Purpose: To design a tool to assist clinician participation with cancer drug funding decisions. Public policy-makers and insurers are struggling with funding decisions regarding increasingly expensive new cancer drugs. Increasingly, oncologists are contributing to the process of review that leads to such decisions. We were asked to design a system for ranking new cancer drugs for priority-based funding decisions.
Methods:The "Accountability for Reasonableness" framework informed the design of a six-module multistakeholder decision process blending evidence-based traditional technology assessment methods with individual and cultural values elicitation. The tool was piloted in three settings: (1) videotaped simulated multistakeholder deliberation sessions; (2) clinical oncology leaders; and (3) a regional (Canadian provincial) pharmacy and therapeutics committee making formulary decisions. The modules involve: decision clarification, drug eligibility screening (filtering), clinical performance scoring index, cost modeling, data integration and values clarification, and process evaluation.
Results:The tool was feasible to use, acceptable to participants, and able to rank candidate drugs. The pharmacy and therapeutics committee with whom it was tested used the tool as a part of their deliberations, and the tumor group leaders requested its incorporation into organization-based decision making.
Conclusion:The decision tool can facilitate priority-based cancer drug funding decisions that meet the conditions of fairness as perceived by participants, including oncologists.
This study attempts to seek data on the main sources of worry among secondary school pupils, the extent to which the type of worry and its frequency vary with age, and the influence of the type of school attended, grammar or secondary modern, upon the frequency and intensity of the type of worry. Two worry list questionnaires were constructed. There was a general decrease with age in the frequency and intensity of worry, and no significant worry differences between grammar and modern pupils, except for the 13‐year‐old group, where the secondary modern pupils had more frequent and intense worries than the grammar. The percentages for the frequency and intensity of worry were similar in both groups for each type of worry, the most frequent sources of worry being the family, social relationships and school, and the least frequent being animals, economic and personal health concerns. Some significant differences existed: grammar school pupils reported significantly more frequent and intense economic and school worries, secondary modern pupils significantly more imagination and health worries, and the only significant difference between the sexes was the tendency for grammar school girls to worry more frequently and intensely than grammar school boys.
This investigation sought data concerning sex differences in the worry patterns of children. The sample comprised 182 comprehensive school pupils, 91 boys and 91 girls, between the ages of 12 years 1 month and 13 years 7 months. The Simon-Ward Worry Survey (1976) was administered in order to ascertain the frequency and intensity of worry experienced in the following areas; family, school, economic, social, personal adequacy, health, imagination and animals. Both in the frequency and intensity of worry girls scored higher than boys in the areas of family, social and imagination, but no significant differences occurred for personal adequacy, health, animal or economic factors. For both sexes the category order, from highest to lowest, was the same--family, social, school, imagination, personal adequacy, health, economic and animals.
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