MDM Policy and Practice最新文献

{"title":"Revising a Training Curriculum on Shared Decision Making for Application in Routine Clinical Care: A Report on the SHARE Approach.","authors":"Douglas H Fernald, Daniel D Matlock, Christopher E Knoepke, W Perry Dickinson, R Mark Gritz, Laura D Scherer","doi":"10.1177/23814683261457450","DOIUrl":"10.1177/23814683261457450","url":null,"abstract":"<p><strong>Background: </strong>Improving shared decision making (SDM) training curricula may support wider training uptake and the use of SDM across health care settings. Limited uptake of a freely available SDM training curriculum suggested it could benefit from a systematic review and revision process. This report describes the process and revisions of the SHARE Approach curriculum, subsequently used in an implementation trial demonstrating that the revised curriculum remained effective.</p><p><strong>Methods: </strong>A qualitative study using a systematic review on shared decision making, training, and physicians published between 2015 and 2020; clinician and patient reviews and feedback on curriculum training materials; and synthesis of recommended improvements and a team-revised curriculum for testing in clinical practice.</p><p><strong>Results: </strong>Recommendations from the literature and reviewers (9 clinicians and 6 patients) focused on substantially reducing the length of the training curriculum, ideally under 4 h. Reviewers found original content well done and important but suggested removing content that was not explicitly focused on training clinicians how to implement shared decision making in clinical practice by removing discussions of applicable laws, medical interpreters, and patient-centered outcomes research while retaining important strategies for addressing patient health literacy/numeracy and use of decision aids.</p><p><strong>Limitations: </strong>Clinician and patient feedback might not represent the full scope of clinical specialties or patient types who may have different recommendations for revising the original curriculum for other clinical settings.</p><p><strong>Conclusion: </strong>Literature review and user feedback agreed that training curricula on shared decision making needed to be shorter and focus on only essential techniques clinicians need to effectively implement shared decision making in routine practice.</p><p><strong>Implications: </strong>A substantially shortened SHARE Approach curriculum is effective and may facilitate broader shared decision making training of clinicians.</p>","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"11 1","pages":"23814683261457450"},"PeriodicalIF":1.7,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13319809/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148370133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Method for Estimating Resource Use and Costs when Empirical Data Are Unavailable: Expert Elicitation Study Using the Example of Melanoma.","authors":"Rob Hainsworth, Louisa Collins, Martin Eden, Adele Green, Paul Lorigan, Gabriel Rogers, Amber Salisbury, Katherine Payne","doi":"10.1177/23814683261451278","DOIUrl":"10.1177/23814683261451278","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Purpose.&lt;/b&gt; The diagnosis, management, and therapy of cancer are rapidly advancing and becoming more costly. Data linking the diagnosis, management, and prescription of systemic anticancer therapy (SACT) are not publicly available, are time-consuming to obtain, and are onerous to analyze. We aimed to illustrate how a simple expert elicitation method can be used rapidly to calculate the cost of diagnosing and treating a cancer by stage of disease. We illustrate the method using the example of melanoma. &lt;b&gt;Methods.&lt;/b&gt; We designed a simple structured elicitation exercise for melanoma experts from the United Kingdom with the aim of describing the diagnosis, management, and SACT prescription for people with melanoma and the associated proportions offered each option. We modeled experts' beliefs using scaled beta distributions. We used random-effects meta-analysis to combine the estimates. Published unit costs (£; 2024-2025) were multiplied by estimated proportions to calculate the mean costs for the diagnosis, management, and SACT by disease stage. &lt;b&gt;Results.&lt;/b&gt; Seven dermatologists, 5 oncologists, and 4 surgeons participated (2022-2023). There was variation in the estimates of the proportions receiving possible diagnosis, management, or SACT options. Diagnosing suspicious lesions cost £424 to £699 depending on the investigations required. Mean (95% confidence intervals) management costs were £782 (£611, £981) for stage 0, £946 (£776, £1,145) for stage 1a, £4,729 (£4,532, £4,944) for stage 1b/2, £3,719 (£3,213, £4,150) for macroscopic 3, and £2,827 (£2,757, £2,904) for microscopic 3. Mean SACT costs were £65,289 (£50,581, £74,521) for stage 3 and £134,065 (£115,787, £152,938) for stage 4. &lt;b&gt;Conclusions.&lt;/b&gt; Our new approach to eliciting and combining estimates balances practical and theoretical considerations. We illustrate how this method produces estimates of the costs, and associated uncertainty, of the diagnosis, management, and SACT for melanoma by stage of disease in the absence of readily accessible diagnosis, management, and prescribing data. These cost estimates were not validated against registry data.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Highlights: &lt;/strong&gt;Linked diagnosis, primary surgical management (hereafter \"management\"), and prescribing of systemic anticancer therapies (SACT) data describing the number and proportion of people with cancer offered these options are not readily available. The time to obtain data together with the time to conduct onerous analyses are a key barrier to obtaining values for use by decision analysts building economic models for evaluating new options for the early detection or prevention of cancer.We designed a simple expert elicitation exercise, completed in Excel. The exercise was designed to provide estimates of the total cost of cancer by stage of disease and crucially also to understand the extent of uncertainty around these estimates. We used melanoma as an exemplar cancer.Clinical experts (consultant dermato","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"11 1","pages":"23814683261451278"},"PeriodicalIF":1.7,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13305569/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148346613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acceptability of Nonpharmaceutical Interventions to Prevent the Risk of COVID-19 Infection in the United States.","authors":"Rachel E Murray-Watson, Marcy Ekanayake-Weber, Ted Cohen, Janel Hanmer, Reza Yaesoubi","doi":"10.1177/23814683261455894","DOIUrl":"10.1177/23814683261455894","url":null,"abstract":"<p><p><b>Background</b>. Nonpharmaceutical interventions (NPIs) were critical for mitigating COVID-19 transmission, yet their social and economic costs generated substantial public resistance. We aimed to quantify US adults' acceptance of key NPIs. <b>Methods</b>. We conducted a national discrete-choice experiment between May and December 2024 among a quota-based panel of US adults, considering 6 NPIs: mask mandates, reduced public transit capacity, school closures with/without remote learning, closure of crowded indoor venues, and closure of nonessential businesses (e.g., restaurants). Scenarios varied by COVID-19 infection risk and health care restrictions. <b>Results</b>. A total of 5,047 adults participated, with age, gender, race, and income distributions reflecting those of the US population. Participants considered mask mandates, reduced transit capacity, and school closures with remote learning acceptable even if they do not reduce cases. School closures without remote learning and closure of nonessential businesses were acceptable only if they reduced cases by at least 75 per 100 persons within 1 mo. Restricted access to primary and optional care was strongly objected to. Male participants, Republicans, Independents, adults ≥65 y, and those without chronic conditions showed the lowest acceptance of NPIs regardless of projected benefit. Female participants, younger adults, those living with children, and those with chronic conditions were more receptive. Still, they required a reduction of >50 cases per 100 persons to accept school closures without remote learning and closure of nonessential businesses. <b>Limitations</b>. Temporal distancing may have affected participants' recollection of their experiences with NPIs. <b>Conclusions</b>. US adults displayed heterogeneous but generally high thresholds for accepting school closures without remote learning, closure of nonessential businesses, and health care restrictions. These findings can guide pandemic preparedness plans that balance public acceptance with disease-control goals.</p><p><strong>Highlights: </strong>What levels of COVID-19 risk reduction were required for US adults to accept nonpharmaceutical interventions (NPIs) such as school or business closures?In a discrete-choice experiment of 5,047 US adults, mask mandates and other moderate NPIs were broadly acceptable even if they do not reduce cases. School closures without remote learning and closure of nonessential businesses were acceptable only if they reduced infections by ≥75 per 100 persons per month.Our survey participants did not find pandemic response plans that rely on disruptive NPIs acceptable but found indoor mask mandates and school closures with remote learning acceptable, independent of their impact on infection risk.</p>","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"11 1","pages":"23814683261455894"},"PeriodicalIF":1.7,"publicationDate":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13305725/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148346673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Consumer Preferences for Care Delivery Modality, Timely Care Access, and Time Costs: Insights from Discrete Choice Experiments.","authors":"Ying Jessica Cao, Amy Schultz, Tiffany Green","doi":"10.1177/23814683261456736","DOIUrl":"10.1177/23814683261456736","url":null,"abstract":"<p><p><b>Background.</b> Policies on telehealth coverage and reimbursement have been evolving. To support national decisions on telehealth use and delivery, this study assessed patient preferences on care delivery modalities and value of time for primary care in outpatient settings. <b>Design.</b> Discrete choice experiments were designed to calibrate care visits by 1 price attribute and 3 nonprice attributes: delivery mode (phone, video, in-person), time costs, and waiting time. Mixed logistic regression models were used to estimate patient preferences and willingness to pay (WTP). <b>Sample.</b> A total of 110 respondents were recruited from a state representative cohort in the Midwestern United States with oversampling of Black and Hispanic minorities. <b>Results.</b> Patients were willing to pay $23.2 (95% confidence interval [CI] 13.3, 37.9) for a primary care visit and $30.3 extra (95% CI 21.1, 44.0) for in-person care but discounted the value of care by $8.7 for a video visit and $21.6 for a phone visit. Reducing time costs from 45 to 30 min increased patients' WTP by $4.0 (1.8, 7.3). Patients' WTP was $4.1 higher (or $2.2) if care visits were scheduled on the same day (or within 3 d) rather than in 7 d. Patients who were non-White minorities, older than 65 y, did not own a property, or were Medicaid beneficiaries valued care visits lower than the average ($11-$18 v. $23) but valued same-day visits more ($6.2-$6.3 v. $4.1). <b>Conclusions.</b> Patients discounted care delivered by phone or video visits but preferred to have such options for flexibility and timely access. The benefits of telehealth such as reducing time costs and providing timely care access increased its desirability and the potential to avoid missed or delayed care for preventive and care maintenance purposes.</p><p><strong>Highlights: </strong>Patients are willing to pay about $23 for a typical primary care visit on prevention and maintenance.Patients discount video or phone visits by $8 to $20 but prefer to have such options for flexibility and timely access.Patients are willing to pay $4 to $6 for shorter time cost obtaining care or same-day timely access to care.Non-White minorities and older and low-income patients have lower valuation for a care visit but a higher price premium for same-day visits than the general population, suggesting high potential of telehealth to help avoid missed or delayed care for these subpopulations.</p>","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"11 1","pages":"23814683261456736"},"PeriodicalIF":1.7,"publicationDate":"2026-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13287406/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148319202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the Impact of Different Natural History Modeling Methods on Cost-Effectiveness Decisions: A Case Study in Duchenne Muscular Dystrophy.","authors":"Jonathan Broomfield, Keith R Abrams, Michael J Crowther, Michela Guglieri, Nicholas R Latimer, Mark J Rutherford","doi":"10.1177/23814683261447231","DOIUrl":"10.1177/23814683261447231","url":null,"abstract":"<p><p><b>Introduction.</b> Cost-effectiveness analyses are vital in guiding decisions on treatment reimbursement. Natural history models are central to these, enabling the estimation of long-term costs and quality-adjusted life-years (QALYs) in the absence of lifetime trial data. Rare disease data are often scarce, resulting in disease progression being estimated through clinical assumptions. This study aims to evaluate how different modeling approaches influence cost-effectiveness estimates in rare disease health technology assessments (HTAs), using Duchenne muscular dystrophy (DMD) as a case study. <b>Methods.</b> A published economic model was used to compare 2 approaches for estimating disease progression: an assumption-based method relying on clinical plausibility and data-driven methods using data from 1,005 patients with DMD across 8 studies. Transition probabilities were estimated assuming increasing flexibility of study heterogeneity and compared with a simulated treatment cohort. Models were evaluated by comparing incremental cost-effectiveness ratios (ICERs) across approaches. No gold standard exists, so the plausibility of predictions was evaluated by comparing survival and disease progression estimates to published milestones. <b>Results.</b> Results showed that although the assumption-based model was clinically plausible, it predicted higher QALY gains (0.77) and lower ICERs (£1.96M per QALY) than data-driven methods did, which estimated QALY gains of 0.25, 0.26, 0.27, and 0.28 and ICERs of £6.2M, £6.2M, £5.8M, and £5.7M per QALY for the least to most flexible models, respectively. <b>Limitations.</b> No covariate effects or updated cost and utility data were incorporated, as the study purpose was a methodological comparison between approaches. Analyses were deterministic not probabilistic. <b>Conclusions and Implications.</b> This study emphasizes the critical role of model selection for HTA in rare diseases, showing that cost-effectiveness estimates from robust data-driven approaches can differ from clinically plausible assumption-based models.</p><p><strong>Highlights: </strong>The choice of a natural history modeling method can drastically alter the cost-effectiveness results in rare disease evaluations.A case study in Duchenne muscular dystrophy demonstrates how different modeling approaches yield divergent cost-effectiveness outcomes.Assumption-based models, even when clinically plausible, may underestimate measures of cost-effectiveness and result in less reliable guidance for decision makers.Data-driven models using real-world patient data provide more reliable estimates for health technology assessment (HTA).This study offers practical guidance for analysts and HTA bodies on selecting robust modeling approaches in rare disease contexts.</p>","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"11 1","pages":"23814683261447231"},"PeriodicalIF":1.7,"publicationDate":"2026-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13260772/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148253629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring Clinicians' Determinants of Participation in Medical Cannabis Decision Making with Older Adults Experiencing Arthritis: A Qualitative Descriptive Study.","authors":"Heba A T Aref, Yazid N Al Hamarneh, Elaine Yacyshyn, Tony K L Kiang, Cheryl A Sadowski","doi":"10.1177/23814683261444057","DOIUrl":"10.1177/23814683261444057","url":null,"abstract":"<p><p><b>Background.</b> Arthritis is a common chronic condition among older adults in Canada. Shared decision making (SDM) regarding medical cannabis (MC) use has been anticipated to result in improved health outcomes. However, the practice of SDM for MC remains limited. Few studies addressed what clinicians need to decide with their patients about MC. We explored clinicians' perspectives on what determines their decisional needs to participate in MC SDM with older adults experiencing arthritis. <b>Methods.</b> In-depth, semi-structured interviews using purposive sampling were conducted online. An interview guide based on the Ottawa Decision Support Framework (ODSF) was used. Recordings were transcribed verbatim, and the data were analyzed deductively and inductively using reflexive thematic analysis. <b>Results.</b> Semi-structured interviews with 12 participants (33% pharmacists, 25% family physicians, 25% rheumatologists, and 17% registered nurses) were conducted. Three main themes were constructed to summarize determinants of clinicians' needs to be able to participate in MC-related SDM: 1) perception of the decision, 2) perception of others, and 3) decisional conflict. <b>Conclusion.</b> While gaps in evidence remain a critical concern affecting inadequate knowledge and contributing to decision-making needs, findings suggest that a tailored decision support intervention (DSI) would strengthen clinicians' self-efficacy, clarify role expectations, and attend to the interpersonal dynamics that shape MC SDM. To enhance usability, a DSI should be developed to address clinicians' decisional needs while remaining responsive to workflow constraints.</p><p><strong>Highlights: </strong>Using the Ottawa Decision Support Framework, this study explored clinicians' decisional needs regarding shared decision making about medical cannabis (MC) use for arthritis.Findings highlight gaps that hinder clinicians from engaging in open discussions, leaving many older adults to make MC decisions without professional guidance.Addressing clinicians' decisional needs is essential for developing decision support interventions and policies that ensure safe, informed care.</p>","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"11 1","pages":"23814683261444057"},"PeriodicalIF":1.7,"publicationDate":"2026-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13195212/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148017709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"Do You Want to Talk to [the Patient]?\" Impact of Visit Modality on Shared Decision Making in Pediatric Primary Care.","authors":"Kelsey Schweiberger, Sandy Lee, Ruby Hyland-Brown, William B Brinkman, Maria T Britto, Andrew F Beck, Kristin N Ray, Ken Tegtmeyer, Ellen A Lipstein","doi":"10.1177/23814683261447292","DOIUrl":"10.1177/23814683261447292","url":null,"abstract":"<p><p><b>Introduction.</b> Telemedicine may improve access to care for children, but whether telemedicine alters decision-making processes is not known. We aimed to describe differences in shared decision making (SDM) in telemedicine and in-person pediatric primary care visits with children with chronic conditions. <b>Methods.</b> We conducted qualitative analyses of primary care visits video recorded across 6 pediatric primary care practices. Telemedicine visits were matched to in-person visits on age, diagnosis, timing of visit, and clinical site. Each recording was summarized by a trained reviewer. The summaries were then coded and analyzed using a framework approach. Codes were organized into a matrix to facilitate thematic analyses both within and across visits and visit types. <b>Results.</b> We analyzed 16 telemedicine and 18 in-person visits with 34 unique patients and 12 unique clinicians. The samples of telemedicine and in-person visits were similar in distribution across patient and parent characteristics. Most of the visits discussed attention-deficit/hyperactivity disorder. Thematic analysis identified 2 major themes. First, employment of SDM processes do not differ by visit modality. Across constructs of team talk, options talk, and decision talk, optimal SDM processes were lacking in both visit modalities. Second, visit modality affects the patient's decision engagement. Patients were physically present during all in-person visits but only briefly present during most telemedicine visits, limiting their opportunities to engage in decision making. <b>Conclusion.</b> Our study did not identify qualitative differences in SDM across the mode of pediatric primary care delivery: telemedicine versus in person. These data may alleviate concerns about potential negative effects of telemedicine on communication in pediatric primary care visits for chronic conditions. However, there is a need to improve shared decision making across visit types in pediatric primary care.</p><p><strong>Highlights: </strong>Our study demonstrates that the mode of pediatric primary care delivery does not affect the use of SDM in primary care visits for pediatric chronic conditions.There are opportunities to improve SDM across both care modalities.Future work should consider how approaches to increasing SDM and family decision engagement may differ by visit modality.</p>","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"11 1","pages":"23814683261447292"},"PeriodicalIF":1.7,"publicationDate":"2026-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13187368/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147989381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Supporting Decision Making on ADHD Medication: Development and Evaluation of a Decision Aid for Parents.","authors":"Yulia Gendler, Hedva Stoin, Tehila Volberstein, Lani Ofri, Dawn Stacey","doi":"10.1177/23814683261446325","DOIUrl":"10.1177/23814683261446325","url":null,"abstract":"<p><p><b>Background.</b> Parents of children diagnosed with attention-deficit/hyperactivity disorder (ADHD) often encounter complex treatment decisions, especially the initiation of pharmacologic therapy. While evidence-based decision aids facilitate informed, values-congruent choices, tools remain limited outside English-speaking settings. <b>Objective.</b> This study aimed to develop and evaluate the feasibility and acceptability of a Hebrew-language decision aid intended to support parents in making informed decisions regarding the initiation of ADHD medication for their children. <b>Methods.</b> The development process adhered to the International Patient Decision Aid Standards and was guided by the Ottawa Decision Support Framework. Acceptability testing involved 20 stakeholders using a mixed-methods questionnaire. Field testing used a pre/post design with 38 parents of children recently diagnosed with ADHD. Outcomes, measured using validated instruments, were knowledge, decisional conflict, decision self-efficacy, decision preparedness, and preference about SDM. <b>Results.</b> Most participants found the decision aid to be clear, well-structured, and easy to understand. All (100%) agreed it would be helpful for others facing similar decisions. Compared with baseline, post-decision aid parental knowledge significantly increased (67.4 to 84.7 out of 100; <i>P</i> < 0.001) and decisional conflict decreased (29.8 to 20.8 out of 100; <i>P</i> = 0.01). Decision self-efficacy increased from 83.6 to 90.0 out of 100 (<i>P</i> = 0.09). Participants reported high decision preparedness (mean = 89.5 of 100), and 45% preferred shared decision making with the physician. <b>Conclusions.</b> The systematically developed decision aid about ADHD treatments demonstrated feasibility and acceptability. It showed potential to enhance informed, value-based parental decision making; reduce decisional conflict; and facilitate shared decision making in pediatric clinical care.</p><p><strong>Highlights: </strong>A decision aid was developed to support parents in making ADHD medication decisions.The decision aid significantly increased parents' knowledge about ADHD and treatment options and reduced parents' decisional conflict.Stakeholders, including parents and health care professionals, reported that the decision aid was acceptable.The decision aid prepared parents for shared decision making within pediatric ADHD care.</p>","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"11 1","pages":"23814683261446325"},"PeriodicalIF":1.7,"publicationDate":"2026-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13180142/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147976025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advancing the Evaluation of Risk-Stratified Colorectal Cancer Screening by Simulating Quantitative Fecal Hemoglobin Concentrations.","authors":"Danica M N van den Berg, Luuk A van Duuren, Lucie de Jonge, Iris Lansdorp-Vogelaar","doi":"10.1177/23814683261440920","DOIUrl":"10.1177/23814683261440920","url":null,"abstract":"<p><p><b>Background.</b> Growing evidence indicates that fecal hemoglobin (f-Hb) concentrations from prior negative fecal immunochemical tests (FITs) can predict the future detection of colorectal cancer (CRC) and advanced neoplasia. As a result, there are opportunities for risk-based screening tailored to prior FIT outcomes. However, current CRC screening decision models do not explicitly simulate quantitative f-Hb concentrations. They simulate only a binary positive or negative test result based on the sensitivity and specificity of the underlying lesions, which makes it impossible to evaluate risk-based screening by f-Hb with these models. <b>Methods.</b> We extended our well-established MISCAN-Colon microsimulation model with a module that simulates quantitative f-Hb concentrations based on age, sex, and the presence of colorectal lesions. This module was based on a zero-inflated negative binomial mixed-effect model and calibrated and validated using observational data from the Dutch national CRC screening program between 2014 and 2020. The new MISCAN-Colon was then applied to a case study, in which we compared the effectiveness of uniform biennial screening intervals versus risk-based intervals (3 y after a FIT result of 0 µg/g, 2 y after >0-15 µg/g, and 1 y after >15-46.9 µg/g). <b>Results.</b> The updated model closely reflected real-world results, including positivity rate (observed: 4.7%, model: 4.3%), CRC detection rates (observed: 0.3%, model: 0.4%), f-Hb distributions, and longitudinal patterns across 3 screening rounds. Compared with biennial screening, the risk-based strategy resulted in slightly more CRC cases (+5%) and deaths (+11%) but required substantially fewer FITs (-28%) and colonoscopies (-13%). <b>Conclusions.</b> Integrating the f-Hb module into MISCAN-Colon enables explicit modeling of f-Hb concentrations and facilitates the evaluation of risk-based screening by prior f-Hb concentrations.</p><p><strong>Highlights: </strong>In colorectal cancer screening (CRC), risk-based screening using fecal hemoglobin (f-Hb) from prior screening rounds has been suggested to improve the balance between the benefits and harms of screening. However, the added value of this approach has never been quantified because none of the existing decision models for CRC screening simulate f-Hb concentrations.We used data from the Dutch national CRC screening program to extend the widely used MISCAN-Colon microsimulation model to explicitly simulate an individual's f-Hb concentration based on sex, age, and the presence of colorectal lesions.This model accurately reproduced cross-sectional and longitudinal associations between f-Hb concentration and screen-detected colorectal lesions, and model estimates showed that risk-based screening using f-Hb concentrations could be more efficient than current uniform screening.</p>","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"11 1","pages":"23814683261440920"},"PeriodicalIF":1.7,"publicationDate":"2026-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13172669/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147964829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Developing a Novel Values Elicitation Measure for Clinical Use in Older Adults with Hematologic Malignancies: Values-HM.","authors":"Daniel R Richardson, Allison M Deal, Carl J Mhina, Matthew Washko, Amy C Cole, Norah L Crossnohere, Kah Poh Loh, Ethan Basch, Stephanie B Wheeler, William A Wood, John F P Bridges, Thomas W LeBlanc, Antonia V Bennett","doi":"10.1177/23814683261440935","DOIUrl":"10.1177/23814683261440935","url":null,"abstract":"<p><p><b>Introduction.</b> The recent expansion of treatment options for older adults with blood cancers has increased the necessity for understanding patient preferences and values to inform treatment decision making. Currently, no values elicitation measures have been validated for clinical use in this population. Values-HM (Values elicitation measure for Hematologic Malignancies) is a novel values elicitation measure based on best-worst scaling. It was developed specifically for older adults with blood cancers involving multiple stakeholders including patients, caregivers, and clinicians. <b>Objective.</b> The objective of this study was to test the preliminary validity, reliability, and acceptability of this measure for clinical use based on US Food and Drug Administration and International Society for Pharmacoeconomics and Outcomes Research guidance. <b>Results.</b> Twenty-nine adults aged ≥60 y with newly diagnosed lymphoma, leukemia, myelodysplastic syndrome, and multiple myeloma were enrolled. Most patients were White (97%). Most patients (88%) felt that the measure was relevant to them, showed their real preferences (73%), and was acceptable to clarify their preferences (68%). The measure demonstrated discriminant validity of importance scores and convergent validity for most patients (77%) with a ranking exercise of the treatment values. Cognitive interviews with 10 participants suggested question comprehension, outcome understanding, and appropriate judgment. Data from 18 participants who completed the measure more than once provide some evidence for the reliability of the measure to capture repeated values over time. <b>Conclusions.</b> These initial data suggest that Values-HM may be acceptable to patients and valid and reliable to capture patient values. Additional data are needed to confirm these findings in a larger and more diverse sample. This trial was registered at www.clinicaltrials.gov as #NCT05061095.</p><p><strong>Highlights: </strong>Values-HM is a novel values elicitation measure designed based on best-worst scaling for adults with blood cancers.Values-HM appears to be acceptable to patients and may be valid and reliable to capture patient values in clinical care.</p>","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"11 1","pages":"23814683261440935"},"PeriodicalIF":1.7,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13167359/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147943126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}