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

Wagner, Monika; Samaha, Dima; Khoury, Hanane; O’Neil, William M.; Lavoie, Louis; Bennetts, Liga; Badgley, Danielle; Gabriel, Sylvie; Berthon, Anthony; Dolan, James G.; Kulke, Matthew H.; Goetghebeur, Mireille

doi:10.1007/s12325-017-0653-1

Cited by 16 publications

(18 citation statements)

References 43 publications

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“…Compared to physicians, patients tended to assign higher weights to the criteria of patients' perceived health, higher quality of life for them is much more important after the intervention. This showed also in other study, that patients' group assigned greater weight to the impact on Health Related Quality of Life [19,20]. Meanwhile compared to patients, physicians took 'safety' more into account.…”

Section: Perspectives Of Participants In General On Decision Criteriasupporting

confidence: 59%

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

Karrer

Zhang

Kühlein

et al. 2020

Preprint

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Background: The detection of thyroid cancer has rapidly increased over last few decades without an increase in disease specific mortality. Several studies claim that the diagnose of thyroid nodules through routine ultrasound imaging is often the trigger for cascade effects leading to unnecessary follow-up over many years or to invasive treatment. The objective of this study was to explore physicians’ and patients’ insights and preferences for diagnosis and treatment of thyroid nodules as well as awareness of over-diagnosis and overtreatment. Methods: An online survey was developed using a comprehensive multi criteria decision Analysis (MCDA) framework, the EVIdence based Decision-Making (EVIDEM). The EVIDEM core model used in this study encompassed 13 quantitative criteria and four qualitative criteria. Participants were asked to provide weights for each criterion, performance scores for appraising the thyroid nodules interventions and their consideration of impact of contextual criteria. Normalized weights and standardized scores were combined to calculate a value contribution across all participants, additionally differences across participants were explored. Results: Of all 105 participants, there are 48 patients, 31 physicians and 26 normal citizens. The highest value estimate of the intervention on thyroid nodules reached 0.401 for citizens’ group and lowest value of 0.287 was reported for physicians’ group, compared to 0.359 for all participants. The highest value contributors were efficacy and prevention. Compared to all participants, physicians gave less weight to quality of life and prevention benefits. In addition, physicians’ group gave less score on the treatment such like thyroid surgery compared to other two groups. 59% participants considered healthcare system had a positive impact on the diagnostic of thyroid nodules. Conclusion: Our study shows participants’ preferences on each criterion, i.e., physician indicated keeping the intervention safe and effective more important, patients indicated quality of life after receiving intervention more important. Through comparison among participants, differences have been highlighted, which can make better communication between physicians and patients. This study provided a supportive decision making for health providers when they conduct researches on thyroid nodules.Trial registration: This study did not report the results of a health care intervention on human participants.

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Section: Perspectives Of Participants In General On Decision Criteriasupporting

confidence: 59%

“…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].…”

Section: Using Online Platform To Conduct Mcdamentioning

confidence: 99%

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

Karrer

Zhang

Kühlein

et al. 2020

Preprint

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“…The study involved adaptation of the previously designed MCDA-based decision support framework for unresectable, well-differentiated, locally advanced or metastatic nonfunctioning GEP-NET to the Spanish context and its application to a group of Spanish patients and clinicians in a decision support workshop. The framework is designed in two modules: [ 12 ] the first allows one to derive a benefit–risk balance based solely on intervention outcomes (“core benefit–risk criteria”, including comparative efficacy/effectiveness, comparative patient-perceived health/patient-reported outcomes, and comparative safety/tolerability), organized in the core benefit–risk tree. The second contains, in addition to the three core criteria, other decision-making factors that may modulate the benefit–risk balance (modulating criteria, organized in the modulated benefit–risk tree) (see Supp.…”

Section: Methodsmentioning

confidence: 99%

“…In a previous study conducted in the USA, a framework to support shared decision-making for GEP-NET management had been designed on the basis of the open-source, multicriteria decision analysis (MCDA) EVIDEM framework [ 12 ]. The framework, in which the available evidence for GEP-NET management options was embedded, enabled patients and clinicians to identify what mattered to them in their individual decision-making context and share their diverse perspectives, thus supporting individual reflection and patient–clinician communication.…”

Section: Introductionmentioning

confidence: 99%

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

Wagner¹,

Samaha

Cuervo³

et al. 2018

Adv Ther

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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.

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“…These methods rely on the evaluation of patients' preferences to rank the multiple criteria that have to be taken into account to compare different decision options. 32,33 In the future, we could consider this as an interesting extension of UceWeb to provide the possibility of a personalized selection of the payoff.…”

Section: Discussionmentioning

confidence: 99%

Eliciting and Exploiting Utility Coefficients in an Integrated Environment for Shared Decision-Making

et al. 2019

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Background In shared decision-making, a key step is quantifying the patient's preferences in relation to all the possible outcomes of the compared clinical options. According to utility theory, this can be done by eliciting utility coefficients (UCs) from the patient. The obtained UCs are then used in decision models (e.g., decision trees). The elicitation process involves the choice of one or more elicitation methods, which is not easy for decision-makers who are unfamiliar with the theoretical framework. Moreover, to our knowledge there are no tools that integrate functionalities for UC elicitation with functionalities to run decision models that include the elicited values. Objectives The first aim of this work is to provide decision support to the clinicians for the selection of the elicitation method. The second aim is to bridge the gap between UC elicitation and the exploitation of those UCs in shared decision-making. Methods Based on evidence from the utility theory literature, we developed a set of production rules that recommend the optimal elicitation method(s) according to the patient's profile and health state. We then complemented this decision support tool with a functionality for quantifying and running decision trees defined through the commercial software TreeAge. Results The result is an integrated framework for shared decision-making. Given the primary aim of this work, we focus for result evaluation on the elicitation tool. It was tested on 51 volunteers, who expressed UCs for four purposely selected health states. The insights on the collected UCs validated the rules included in the decision support system. The usability of the tool was assessed through the System Usability Scale, obtaining positive results. Conclusion We developed an integrated environment to facilitate shared decision-making in the clinical practice. The next step is the validation of the entire framework and its use besides shared decision-making. As a matter of fact, it may also be exploited to target cost-utility analysis to a specific patient population.

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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

Cited by 16 publications

References 43 publications

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

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

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

Eliciting and Exploiting Utility Coefficients in an Integrated Environment for Shared Decision-Making

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