Abstract
Shared decision-making is a collaborative process whereby patients and their providers make healthcare decisions together, taking into account both the best scientific evidence available and the patient’s values and preferences. Effective implementation of shared decision-making therefore requires ready access to current evidence comparing expected outcomes of decision alternatives, assessment of decision-related values and preferences, and integration of this information to identify the most suitable course of action. Multi-criteria decision analysis (MCDA) is designed to help people make better choices when faced with complex decisions that involve trade-offs between competing objectives. MCDA methods fulfill all of the required elements of shared decision-making. This similarity suggests that MCDA methods could be used effectively to facilitate shared decision-making in practice.
The evidence currently available supports this hypothesis. This chapter will illustrate how two MCDA methods – the conjoint analysis and analytic hierarchy process (AHP) – have been used to foster shared decision-making in clinical settings.
Conjoint analysis refers to methods that derive an individual’s decision-related preferences by examining how they make a series of hypothetical decisions that involve alternatives that differ in how well they achieve a set of decision objectives. We illustrate the use of conjoint analysis to foster shared decision-making by discussing how it has successfully been used to facilitate osteoarthritis treatment choices in real time and improve physician understanding of patient preferences for treatment of lupus nephritis.
The analytic hierarchy process (AHP) is an example of a value-based multi-criteria method. Value-based methods provide a framework for structuring a decision, comparing alternatives relative to specific criteria, defining the relative priorities of criteria in achieving the decision goal, and synthesizing this information to create scores that summarize how well the alternatives are judged to meet the decision goal. They also allow for sensitivity analyses that allow users to explore the effects of different judgments and perspectives on the relative evaluations of the alternatives. We will illustrate the use of the AHP to foster shared decision-making in practice by describing how it has been used to facilitate decisions regarding colorectal cancer screening.
We conclude with a list of suggestions regarding further research to continue this line of investigation with an emphasis on research needed to effectively implement these methods in routine practice settings.
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Australian CRC Screening Guidelines [Internet]. [cited 4–30/15]. Available from: http://www.cancerscreening.gov.au/internet/screening/publishing.nsf/Content/bowel-screening-1
Bridges JFP (2003) Stated preference methods in health care evaluation: an emerging methodological paradigm in health economics. Appl Health Econ Health Policy 2(4):213–224
Brownlee S, Wennberg JE, Barry M, Fisher ES, Goodman DC, Byrum JPW. Improving patient decision-making in health care: a 2011 Dartmouth Atlas report highlighting Minnesota
Canadian CRC Screening Guidelines [Internet]. [cited 4–20/15]. Available from: http://www.cancer.ca/en/prevention-and-screening/early-detection-and-screening/screening/screening-for-colorectal-cancer/?region=bc
Dolan JG (2005) Patient priorities in colorectal cancer screening decisions. Health Expect 8(4):334–344
Dolan JG (2010) Multi-criteria clinical decision support. Patient: Patient-Centered Outcom Res Springer, 3(4):229–248
Dolan JG, Frisina S (2002) Randomized controlled trial of a patient decision aid for colorectal cancer screening. Med Decis Making 22(2):125–139
Dolan JG, Isselhardt BJ, Cappuccio JD (1989) The analytic hierarchy process in medical decision making a tutorial. Med Decis Making 9(1):40–50
Fraenkel L, Bodardus S, Wittink DR (2001) Understanding patient preferences for the treatment of lupus nephritis with adaptive conjoint analysis. Med Care 39(11):1203–1216
Fraenkel L, Bogardus ST, Concato J, Wittink DR (2004) Treatment options in knee osteoarthritis: the patient’s perspective. Arch Intern Med 164(12):1299–1304
Fraenkel L, Rabidou N, Wittink D, Fried T (2007) Improving informed decision-making for patients with knee pain. J Rheumatol 34(9):1894–1898
Ho W (2008) Integrated analytic hierarchy process and its applications-A literature review. Eur J Oper Res 186(1):211–228
Huber J, Orme B, Miller R (2007) The value of choice simulators. In: Gustafsson A, Herrman AF (eds) Conjoint measurement. Springer, New York, pp 347–362
Ishizaka A, Labib A (2011) Review of the main developments in the analytic hierarchy process. Exp Syst Applic 38(11):14336–14345
Joseph-Williams N, Elwyn G, Edwards A (2014) Knowledge is not power for patients: a systematic review and thematic synthesis of patient-reported barriers and facilitators to shared decision making. Patient Educ Couns 94(3):291–309
Légaré F (2013) Shared decision making: moving from theorization to applied research and hopefully to clinical practice. Patient Educ Couns 91(2):129
Liberatore MJ, Nydick RL (2008) The analytic hierarchy process in medical and health care decision making: a literature review. Eur J Operat Res 189(1):194–207
Mulley AG, Trimble C, Elwyn G (2012) Stop the silent misdiagnosis: patients’ preferences matter. BMJ 345:e6572
O’Connor AM (1995) Validation of a decisional conflict scale. Med Decis Making 15(1):25–30
O’Connor AM, Wennberg JE, Legare F, Llewellyn-Thomas HA, Moulton BW, Sepucha KR et al (2007) Toward the “tipping point”: decision aids and informed patient choice. Health Aff 26(3):716–725
Osteoarthritis [Internet]. [cited 2015]. Available from: http://www.cdc.gov/arthritis/basics/osteoarthritis.htm
Politi MC, Street RL (2011) The importance of communication in collaborative decision making: facilitating shared mind and the management of uncertainty. J Eval Clin Pract 17(4):579–584
Ryan M, Farrar S (2000) Using conjoint analysis to elicit preferences for health care. BMJ 320:1530–1533
Saaty TL (1994) How to make a decision: the analytic hierarchy process. Interfaces 48(24):19–43
Saaty TL (2008) Decision making with the analytic hierarchy process. Int J Serv Sci 1(1):83–98
Stacey D et al (2014) Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev (1):CD001431
Subramanian N, Ramanathan R (2012) A review of applications of analytic hierarchy process in operations management. Int J Produc Econ 138(2):215–241
UK CR. Worldwide cancer mortality statistics [Internet]. 2014 [cited 23 Apr 2015]. Available from: http://www.cancerresearchuk.org/cancer-info/cancerstats/world/mortality/
USPSTF crc screening guidelines 2008 [Internet]. [cited 4–30/15]. Available from: https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/colorectal-cancer-screening2
Vaidya OS, Kumar S (2006) Analytic hierarchy process: an overview of applications. Eur J Operat Res 169(1):1–29
Veroff D, Marr A, Wennberg DE (2013) Enhanced support for shared decision making reduced costs of care for patients with preference-sensitive conditions. Health Aff 32(2):285–293
Wennberg JE, Fisher ES, Skinner JS et al (2002) Geography and the debate over Medicare reform. Health Aff 21(2):10
Winawer SJ, Zauber AG, Ho MN, O’Brien MJ, Gottlieb LS, Sternberg SS et al (1993) Prevention of colorectal cancer by colonoscopic polypectomy. N Engl J Med 329(27):1977–1981
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Dolan, J.G., Fraenkel, L. (2017). Shared Decision-Making. In: Marsh, K., Goetghebeur, M., Thokala, P., Baltussen, R. (eds) Multi-Criteria Decision Analysis to Support Healthcare Decisions. Springer, Cham. https://doi.org/10.1007/978-3-319-47540-0_11
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