no differences in sensitivity (P = 0.99) or specificity (P = 0.54) between the two methods. In the secondary analysis, pooled sensitivity for choromoendoscopy and NBI was 0.93 (95% CI, 0.90-0.97) and 0.96 (0.93-0.99) and specificity was 0.80 (0.73-0.87) and 0.85 (0.78-0.92). respectively. Overall, the pooled false-negative rate was 0.057 (95% CI, 0.040-0.73) for chromoendoscopy and 0.057 (95% CI, 0.028-0.085) for NBI. CONCLUSION Chromoendoscopy and NBI had similar diagnostic test characteristics in the assessment of colonic neoplasms; however, the false-negative rate for both methods of 5.7% is an unacceptably high rate and currently therefore, neither method is ready for general use.
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Affiliation(s)
- Y Kobayashi
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
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Kobayashi Y, Kudo SE, Miyachi H, Hosoya T, Ikehara N, Ohtsuka K, Kashida H, Hamatani S, Hinotsu S, Kawakami K. Clinical usefulness of pit patterns for detecting colonic lesions requiring surgical treatment. Int J Colorectal Dis 2011; 26:1531-40. [PMID: 21607587 DOI: 10.1007/s00384-011-1246-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/03/2011] [Indexed: 02/04/2023]
Abstract
BACKGROUND The number of patients suffering from colorectal cancer is increasing. According to Japanese guidelines, lesions with a submucosal invasive depth >1,000 μm should be treated with radical proctocolectomy. We propose and evaluate a new clinical classification for pit patterns that uses endoscopy to assess lesion depth for determination of the appropriate therapeutic approach for early colorectal cancers and adenomas. METHODS Endoscopic images of colorectal adenomas and early cancer cases with type V(I) pit pattern, resected surgically or endoscopically from April 2002 to April 2007 at Showa University Yokohama Northern Hospital, were utilized for analysis. Each image was retrospectively analyzed for (A) pit narrowness, (B) irregular pit margins, and (C) indistinct stromal staining. Sensitivity, specificity, and predictive value were evaluated as major outcomes, using pathological results as the standard. RESULT In total, 186 cases were assessed. With all features considered (A, B, and C), the sensitivity, specificity, and positive and negative predictive values were 47.8%, 86.3%, 66.0%, and 74.2%, respectively. When limited to two features (A and B), these values were 75.3%, 81.2%, 70.2%, and 84.8%, respectively. CONCLUSION Our results suggest that the established criteria can, to a certain degree, distinguish between high and low irregularity in colorectal lesions with V(I) pit pattern indicating submucosal cancer infiltration of more or less than 1,000 μm with the clinical consequence of surgery versus endoscopic mucosal resection/endoscopic mucosal dissection.
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Affiliation(s)
- Yasutoshi Kobayashi
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshida Konoecho, Sakyoku, Kyoto, 606-8505, Japan
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NGcGM3 ganglioside: a privileged target for cancer vaccines. Clin Dev Immunol 2010; 2010:814397. [PMID: 21048926 PMCID: PMC2965427 DOI: 10.1155/2010/814397] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2010] [Accepted: 09/24/2010] [Indexed: 01/05/2023]
Abstract
Active specific immunotherapy is a promising field in cancer research. N-glycolyl (NGc) gangliosides, and particularly NGcGM3, have received attention as a privileged target for cancer therapy. Many clinical trials have been performed with the anti-NGc-containing gangliosides anti-idiotype monoclonal antibody racotumomab (formerly known as 1E10) and the conjugated NGcGM3/VSSP vaccine for immunotherapy of melanoma, breast, and lung cancer. The present paper examines the role of NGc-gangliosides in tumor biology as well as the available preclinical and clinical data on these vaccine products. A brief discussion on the relevance of prioritization of cancer antigens in vaccine development is also included.
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Quality assurance of endoscopy in colorectal cancer screening. Best Pract Res Clin Gastroenterol 2010; 24:451-64. [PMID: 20833349 DOI: 10.1016/j.bpg.2010.06.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2010] [Accepted: 06/23/2010] [Indexed: 01/31/2023]
Abstract
This chapter explores the concept of quality assurance of colorectal cancer screening. It argues that effective quality assurance is critical to ensure that the benefits of screening outweigh the harms. The three key steps of quality assurance, definition of standards, measurement of standards and enforcement of standards, are explained. Quality is viewed from the perspective of the patient and illustrated by following the path of patients accessing endoscopy within screening services. The chapter discusses the pros and cons of programmatic versus non-programmatic screening and argues that quality assurance of screening can and should benefit symptomatic services. Finally, the chapter emphasises the importance of a culture of excellence underpinned by continuous quality improvement and effective service leadership.
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Marshall D, McGregor SE, Currie G. Measuring Preferences for Colorectal Cancer Screening. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2010; 3:79-89. [DOI: 10.2165/11532250-000000000-00000] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Abstract
Colorectal cancer (CRC) is one of the most common cancers in both Japan and the USA. Age-adjusted incidence of CRC has been in decline in the USA since 1985, while rates in Japan have been increasing. The decline in the USA is commonly attributed to CRC screening programs but there is little direct evidence to support this assertion. The current screening recommendations in the USA cover several options including colonoscopy and computerized tomographic colonography (CTC). The Japanese CRC screening program is centered on fecal immunochemistry testing (FIT). The US government Medicare program's approval of colonoscopy as a primary screening test has lead to a large increase in the number of patients undergoing the procedure. However, the benefit achieved from this change in screening program emphasis is not clear. Simulation models demonstrate that a screening program centered on FIT achieves 94% of the benefit that an all-colonoscopy program is able to accomplish but at a lower cost per life year gained. Clinical studies of colonoscopy have failed to demonstrate the 76-90% declines in CRC incidence predicted by the National Polyp Study published in 1993. A potential reason for this failure is the quality of colonoscopy performance. Until more compelling data becomes available demonstrating the utility of colonoscopy as a primary screening modality, there is little incentive to alter the proven cost-effective approach to CRC screening currently in practice in Japan.
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Affiliation(s)
- William A Ross
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA.
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Dolan JG. Multi-criteria clinical decision support: A primer on the use of multiple criteria decision making methods to promote evidence-based, patient-centered healthcare. THE PATIENT 2010; 3:229-248. [PMID: 21394218 PMCID: PMC3049911 DOI: 10.2165/11539470-000000000-00000] [Citation(s) in RCA: 113] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Current models of healthcare quality recommend that patient management decisions be evidence-based and patient-centered. Evidence-based decisions require a thorough understanding of current information regarding the natural history of disease and the anticipated outcomes of different management options. Patient-centered decisions incorporate patient preferences, values, and unique personal circumstances into the decision making process and actively involve both patients along with health care providers as much as possible. Fundamentally, therefore, evidence-based, patient-centered decisions are multi-dimensional and typically involve multiple decision makers.Advances in the decision sciences have led to the development of a number of multiple criteria decision making methods. These multi-criteria methods are designed to help people make better choices when faced with complex decisions involving several dimensions. They are especially helpful when there is a need to combine "hard data" with subjective preferences, to make trade-offs between desired outcomes, and to involve multiple decision makers. Evidence-based, patient-centered clinical decision making has all of these characteristics. This close match suggests that clinical decision support systems based on multi-criteria decision making techniques have the potential to enable patients and providers to carry out the tasks required to implement evidence-based, patient-centered care effectively and efficiently in clinical settings.The goal of this paper is to give readers a general introduction to the range of multi-criteria methods available and show how they could be used to support clinical decision-making. Methods discussed include the balance sheet, the even swap method, ordinal ranking methods, direct weighting methods, multi-attribute decision analysis, and the analytic hierarchy process (AHP).
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Affiliation(s)
- James G Dolan
- Department of Community and Preventive Medicine, University of Rochester, Rochester, New York, USA
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Klabunde CN, Lanier D, Nadel MR, McLeod C, Yuan G, Vernon SW. Colorectal cancer screening by primary care physicians: recommendations and practices, 2006-2007. Am J Prev Med 2009; 37:8-16. [PMID: 19442479 PMCID: PMC2727732 DOI: 10.1016/j.amepre.2009.03.008] [Citation(s) in RCA: 162] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2008] [Revised: 02/10/2009] [Accepted: 03/10/2009] [Indexed: 12/24/2022]
Abstract
BACKGROUND Primary care physicians (hereafter, physicians) play a critical role in the delivery of colorectal cancer (CRC) screening in the U.S. This study describes the CRC screening recommendations and practices of U.S. physicians and compares them to findings from a 1999-2000 national provider survey. METHODS Data from 1266 physicians responding to the 2006-2007 National Survey of Primary Care Physicians' Recommendations and Practices for Breast, Cervical, Colorectal, and Lung Cancer Screening (cooperation rate=75%) were analyzed in 2008. Descriptive statistics were used to examine physicians' CRC screening recommendations and practices as well as the office systems used to support screening activities. Sample weights were applied in the analyses to obtain national estimates. RESULTS Ninety-five percent of physicians routinely recommend screening colonoscopy to asymptomatic, average-risk patients; 80% recommend fecal occult blood testing (FOBT). Only a minority recommend sigmoidoscopy, double-contrast barium enema, computed tomographic colonography, or fecal DNA testing. Fifty-six percent recommend two screening modalities; 17% recommend one. Nearly all physicians who recommend endoscopy refer their patients for the procedure. Four percent perform sigmoidoscopy, a 25-percentage-point decline from 1999-2000. Although 61% of physicians reported that their practice had guidelines for CRC screening, only 30% use provider reminders; 15% use patient reminders. CONCLUSIONS Physicians' CRC screening recommendations and practices have changed substantially since 1999-2000. Colonoscopy is now the most frequently recommended test. Most physicians do not recommend the full menu of test options prescribed in national guidelines. Few perform sigmoidoscopy. Office systems to support CRC screening are lacking in many physicians' practices. Given ongoing changes in CRC screening technologies and guidelines, the continued monitoring of physicians' CRC screening recommendations and practices is imperative.
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Affiliation(s)
- Carrie N Klabunde
- Health Services and Economics Branch, Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland 20892-7344, USA.
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