MDM policy & practice最新文献

{"title":"A Method for Reconstructing Individual Patient Data From Kaplan-Meier Survival Curves That Incorporate Marked Censoring Times.","authors":"Basia Rogula, Greta Lozano-Ortega, Karissa M Johnston","doi":"10.1177/23814683221077643","DOIUrl":"https://doi.org/10.1177/23814683221077643","url":null,"abstract":"Introduction. Access to individual patient data (IPD) can be advantageous when conducting cost-effectiveness analyses or indirect treatment comparisons. While exact times of censoring are often marked on published Kaplan-Meier (KM) curves, an algorithm for reconstructing IPD from such curves that allows for their incorporation is presently unavailable. Methods. An algorithm capable of incorporating marked censoring times was developed to reconstruct IPD from KM curves, taking as additional inputs the total patient count and coordinates of the drops in survival. The reliability of the algorithm was evaluated via a simulation exercise, in which survival curves were simulated, digitized, and then reconstructed. To assess the reliability of the reconstructed curves, hazard ratios (HRs) and quantiles of survival were compared between the original and reconstructed curves, and the reconstructed curves were visually inspected. Results. No systematic differences were found in HRs and quantiles in the original versus reconstructed curves. Upon visual inspection, the reconstructed IPD provided a close fit to the digitized data from the published KM curves. Inherent to the algorithm, censoring times were incorporated into the reconstructed data exactly as specified. Conclusion. This new algorithm can reliably be used to reconstruct IPD from reported KM survival curves in the presence of extractable censoring times. Use of the algorithm will allow health researchers to reconstruct IPD more closely by incorporating censoring times exactly as marked, requiring as additional inputs the total patient count and coordinates of the drops in survival. Graphical Abstract This is a visual representation of the abstract.","PeriodicalId":520707,"journal":{"name":"MDM policy & practice","volume":" ","pages":"23814683221077643"},"PeriodicalIF":0.0,"publicationDate":"2022-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/72/40/10.1177_23814683221077643.PMC8808036.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39895705","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":"Primary Care Providers' Perceptions of the Acceptability, Appropriateness, and Feasibility of a Mammography Decision Aid for Women Aged 75 and Older.","authors":"Mara A Schonberg,&nbsp;Mary Beth Hamel,&nbsp;Roger B Davis,&nbsp;Maria Karamourtopoulos,&nbsp;Adlin Pinheiro,&nbsp;Michelle C Hayes,&nbsp;Christina C Wee,&nbsp;Christine Kistler","doi":"10.1177/23814683221074310","DOIUrl":"https://doi.org/10.1177/23814683221074310","url":null,"abstract":"<p><p><b>Background.</b> Clinicians need to find decision aids (DAs) useful for their successful implementation. Therefore, we aimed to conduct an exploratory study to learn primary care clinicians' (PCPs) perspectives on a mammography DA for women ≥75 to inform its implementation. <b>Methods.</b> We sent a cross-sectional survey to 135 PCPs whose patients had participated in a randomized trial of the DA. These PCPs practiced at 1 of 11 practices in Massachusetts or North Carolina. PCPs were asked closed-ended and open-ended questions on shared decision making (SDM) around mammography with women ≥75 and on the DA's acceptability, appropriateness, and feasibility. <b>Results.</b> Eighty PCPs participated (24 [30%] from North Carolina). Most (<i>n</i> = 69, 86%) thought that SDM about mammography with women ≥75 was extremely/very important and that they engaged women ≥75 in SDM around mammography frequently/always (<i>n</i> = 49, 61%). Regarding DA acceptability, 60% felt the DA was too long. Regarding appropriateness, 70 (89%) thought it was somewhat/very helpful and that it would help patients make more informed decisions; 55 (70%) would recommend it. Few (<i>n</i> = 6, 8%) felt they had other resources to support this decision. Regarding feasibility, 53 (<i>n</i> = 67%) thought it would be most feasible for patients to receive the DA before a visit from medical assistants rather than during or after a visit or from health educators. Most (<i>n</i> = 62, 78%) wanted some training to use the DA. <b>Limitations.</b> Sixty-nine percent of PCPs in this small study practiced in academic settings. <b>Conclusions.</b> Although PCPs were concerned about the DA's length, most found it helpful and informative and felt it would be feasible for medical assistants to deliver the DA before a visit. <b>Implications.</b> Study findings may inform implementation of this and other DAs.</p>","PeriodicalId":520707,"journal":{"name":"MDM policy & practice","volume":" ","pages":"23814683221074310"},"PeriodicalIF":0.0,"publicationDate":"2022-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/90/52/10.1177_23814683221074310.PMC8796098.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39573412","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":"Optimal Surveillance Strategies for Early-Stage Cutaneous Melanoma Post Primary Tumor Excision: An Economic Evaluation.","authors":"Vasileios Kontogiannis,&nbsp;Diarmuid Coughlan,&nbsp;Mehdi Javanbakht,&nbsp;Patience Kunonga,&nbsp;Fiona Beyer,&nbsp;Catherine Richmond,&nbsp;Andy Bryant,&nbsp;Dalvir Bajwa,&nbsp;Robert A Ellis,&nbsp;Luke Vale","doi":"10.1177/23814683211069988","DOIUrl":"https://doi.org/10.1177/23814683211069988","url":null,"abstract":"<p><p><b>Background.</b> Consensus on standardized active surveillance or follow-up care by clinicians is lacking leading to considerable variation in practice across countries. An important structural modelling consideration is that self-examination by patients and their partners can detect melanoma recurrence outside of active surveillance regimes. <b>Objectives.</b> To identify candidate melanoma surveillance strategies for American Joint Committee on Cancer (AJCC) stage I disease and compare them with the current recommended practice in a cost-utility analysis framework. <b>Methods.</b> In consultation with UK clinical experts, a microsimulation model was built in TreeAge Pro 2019 R1.0 (Williamstown, MA, USA) to evaluate surveillance strategies for AJCC stage IA and IB melanoma patients separately. The model incorporated patient behaviors such as self-detection and emergency visits to examine suspicious lesions. A National Health Service (NHS) perspective was taken. Model input parameters were taken from the literature and where data were not available, local expert opinion was sought. Probabilistic sensitivity analysis, one-way sensitivity analysis on pertinent parameters and value of information was performed. <b>Results.</b> In the base-case probabilistic sensitivity analysis, less intensive surveillance strategies for AJCC stage IA and IB had lower total lifetime costs than the current National Institute for Health and Care Excellence (NICE) recommended strategy with similar effectiveness in terms of quality-adjusted life years and thereby likely to be cost-effective. Many strategies had similar effectiveness due to the relatively low chance of recurrence and the high rate of self-detection. Sensitivity and scenario analyses did not change these findings. <b>Conclusions.</b> Our model findings suggest that less resource intensive surveillance may be cost-effective compared with the current NICE surveillance guidelines. However, to advocate convincingly for changes, better evidence is required.</p>","PeriodicalId":520707,"journal":{"name":"MDM policy & practice","volume":" ","pages":"23814683211069988"},"PeriodicalIF":0.0,"publicationDate":"2022-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d3/f1/10.1177_23814683211069988.PMC8743969.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39693714","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":"Impact of Delaying Effective and Cost-Effective Policy Decisions: An Example From Cervical Cancer Prevention in Norway.","authors":"Allison Portnoy,&nbsp;Mari Nygård,&nbsp;Lill Trogstad,&nbsp;Jane J Kim,&nbsp;Emily A Burger","doi":"10.1177/23814683211071093","DOIUrl":"https://doi.org/10.1177/23814683211071093","url":null,"abstract":"<p><p><b>Introduction.</b> Delayed implementation of evidence-driven interventions has consequences that can be formally evaluated. In Norway, programs to prevent cervical cancer (CC)-screening and treatment of precancerous lesions and prophylactic vaccination against human papillomavirus (HPV) infection-have been implemented, but each encountered delays in policy implementation. To examine the effect of these delays, we project the outcomes that would have been achieved with timely implementation of two policy changes compared with the de facto delays in implementation (in Norway). <b>Methods.</b> We used a multimodeling approach that combined HPV transmission and cervical carcinogenesis to estimate the health outcomes and timeline for CC elimination associated with the implementation of two CC prevention policy decisions: a multicohort vaccination program of women up to age 26 years with bivalent vaccine in 2009 compared with actual \"delayed\" implementation in 2016, and a switch from cytology to primary HPV-based testing in 2015 compared with \"delayed\" rollout in 2020. <b>Results.</b> Timely implementation of two policy changes compared with current Norwegian prevention policy timeline could have averted approximately 970 additional cases (range of top 10 sets: 830-1060) and accelerated the CC elimination timeline by around 4 years (from 2039 to 2035). <b>Conclusions.</b> If delaying implementation of effective and cost-effective interventions is being considered, the decision-making process should include quantitative analyses on the effects of delays.</p>","PeriodicalId":520707,"journal":{"name":"MDM policy & practice","volume":" ","pages":"23814683211071093"},"PeriodicalIF":0.0,"publicationDate":"2022-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/9d/ce/10.1177_23814683211071093.PMC8744166.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39693718","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 Communication of Shared Decision-Making Principles in US Preventive Services Task Force Recommendations.","authors":"Michelle Eder,&nbsp;Ilya Ivlev,&nbsp;Jennifer S Lin","doi":"10.1177/23814683211067522","DOIUrl":"https://doi.org/10.1177/23814683211067522","url":null,"abstract":"<p><p><b>Aims.</b> This methods project was conducted to support the US Preventive Services Task Force's (USPSTF) consideration of how information pertinent to shared decision making (SDM) can be best communicated in its recommendations. <b>Methods.</b> The project included a literature scan to identify SDM frameworks, audit of six USPSTF recommendations to judge the completeness of SDM communication, input from eight SDM experts on the most helpful SDM guidance to provide in USPSTF recommendations, and review of USPSTF recommendations and evidence reports to establish criteria for identifying topics that would most benefit from additional communication resources. <b>Results.</b> We identified eight SDM frameworks and selected one to guide the audit of USPSTF recommendations. All six recommendations include SDM elements related to the patient's role in decision making, preventive service being considered, pros and cons of options, uncertainties about benefits and harms, and importance of patient preferences. Two SDM elements are not routinely communicated in the recommendations-identification of <i>not</i> screening or initiating preventive medication as an alternative and the importance of patient understanding of options. Experts offered suggestions for essential SDM elements to address, such as assessing decisional conflict to measure patient uncertainty in choosing an option and highlighting uncertainty in estimates of benefit and harm, credibility of the evidence base, precision of estimates, and applicability to the individual patient. We developed six criteria for selection of USPSTF recommendations to supplement with a communication resource. <b>Conclusions.</b> The findings of this project can assist the USPSTF and other clinical guideline developers in incorporating SDM information in recommendations and determining which topics would most benefit from additional communication resources to support clinicians in engaging patients in SDM.</p>","PeriodicalId":520707,"journal":{"name":"MDM policy & practice","volume":" ","pages":"23814683211067522"},"PeriodicalIF":0.0,"publicationDate":"2021-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ab/cd/10.1177_23814683211067522.PMC8725016.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39792602","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":"Factors Associated With Obtaining Lung Cancer Screening Among Persons Who Smoke.","authors":"Kristin G Maki,&nbsp;Kaiping Liao,&nbsp;Lisa M Lowenstein,&nbsp;M Angeles Lopez-Olivo,&nbsp;Robert J Volk","doi":"10.1177/23814683211067810","DOIUrl":"https://doi.org/10.1177/23814683211067810","url":null,"abstract":"<p><p><b>Background.</b> Screening with low-dose computed tomography scans can reduce lung cancer deaths but uptake remains low. This study examines psychosocial factors associated with obtaining lung cancer screening (LCS) among individuals. <b>Methods.</b> This is a secondary analysis of a randomized clinical trial conducted with 13 state quitlines' clients. Participants who met age and smoking history criteria were enrolled and followed-up for 6 months. Only participants randomized to the intervention group (a patient decision aid) were included in this analysis. A logistic regression was performed to identify determinants of obtaining LCS 6 months after the intervention. <b>Results.</b> There were 204 participants included in this study. Regarding individual attitudes, high and moderate levels of concern about overdiagnosis were associated with a decreased likelihood of obtaining LCS compared with lower levels of concern (high levels of concern, odds ratio [OR] 0.17, 95% confidence interval [CI] 0.04-0.65; moderate levels of concern, OR 0.15, 95% CI 0.05-0.53). In contrast, higher levels of anticipated regret about not obtaining LCS and later being diagnosed with lung cancer were associated with an increased likelihood of being screened compared with lower levels of anticipated regret (OR 5.59, 95% CI 1.72-18.10). Other potential harms related to LCS were not significant. <b>Limitations.</b> Follow-up may not have been long enough for all individuals who wished to be screened to complete the scan. Additionally, participants may have been more health motivated due to recruitment via tobacco quitlines. <b>Conclusions.</b> Anticipated regret about not obtaining screening is associated with screening behavior, whereas concern about overdiagnosis is associated with decreased likelihood of LCS. <b>Implications.</b> Decision support research may benefit from further examining anticipated regret in screening decisions. Additional training and information may be helpful to address concerns regarding overdiagnosis.</p>","PeriodicalId":520707,"journal":{"name":"MDM policy & practice","volume":" ","pages":"23814683211067810"},"PeriodicalIF":0.0,"publicationDate":"2021-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/3c/04/10.1177_23814683211067810.PMC8725001.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39792603","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":"The Magnitude of the Health and Economic Impact of Increased Organ Donation on Patients With End-Stage Renal Disease.","authors":"Huey-Fen Chen,&nbsp;Hayatt Ali,&nbsp;Wesley J Marrero,&nbsp;Neehar D Parikh,&nbsp;Mariel S Lavieri,&nbsp;David W Hutton","doi":"10.1177/23814683211063418","DOIUrl":"https://doi.org/10.1177/23814683211063418","url":null,"abstract":"<p><p><b>Objectives.</b> There are several approaches such as presumed consent and compensation for deceased donor organs that could reduce the gap between supply and demand for kidneys. Our objective is to evaluate the magnitude of the economic impact of policies to increase deceased donor organ donation in the United States. <b>Methods.</b> We built a Markov model and simulate an open cohort of end-stage renal disease patients awaiting kidney transplantation in the United States over 20 years. Model inputs were derived from the United States Renal Data System and published literature. We evaluate the magnitude of the health and economic impact of policies to increase deceased donor kidney donation in the United States. <b>Results.</b> Increasing deceased kidney donation by 5% would save $4.7 billion, and gain 30,870 quality-adjusted life years over the lifetime of an open cohort of patients on dialysis on the waitlist for kidney transplantation. With an increase in donations of 25%, the cost saved was $21 billion, and 145,136 quality-adjusted life years were gained. Policies increasing deceased kidney donation by 5% could pay donor estates $8000 or incur a onetime cost of up to $4 billion and still be cost-saving. <b>Conclusions.</b> Increasing deceased kidney donation could significantly impact national spending and health for end-stage renal disease patients.</p>","PeriodicalId":520707,"journal":{"name":"MDM policy & practice","volume":" ","pages":"23814683211063418"},"PeriodicalIF":0.0,"publicationDate":"2021-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/83/34/10.1177_23814683211063418.PMC8655828.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39720719","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-Reported Roles in Decision-Making Among Asian Patients With Advanced Cancer: A Multicountry Study.","authors":"Semra Ozdemir,&nbsp;Chetna Malhotra,&nbsp;Irene Teo,&nbsp;Si Ning Germaine Tan,&nbsp;Wei Han Melvin Wong,&nbsp;Anjum S Khan Joad,&nbsp;Thushari Hapuarachchi,&nbsp;Gayatri Palat,&nbsp;Pham Nguyen Tuong,&nbsp;Sushma Bhatnagar,&nbsp;Rubayat Rahman,&nbsp;Lubna Mariam,&nbsp;Xiaohong Ning,&nbsp;Eric Andrew Finkelstein","doi":"10.1177/23814683211061398","DOIUrl":"https://doi.org/10.1177/23814683211061398","url":null,"abstract":"<p><p><b>Purpose.</b> We investigated 1) perceived roles in decision-making among advanced cancer patients in 5 Asian countries 2) associations of patient characteristics with these roles, and 3) the association of perceived roles with quality of life and perceived quality of care. <b>Methods.</b> We surveyed 1585 patients with stage IV solid cancer. Multinomial logistic regressions were used to analyze associations of patient characteristics with decision-making roles. Multivariate regressions were used to analyze associations of decision-making roles with quality of life and care. <b>Results.</b> The most common perceived-role was no patient involvement. Most patients (73%) reported roles consistent with their preferences. Being male, nonminority, higher educated, aware of advanced cancer diagnosis, and knowledge of cancer diagnosis for ≥1 year were associated with higher levels of patient involvement in decision-making. Compared to no patient involvement, joint decision-making (together with physicians/family) was associated with higher social (β = 2.49, <i>P</i> < 0.01) and spiritual (β = 2.64, <i>P</i> < 0.01) well-being, and better quality of physician communication (β = 9.73, <i>P</i> < 0.01) and care coordination (β = 13.96, <i>P</i> < 0.01) while making decisions alone was associated with lower emotional (β = -1.43, <i>P</i> < 0.01), social (β = -2.39, <i>P</i> < 0.01), and spiritual (β = -2.98, <i>P</i> < 0.01) well-being. <b>Conclusions.</b> Findings suggest that a substantial number of advanced cancer patients were not (and preferred not to be) involved in decision-making. Despite this finding, joint decision-making together with physicians/family was associated with better quality of life and care. <b>Implications.</b> Physicians should explain the benefits of shared decision making to patients and encourage participation in decision-making, while ensuring that patients feel supported and do not find decision-making overwhelming.</p>","PeriodicalId":520707,"journal":{"name":"MDM policy & practice","volume":" ","pages":"23814683211061398"},"PeriodicalIF":0.0,"publicationDate":"2021-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/05/f4/10.1177_23814683211061398.PMC8606935.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39924209","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 Decision Rule for Determining the Optimal Transplant Listing Window for Patients With a Fontan Physiology.","authors":"Laura Delaney","doi":"10.1177/23814683211057472","DOIUrl":"https://doi.org/10.1177/23814683211057472","url":null,"abstract":"<p><p>The Fontan is a complex surgical procedure used as a palliative treatment for children with univentricular hearts. In the past, the mortality rate was high and the associated comorbidities as a result of the Fontan circulation were many. However, as research into the condition developed, better understanding has led to a massive reduction in early mortality and a rapidly increasing population of such patients surviving well into adulthood. This has led to a large surge in patients with congenital heart disease being referred for cardiac transplant assessment. According to research, listing these patients at the optimal time is the key to improving transplant outcomes. However, determining that optimal time is unclear and controversial. In this article, I address this issue by developing an optimal timing rule that accounts for the factors faced by specialist cardiologists in determining when transplant ought to be considered for this cohort of patients.</p>","PeriodicalId":520707,"journal":{"name":"MDM policy & practice","volume":" ","pages":"23814683211057472"},"PeriodicalIF":0.0,"publicationDate":"2021-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8597073/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39733945","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 Decisional Conflict With Measures of Numeracy and Optimism in a Stated Preference Survey.","authors":"Jessie Sutphin,&nbsp;Rachael L DiSantostefano,&nbsp;Colton Leach,&nbsp;Brett Hauber,&nbsp;Carol Mansfield","doi":"10.1177/23814683211058663","DOIUrl":"https://doi.org/10.1177/23814683211058663","url":null,"abstract":"<p><strong>Objectives: </strong>Low optimism and low numeracy are associated with difficulty or lack of participation in making treatment-related health care decisions. We investigated whether low optimism and low self-reported numeracy scores could help uncover evidence of decisional conflict in a discrete-choice experiment (DCE).</p><p><strong>Methods: </strong>Preferences for a treatment to delay type 1 diabetes were elicited using a DCE among 1501 parents in the United States. Respondents chose between two hypothetical treatments or they could choose no treatment (opt out) in a series of choice questions. The survey included a measure of optimism and a measure of subjective numeracy. We used latent class analyses where membership probability was predicted by optimism and numeracy scores.</p><p><strong>Results: </strong>Respondents with lower optimism scores had a higher probability of membership in a class with disordered preferences (<i>P</i> value for optimism coefficient = 0.032). Those with lower self-reported numeracy scores were more likely to be in a class with a strong preference for opting out and disordered preferences (<i>P</i> = 0.000) or a class with a preference for opting out and avoiding serious treatment-related risks (<i>P</i> = 0.015).</p><p><strong>Conclusions: </strong>If respondents with lower optimism and numeracy scores are more likely to choose to opt out or have disordered preferences in a DCE, it may indicate that they have difficulty completing choice tasks.</p>","PeriodicalId":520707,"journal":{"name":"MDM policy & practice","volume":" ","pages":"23814683211058663"},"PeriodicalIF":0.0,"publicationDate":"2021-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/f5/79/10.1177_23814683211058663.PMC8593299.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39637812","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}