MDM Policy and Practice最新文献

{"title":"Development of Complementary Encounter and Patient Decision Aids for Shared Decision Making about Stroke Prevention in Atrial Fibrillation.","authors":"Aubrey E Jones, Madeleine M McCarty, Kenzie A Cameron, Kerri L Cavanaugh, Benjamin A Steinberg, Rod Passman, Preeti Kansal, Adriana Guzman, Emily Chen, Lingzi Zhong, Angela Fagerlin, Ian Hargraves, Victor M Montori, Juan P Brito, Peter A Noseworthy, Elissa M Ozanne","doi":"10.1177/23814683231178033","DOIUrl":"10.1177/23814683231178033","url":null,"abstract":"<p><strong>Introduction: </strong>Decision aids (DAs) are helpful instruments used to support shared decision making (SDM). Patients with atrial fibrillation (AF) face complex decisions regarding stroke prevention strategies. While a few DAs have been made for AF stroke prevention, an encounter DA (EDA) and patient DA (PDA) have not been created to be used in conjunction with each other before.</p><p><strong>Design: </strong>Using iterative user-centered design, we developed 2 DAs for anticoagulation choice and stroke prevention in AF. Prototypes were created, and we elicited feedback from patients and experts via observations of encounters, usability testing, and semistructured interviews.</p><p><strong>Results: </strong>User testing was done with 33 experts (in AF and SDM) and 51 patients from 6 institutions. The EDA and PDA underwent 1 and 4 major iterations, respectively. Major differences between the DAs included AF pathophysiology and a preparation to meet with the clinician in the PDA as well as different language throughout. Content areas included personalized stroke risk, differences between anticoagulants, and risks of bleeding. Based on user feedback, developers 1) addressed feelings of isolation with AF, 2) improved navigation options, 3) modified content and flow for users new to AF and those experienced with AF, 4) updated stroke risk pictographs, and 5) added structure to the preparation for decision making in the PDA.</p><p><strong>Limitations: </strong>These DAs focus only on anticoagulation for stroke prevention and are online, which may limit participation for those less comfortable with technology.</p><p><strong>Conclusions: </strong>Designing complementary DAs for use in tandem or separately is a new method to support SDM between patients and clinicians. Extensive user testing is essential to creating high-quality tools that best meet the needs of those using them.</p><p><strong>Highlights: </strong>First-time complementary encounter and patient decision aids have been designed to work together or separately.User feedback led to greater structure and different experiences for patients naïve or experienced with anticoagulants in patient decision aids.Online tools allow for easier dissemination, use in telehealth visits, and updating as new evidence comes out.</p>","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"8 1","pages":"23814683231178033"},"PeriodicalIF":1.9,"publicationDate":"2023-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10765759/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47470488","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":"Estimating the Cost of 3 Risk Prediction Strategies for Potential Use in the United Kingdom National Breast Screening Program.","authors":"Stuart J Wright, Martin Eden, Helen Ruane, Helen Byers, D Gareth Evans, Michelle Harvie, Sacha J Howell, Anthony Howell, David French, Katherine Payne","doi":"10.1177/23814683231171363","DOIUrl":"10.1177/23814683231171363","url":null,"abstract":"<p><strong>Background: </strong>Economic evaluations have suggested that risk-stratified breast cancer screening may be cost-effective but have used assumptions to estimate the cost of risk prediction. The aim of this study was to identify and quantify the resource use and associated costs required to introduce a breast cancer risk-stratification approach into the English national breast screening program.</p><p><strong>Methods: </strong>A micro-costing study, conducted alongside a cohort-based prospective trial (BC-PREDICT), identified the resource use and cost per individual (£; 2021 price year) of providing a risk-stratification strategy at a woman's first mammography. Costs were calculated for 3 risk-stratification approaches: Tyrer-Cuzick survey, Tyrer-Cuzick with Volpara breast-density measurement, and Tyrer-Cuzick with Volpara breast-density measurement and testing for 142 single nucleotide polymorphisms (SNP). Costs were determined for the intervention as implemented in the trial and in the health service.</p><p><strong>Results: </strong>The cost of providing the risk-stratification strategy was calculated to be £16.45 for the Tyrer-Cuzick survey approach, £21.82 for the Tyrer-Cuzick with Volpara breast-density measurement, and £102.22 for the Tyrer-Cuzick with Volpara breast-density measurement and SNP testing.</p><p><strong>Limitations: </strong>This study did not use formal expert elicitation methods to synthesize estimates.</p><p><strong>Conclusion: </strong>The costs of risk prediction using a survey and breast density measurement were low, but adding SNP testing substantially increases costs. Implementation issues present in the trial may also significantly increase the cost of risk prediction.</p><p><strong>Implications: </strong>This is the first study to robustly estimate the cost of risk-stratification for breast cancer screening. The cost of risk prediction using questionnaires and automated breast density measurement was low, but full economic evaluations including accurate costs are required to provide evidence of the cost-effectiveness of risk-stratified breast cancer screening.</p><p><strong>Highlights: </strong>Economic evaluations have suggested that risk-stratified breast cancer screening may be a cost-effective use of resources in the United Kingdom.Current estimates of the cost of risk stratification are based on pragmatic assumptions.This study provides estimates of the cost of risk stratification using 3 strategies and when these strategies are implemented perfectly and imperfectly in the health system.The cost of risk stratification is relatively low unless single nucleotide polymorphisms are included in the strategy.</p>","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"8 1","pages":"23814683231171363"},"PeriodicalIF":1.9,"publicationDate":"2023-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10161319/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10299182","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":"Catalog of EQ-5D-3L Health-Related Quality-of-Life Scores for 199 Chronic Conditions and Health Risks in Denmark.","authors":"Michael Falk Hvidberg, Karin Dam Petersen, Michael Davidsen, Flemming Witt Udsen, Anne Frølich, Lars Ehlers, Mónica Hernández Alava","doi":"10.1177/23814683231159023","DOIUrl":"10.1177/23814683231159023","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Background&lt;/b&gt;. Assessments of health-related quality of life (HRQoL) are essential in estimating quality-adjusted life-years. It is sometimes not feasible to collect primary HRQoL data, and reliable secondary sources are necessary. Current \"off-the-shelf\" HRQoL catalogs are based on older diagnosis classifications and include a limited number of diseases. This article aims to provide 1) a Danish EQ-5D-3L-based HRQoL catalog for 199 nationally representative chronic conditions based on ICD-10 codes and 2) a complementary model-based catalog controlling for age, sex, comorbidities, lifestyle, and health risks. &lt;b&gt;Design&lt;/b&gt;. A total of 55,616 respondents from 3 national health survey samples were pooled and combined with 7 national registers containing patient-level information on diagnoses, health care activity, and sociodemographics. EQ-5D-3L data were converted to utility scores using the Danish EQ-5D-3L value set to estimate the mean utility for each chronic disease population. Adjusted limited dependent variable mixture models were estimated and used to provide a regression-based catalog of utilities/disutilities. &lt;b&gt;Results&lt;/b&gt;. Diseases with the lowest mean EQ-5D score in the Danish population were systemic sclerosis (M34; score = 0.432), fibromyalgia (M797; score = 0.490), rheumatism (M790; score = 0.515), dementia (F00, G30; score = 0.546), posttraumatic stress syndrome (F431; score = 0.557), and systemic atrophies (G10-G14; score = 0.583. Based on the estimated models, the largest estimated disutilities were cystic fibrosis, cerebral palsy, depression, dorsalgia, sclerosis, and fibromyalgia. Lifestyle factors, including perceived stress, loneliness, and body mass index, were also significantly associated with low HRQoL. &lt;b&gt;Conclusions&lt;/b&gt;. This study provides a comprehensive nationally representative catalog and a model-based catalog of EQ-5D-3L-based HRQoL scores for Denmark that can be used to describe aspects of disease burden and allocate resources within health care. Additional Stata programs are also provided to facilitate predictions in other populations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Highlights: &lt;/strong&gt;A Danish national representative catalog of health-related quality-of-life scores for 199 chronic conditions is presented, which provides population estimates for chronic conditions subgroups that can be used for health economic evaluation.Two separate regression models of EQ-5D-3L utility scores with different sets of control variables are estimated to allow researchers to adjust for differences in the composition of the subgroups and provide a tool that can be used in other settings.Results indicate that health-related quality of life varies across disease groups but is lowest for renal disease, mental and behavioral disorders, benign neoplasms and diseases of the blood, digestive systems, and nervous systems.Health risks and lifestyle factors such as perceived stress, loneliness, and a large body mass index are highly correlated with","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"8 1","pages":"23814683231159023"},"PeriodicalIF":0.0,"publicationDate":"2023-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/6b/5b/10.1177_23814683231159023.PMC10088414.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9305630","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":"Involvement in Chemotherapy Decision Making among Patients with Stage II and III Colon Cancer.","authors":"Jessica D Austin, Elizabeth Shelton, Danielle M Crookes, Parisa Tehranifar, Alfred I Neugut, Rachel C Shelton","doi":"10.1177/23814683231163189","DOIUrl":"10.1177/23814683231163189","url":null,"abstract":"<p><p><b>Background.</b> To explore preferred and actual involvement in chemotherapy decision making among stage II and III colon cancer (CC) patients by sociodemographic, interpersonal, and intrapersonal communication factors. <b>Methods.</b> Cross-sectional exploratory study collecting self-reported survey data from stage II and III CC patients from 2 cancer centers located in northern Manhattan. <b>Results.</b> Of 88 patients approached, 56 completed the survey. Only 19.3% reported shared involvement in their chemotherapy decisions. We observed significant differences in preferred involvement by gender, with women preferring more physician-controlled decisions. CC patients with higher levels of decisional self-efficacy significantly preferred shared decisions (<i>F</i> = 4.4 [2], <i>P</i> = 0.02). Actual involvement in decisions differed by race (physician controlled 33% for White v. 67% for Other, <i>P</i> < 0.01), age (shared control 18% for ≤55 y, 55% for 55-64 y, and 27% for 65+ y, <i>P</i> = 0.04), and perception of choice (shared control 73% \"yes\" v. 27% \"no,\"<i>P</i> = 0.02). Actual or preferred involvement did not differ by stage. Significantly higher levels of medical mistrust (discrimination <i>t</i> = 2.8 [50], <i>P = 0</i>.01; lack of support <i>t</i> = 3.6 [49], <i>P</i> < 0.01), and lower levels of decisional self-efficacy (<i>t</i> = 2.5 [49], <i>P = 0</i>.01) were reported among women. <b>Discussion.</b> Reports of shared involvement around chemotherapy decisions is limited among CC patients. Factors influencing preferred versus actual chemotherapy decision making are complex and may differ; hence, more research is needed to understand and address factors contributing to discordance between preferred and actual involvement in chemotherapy decision making for CC patients.</p><p><strong>Highlights: </strong>Shared involvement around chemotherapy decisions remains limited for patients diagnosed with colon cancer.Sociodemographic (age, race, gender), interpersonal (medical mistrust), and intrapersonal (decisional self-efficacy, perception of choice) factors that influence preferred involvement in chemotherapy decision making may differ from those influencing actual involvement in chemotherapy decision making.Shared involvement in chemotherapy decisions may look different than currently conceptualized, notably when uncertainty around the benefits exists.</p>","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"8 1","pages":"23814683231163189"},"PeriodicalIF":1.9,"publicationDate":"2023-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/db/e1/10.1177_23814683231163189.PMC10052499.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9597014","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":"Modeling the Natural History and Screening Effects of Colorectal Cancer Using Both Adenoma and Serrated Neoplasia Pathways: The Development, Calibration, and Validation of a Discrete Event Simulation Model.","authors":"Chih-Yuan Cheng, Silvia Calderazzo, Christoph Schramm, Michael Schlander","doi":"10.1177/23814683221145701","DOIUrl":"10.1177/23814683221145701","url":null,"abstract":"<p><p><b>Background.</b> Existing colorectal cancer (CRC) screening models mostly focus on the adenoma pathway of CRC development, overlooking the serrated neoplasia pathway, which might result in overly optimistic screening predictions. In addition, Bayesian inference methods have not been widely used for model calibration. We aimed to develop a CRC screening model accounting for both pathways, calibrate it with approximate Bayesian computation (ABC) methods, and validate it with large CRC screening trials. <b>Methods.</b> A discrete event simulation (DES) of the CRC natural history (DECAS) was constructed using the adenoma and serrated pathways in R software. The model simulates CRC-related events in a specific birth cohort through various natural history states. Calibration took advantage of 74 prevalence data points from the German screening colonoscopy program of 5.2 million average-risk participants using an ABC method. CRC incidence outputs from DECAS were validated with the German national cancer registry data; screening effects were validated using 17-y data from the UK Flexible Sigmoidoscopy Screening sigmoidoscopy trial and a German screening colonoscopy cohort study. <b>Results.</b> The Bayesian calibration rendered 1,000 sets of posterior parameter samples. With the calibrated parameters, the observed age- and sex-specific CRC prevalences from the German registries were within the 95% DECAS-predicted intervals. Regarding screening effects, DECAS predicted a 41% (95% intervals 30%-51%) and 62% (95% intervals 55%-68%) reduction in 17-y cumulative CRC mortality for a single screening sigmoidoscopy and colonoscopy, respectively, falling within 95% confidence intervals reported in the 2 clinical studies used for validation. <b>Conclusions.</b> We presented DECAS, the first Bayesian-calibrated DES model for CRC natural history and screening, accounting for 2 CRC tumorigenesis pathways. The validated model can serve as a valid tool to evaluate the (cost-)effectiveness of CRC screening strategies.</p><p><strong>Highlights: </strong>This article presents a new discrete event simulation model, DECAS, which models both adenoma-carcinoma and serrated neoplasia pathways for colorectal cancer (CRC) development and CRC screening effects.DECAS is calibrated based on a Bayesian inference method using the data from German screening colonoscopy program, which consists of more than 5 million first-time average-risk participants aged 55 years and older in 2003 to 2014.DECAS is flexible for evaluating various CRC screening strategies and can differentiate screening effects in different parts of the colon.DECAS is validated with large screening sigmoidoscopy and colonoscopy clinical study data and can be further used to evaluate the (cost-)effectiveness of German colorectal cancer screening strategies.</p>","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"8 1","pages":"23814683221145701"},"PeriodicalIF":1.9,"publicationDate":"2023-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/8b/d9/10.1177_23814683221145701.PMC9869210.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9190557","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":"Discussing Cost and Value in Patient Decision Aids and Shared Decision Making: A Call to Action.","authors":"Mary C Politi, Ashley J Housten, Rachel C Forcino, Jesse Jansen, Glyn Elwyn","doi":"10.1177/23814683221148651","DOIUrl":"10.1177/23814683221148651","url":null,"abstract":"<p><p>Direct and indirect costs of care influence patients' health choices and the ability to implement those choices. Despite the significant impact of care costs on patients' health and daily lives, patient decision aid (PtDA) and shared decision-making (SDM) guidelines almost never mention a discussion of costs of treatment options as part of minimum standards or quality criteria. Given the growing study of the impact of costs in health decisions and the rising costs of care more broadly, in fall 2021 we organized a symposium at the Society for Medical Decision Making's annual meeting. The focus was on the role of cost information in PtDAs and SDM. Panelists gave an overview of work in this space at this virtual meeting, and attendees engaged in rich discussion with the panelists about the state of the problem as well as ideas and challenges in incorporating cost-related issues into routine care. This article summarizes and extends our discussion based on the literature in this area and calls for action. We recommend that PtDA and SDM guidelines routinely include a discussion of direct and indirect care costs and that researchers measure the frequency, quality, and response to this information.</p>","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"8 1","pages":"23814683221148651"},"PeriodicalIF":0.0,"publicationDate":"2023-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/53/50/10.1177_23814683221148651.PMC9834940.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9084822","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":"Patient Perceptions of a Decision Support Tool for Men with Localized Prostate Cancer.","authors":"Mia Austria,&nbsp;Colin Kimberlin,&nbsp;Tiffany Le,&nbsp;Kathleen A Lynch,&nbsp;Behfar Ehdaie,&nbsp;Thomas M Atkinson,&nbsp;Andrew J Vickers,&nbsp;Sigrid V Carlsson","doi":"10.1177/23814683231156427","DOIUrl":"https://doi.org/10.1177/23814683231156427","url":null,"abstract":"<p><p><b>Purpose.</b> To evaluate patient perceptions of a Web-based decision aid for the treatment of localized prostate cancer. <b>Methods.</b> We assessed patient perceptions of a multicomponent, Web-based decision aid with a preference elicitation/values clarification exercise using adaptive conjoint analysis, the generation of a summary report, and provision of information about localized prostate cancer treatment options. Using a think-aloud approach, we conducted 21 cognitive interviews with prostate cancer patients presented with the decision aid prior to seeing their urologist. Thematic content analysis was used to examine patient perceptions of the tool's components and content prior to engaging in shared decision making with their clinician. <b>Results.</b> Five themes were identified: 1) patients had some negative emotional reactions to the tool, pointing out what they perceived to be unnecessarily negative framing and language used; 2) patients were forced to stop and think about preferences while going through the tool and found this deliberation to be useful; 3) patients were confused by the tool; 4) patients tried to discern the intent of the conjoint analysis questions; and 5) there was a disconnect between patients' negative reactions while using the tool and a contrasting general satisfaction with the final \"values profile\" created by the tool. <b>Conclusions.</b> Studies are needed to explore the disconnect between patients' expressing negative reactions while going through some components of decision aids but satisfaction with the final output. In particular, we hypothesize that this effect might be explained by cognitive biases such as choice-supportive bias, hindsight bias, and the \"IKEA effect.\" This is one of the first projects to elicit patient reactions while they were completing a decision aid, and we recommend further similar, qualitative postprocess evaluation studies.</p><p><strong>Highlights: </strong>We explored perceptions of a decision aid with education about localized prostate cancer treatment and preference elicitation using adaptive conjoint analysis.Patients found the tool useful but were also confused by it, tried to discern the intent of the questions, and expressed negative emotional reactions.In particular, there was a disconnect between patients' negative reactions while using the tool and general satisfaction with the final values profile generated by the tool, which is an area for future research.</p>","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"8 1","pages":"23814683231156427"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/06/7e/10.1177_23814683231156427.PMC10009039.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9131721","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":"Evolution of Pneumococcal Vaccine Recommendations and Criteria for Decision Making in 5 Western European Countries and the United States.","authors":"Roxane Noharet-Koenig,&nbsp;Katarzyna Lasota,&nbsp;Pascaline Faivre,&nbsp;Edith Langevin","doi":"10.1177/23814683231174432","DOIUrl":"https://doi.org/10.1177/23814683231174432","url":null,"abstract":"<p><strong>Objectives: </strong>Pneumococcal vaccine recommendations have become increasingly complex. This study aims to understand how national immunization technical advisory groups (NITAGs) and health technology assessment (HTA) agencies of 5 European countries and the United States formed their pneumococcal vaccine recommendations, by providing reviewed evidence and key drivers for new recommendations.</p><p><strong>Methods: </strong>Centers for Disease Control and Prevention, European Centre for Disease Prevention and Control, and National Health Authorities Web sites were screened to capture the evolution of pneumococcal recommendations. A narrative review was conducted on NITAGs and HTA bodies' Web sites. Assessments of pneumococcal vaccines published from 2009 to 2022 were included.</p><p><strong>Results: </strong>Thirty-four records were identified including 21 assessments for risk groups, 17 for elderly, and 12 for children. Burden of disease and vaccine characteristics were almost systematically reviewed during assessments. All 6 countries recommended the use of higher-valent pneumococcal vaccine (PCV; i.e., PCV10 and PCV13) in childhood vaccination programs, given their broader serotype coverage and their comparable profile to PCV7. PCV13 was progressively added to the vaccine schedule (in addition to polysaccharide vaccine) in at least the high-risk group, given the high burden in this population and expected additional benefits of PCV13. For the elderly, unlike the United States, European countries issued negative recommendation for PCV13 routine use because of substantial herd effects from childhood vaccination program making PCV13 likely not cost-effective.</p><p><strong>Conclusions: </strong>This research provides an overview of decision-making processes for higher-valent PCVs recommendations and could be of interest to anticipate the place of next generation of PCVs in the vaccination landscape.</p><p><strong>Highlights: </strong>By describing evidence-based criteria for decision making, this study emphasizes the framework analysis of NITAGs and HTA bodies when assessing pneumococcal vaccines and demonstrates that variation exists between countries and also according to population evaluated.While the burden of disease and immunogenicity/efficacy data were almost systematically reviewed by national stakeholders, economic assessments were reported to a lesser extent but played a major role in the limited use of PCV13 in the adult population.</p>","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"8 1","pages":"23814683231174432"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ec/aa/10.1177_23814683231174432.PMC10233586.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10663612","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":"Preferences for Decision Control among a High-Risk Cohort Offered Lung Cancer Screening: A Brief Report of Secondary Analyses from the Lung Screen Uptake Trial (LSUT).","authors":"Stefanie Bonfield,&nbsp;Mamta Ruparel,&nbsp;Jo Waller,&nbsp;Jennifer L Dickson,&nbsp;Samuel M Janes,&nbsp;Samantha L Quaife","doi":"10.1177/23814683231163190","DOIUrl":"https://doi.org/10.1177/23814683231163190","url":null,"abstract":"<p><p><b>Background.</b> Personal autonomy in lung cancer screening is advocated internationally, but health systems diverge in their approach, mandating either shared decision making (with a health care professional) or individual decision making. Studies of other cancer screening programs have found that individual preferences for the level of involvement in screening decisions vary across different sociodemographic groups and that aligning approaches with individual preferences has the potential to improve uptake. <b>Method.</b> For the first time, we examined preferences for decision control among a cohort of UK-based high-risk lung cancer screening candidates (<i>N</i> = 727). We used descriptive statistics to report the distribution of preferences and chi-square tests to examine associations between decision preferences and sociodemographic variables. <b>Results.</b> Most (69.7%) preferred to be involved in the decision with varying degrees of input from a health care professional. Few (10.2%) wanted to make the decision alone. Preferences were also associated with educational attainment. <b>Conclusion.</b> These findings suggest one-size-fits-all approaches may be inadequate in meeting diverse preferences, particularly those placing sole onus on the individual.</p><p><strong>Highlights: </strong>Preferences for involvement in decision making about lung cancer screening are heterogeneous among high-risk individuals in the United Kingdom and vary by educational attainment.Further work is needed to understand how policy makers might implement hybrid approaches to accommodate individual preferences and optimize lung cancer screening program outcomes.</p>","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"8 1","pages":"23814683231163190"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10064161/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9597017","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":"\"To Be or Not to Be\"-Cardiopulmonary Resuscitation for Hospitalized People Who Have a Low Probability of Benefit: Qualitative Analysis of Semi-structured Interviews.","authors":"Daniel Kobewka,&nbsp;Yasmin Lalani,&nbsp;Victoria Shaffer,&nbsp;Tolulope Adewole,&nbsp;Kiefer Lypka,&nbsp;Pete Wegier","doi":"10.1177/23814683231168589","DOIUrl":"https://doi.org/10.1177/23814683231168589","url":null,"abstract":"<p><strong>Purpose: </strong>Our aim was to understand the decision making of patients in hospital who wanted cardiopulmonary resuscitation despite low probability of benefit.</p><p><strong>Methods: </strong>We included patients admitted to general medical wards who had a low chance of surviving in-hospital cardiopulmonary resuscitation (CPR) and had an order in the chart to administer CPR. We developed an interview guide to explore participants' decision-making process, sources of information, and emotions associated with this decision.</p><p><strong>Results: </strong>We developed 3 themes from the data. 1) \"Life is worth living . . . for now\": Participants describe their enjoyment of life and desire to carry on in their current state. 2) \"Making sense of CPR outcomes\": Participants saw CPR outcomes as binary, either they live, or they die; deciding not to receive CPR means choosing death. Participants were optimistic they would survive CPR and cited personal experience and TV as information sources. 3) \"Decision process\": Participants did not engage in shared decision making. Instead, they were asked a binary yes/no question with no reflection on their values or discussion about harms or benefits.</p><p><strong>Limitations: </strong>The probability of successful CPR in our sample is unknown. Findings may be different in a population who is imminently dying but still requesting CPR.</p><p><strong>Conclusions: </strong>Participants chose CPR because they perceived life as worth living and CPR as a chance worth taking. Participants did not want to be left in a severely debilitated state but did not have accurate information about this risk.</p><p><strong>Implications: </strong>Decision making about CPR in-hospital can be improved if it is grounded in accurate risk understanding and the patient's values and wishes.</p>","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"8 1","pages":"23814683231168589"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d7/b7/10.1177_23814683231168589.PMC10141296.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9398038","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}