Applying Reflective Multicriteria Decision Analysis (MCDA) to Patient–Clinician Shared Decision-Making on the Management of Gastroenteropancreatic Neuroendocrine Tumors (GEP-NET) in the Spanish Context

Abstract

IntroductionUnresectable, well-differentiated nonfunctioning gastroenteropancreatic neuroendocrine tumors (GEP-NETs) can be monitored (watchful waiting, WW) or treated with systemic therapy such as somatostatin analogues (SSAs) to delay progression. We applied a reflective multicriteria decision analysis (MCDA) shared-decision framework (previously developed for the USA) to explore what matters to Spanish patients and clinicians considering GEP-NET treatment options.MethodsThe EVIDEM-derived framework was updated and adapted to the Spanish context. During a Chatham House session, five patients and six physicians assigned criteria weights using hierarchical point allocation and direct rating scale (alternative analysis). Informed by synthesized evidence embedded in the framework, participants scored how each criterion favored SSA treatment (reference case lanreotide) or WW and shared insights and knowledge. Weights and scores were combined into value contributions (norm. weight × score/5), which were added across criteria to derive the relative benefit–risk balance (RBRB, scale − 1 to + 1). Exploratory comparisons to US study findings were performed.ResultsFocusing on intervention outcomes (effectiveness, patient-reported, and safety), the mean RBRB favored treatment over WW (+ 0.32 ± 0.24), with the largest contributions from progression-free survival (+ 0.11 ± SD 0.07), fatal adverse events (+ 0.06 ± SD 0.08), and impact on HRQoL (+ 0.04 ± SD 0.04). Consideration of modulating criteria (type of benefit, need, costs, evidence, and feasibility) increased the RBRB to + 0.50 ± 0.14, with type of therapeutic benefit (+ 0.10 ± SD 0.08) and quality of evidence (+ 0.08 ± SD 0.06) contributing most towards treatment. Alternative weighting yielded similar results. Results were broadly comparable to those derived from the US study.ConclusionThe multicriteria framework helped Spanish patients and clinicians identify and express what matters to them. The approach is transferable across decision-making contexts.FundingIPSEN Pharma.Electronic supplementary materialThe online version of this article (10.1007/s12325-018-0745-6) contains supplementary material, which is available to authorized users.

A Multiple Stakeholder Multicriteria Decision Analysis in Diabetic Macular Edema Management: The MULTIDEX-EMD Study

“…In our country, Spain, only a few MCDAs have been published in the field of healthcare [20][21][22][23][24][25][26][27][28], although the number of healthcare-related publications that incorporate MCDA is increasing in Spain and globally.…”

“…Some MCDAs have been used in our country to compare alternative treatments for various pathologies, such as chronic dermatological inflammatory diseases, cancer, rare diseases, and cardiovascular diseases such as nonvalvular atrial fibrillation and pulmonary hypertension [24][25][26]28]. Other applications of MCDA include the development of an assessment framework for rare diseases at a regional level in Catalonia [22] and the development of a decision-support tool for drug evaluation in a pharmacy and therapeutics committee setting at the hospital level [20].…”

“…Some studies have used the EVIDEM methodology to develop the analysis [20,[22][23][24][25]28]. In those studies, the methods used to prioritize the criteria were fundamentally compositional, such as direct classification or the analytic hierarchical process [22][23][24][25][26][27][28].…”

“…Some studies have used the EVIDEM methodology to develop the analysis [20,[22][23][24][25]28]. In those studies, the methods used to prioritize the criteria were fundamentally compositional, such as direct classification or the analytic hierarchical process [22][23][24][25][26][27][28]. Either a single-stakeholder perspective was used, such as that of patients [20,21,26] or evaluation agencies [22,27], or a multidisciplinary perspective was employed, which included patients, physicians, and other stakeholders [23][24][25]28].…”

Exploring Perspectives and Preferences for Over-Diagnosis and Overtreatment of Thyroid Nodules using a MCDA Method

“…There are more and more researchers using EVIDEM to explore perspectives on healthcare intervention. Most of them recruited a group of people to make a focus group to do interview face to face [17][18][19][20]. Our study used an on-line platform to involve more participants [21].…”