scholarly journals Supporting Individual Reflection and Patient-Clinician Shared Decision-Making on GEP-NET Management Options Using Reflective Multi-Criteria Decision Analysis

2017 ◽  
Vol 20 (9) ◽  
pp. A877-A878
Author(s):  
M Wagner ◽  
D Samaha ◽  
B O'Neil ◽  
H Khoury ◽  
L Bennetts ◽  
...  
Author(s):  
Brittany Humphries ◽  
Montserrat León-García ◽  
Ena Niño de Guzman Quispe ◽  
Carlos Canelo-Aybar ◽  
Claudia Valli ◽  
...  

2019 ◽  
Vol 39 (4) ◽  
pp. 437-449 ◽  
Author(s):  
Edouard Kujawski ◽  
Evangelos Triantaphyllou ◽  
Juri Yanase

Background. There is growing interest in multicriteria decision analysis (MCDA) for shared decision making (SDM). A distinguishing feature is that a preferred treatment should extend years of life and/or improve health-related quality of life (HRQL). Additive MCDA models are inadequate for the task. A plethora of MCDA models exist, each claiming that it can correctly solve real-world problems. However, most were developed in nonhealth fields and rely on additive models. This makes the problem of choosing an MCDA model as an aid for SDM a challenging and urgent one. Methods. A published 2017 MCDA of a hypothetical prostate cancer patient is used as a case in point of how not to do and how to do MCDA for SDM. We critically review it and analyze it using several additive linear MCDA models with years of life and HRQL as attributes and the linear quality-adjusted life-year (QALY) model. The following simple reasonableness test is presented for applicability of a method as an aid for SDM: Can a treatment that causes premature death trump a treatment that causes acceptable adverse effects? Results. Additive MCDA models and the linear QALY recommend significantly different alternatives. Additive MCDA models fail the proposed reasonableness test; the linear QALY model passes. Conclusions. MCDA possesses a strong craft element in addition to its technical aspects. MCDA practitioners and clinicians need to understand model limitations to choose models appropriate to the context. Additive MCDA models are inadequate for life-critical SDM. We advocate QALY models with additional research for increased realism as a tool for SDM.


2020 ◽  
Vol 14 (12) ◽  
Author(s):  
Kristen McAlpine ◽  
Rodney H. Breau ◽  
Dawn Stacey ◽  
Christopher Knee ◽  
Michael A.S. Jewett ◽  
...  

Introduction: Shared decision-making incorporates patient’s values and preferences to achieve high-quality decisions. The objective of this study was to develop an acceptable patient decision aid to facilitate shared decision-making for the management of small renal masses (SRMs). Methods: The International Patient Decision Aids Standards were used to guide an evidence-based development process. Management options included active surveillance, thermal ablation, partial nephrectomy, and radical nephrectomy. A literature review was performed to provide incidence rates for outcomes of each option. Once a prototype was complete, alpha-testing was performed using a 10-question survey to assess acceptability with patients, patient advocates, urologists, and methodological experts. The primary outcome was acceptability of the decision aid. Results: A novel patient decision aid was created to facilitate shared decision-making for the management of SRMs. Acceptability testing was performed with 20 patients, 10 urologists, two patient advocates, and one methodological expert. Responders indicated the decision aid was appropriate in length (82%, 27 of 33), well-balanced (82%, 27 of 33), and had language that was easy to follow (94%, 31 of 33). All patient responders felt the decision aid would have been helpful during their consultation and would recommend the decision aid for future patients (100%, 20 of 20). Most urologists reported they intend to use the decision aid (90%, 9 of 10). Conclusions: A novel patient decision aid was created to facilitate shared decision-making for management of SRMs. This clinical tool was acceptable with patients, patient advocates, and urologists and is freely available at: https://decisionaid.ohri.ca/decaids.html.


2021 ◽  
Vol 17 (1) ◽  
Author(s):  
François Graham ◽  
Douglas P. Mack ◽  
Philippe Bégin

AbstractOral immunotherapy (OIT) is now widely recognized as a valid option for the management of IgE-mediated food allergies. However, in real-life practice, OIT can lead to a variety of unique situations where the best course of action is undetermined. In patient-centered care, individual patient preferences, needs and values, should guide all clinical decisions. This can be achieved by using shared-decision making and treatment customization to navigate areas of uncertainty in a way that is responsive to patient’s needs and preferences. However, in the context of OIT, lack of awareness of potential protocol adaptability or alternatives can become a barrier to treatment personalization. The purpose of this article is to review the theoretical bases of patient-centered care and shared decision-making and their practical implication for the patient-centered delivery of OIT. Clinical cases highlighting common challenges in real-life OIT practice are presented along with a discussion of potential personalized management options to be considered. While the practice of OIT is bound to evolve as additional scientific and experiential knowledge is gained, it should always remain rooted in the general principles of patient-centered care.


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