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From Decision to Shared-Decision: Introducing Patients’ Preferences in Clinical Decision Analysis - A Case Study in Thromboembolic Risk Prevention

  • Lucia Sacchi
  • Carla Rognoni
  • Stefania Rubrichi
  • Silvia Panzarasa
  • Silvana Quaglini
Part of the Lecture Notes in Computer Science book series (LNCS, volume 7885)

Abstract

In the context of the EU project MobiGuide, the development of a patient-centric decision support system based on clinical guidelines is the main focus. The project is addressed to patients with chronic illnesses, including atrial fibrillation (AF). In this paper we describe a shared-decision model framework to address those situations, described in the guideline, where the lack of hard evidence makes it important for the care provider to share the decision with the patient and/or his relatives. To illustrate this subject we focus on an important subject tackled in the AF guideline: thromboembolic risk prevention. We introduce a utility model and a cost model to collect patient’s preferences. On the basis of these preferences and of literature data, a decision model is implemented to compare different therapeutic options. The development of this framework increases the involvement of patients in the process of care focusing on the centrality of individual subjects.

Keywords

Decision Trees Patient Preferences QALYs Atrial Fibrillation 

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References

  1. 1.
    Llewellyn-Thomas, H.A., Crump, T.: Decision Support for Patients: Values Clarification and Preference Elicitation. Med. Care Res. Rev. (2012) (Epub ahead of print) Google Scholar
  2. 2.
    Hack, T.F., Degner, L.F., Watson, P., Sinha, L.: Do patients benefit from participating in medical decision making? Longitudinal follow-up of women with breast cancer. Psychooncology 15(1), 9–19 (2006)CrossRefGoogle Scholar
  3. 3.
    Weinstein, M.C., Fineberg, H.V.: Clinical Decision Analysis. Saunders, Philadelphia (1980)Google Scholar
  4. 4.
    Charles, C., Gafni, A., Whelan, T.: Shared decision- making in the medical encounter: What does it mean? Social Science Medicine 44, 681–692 (1997)CrossRefGoogle Scholar
  5. 5.
    Stacey, D., Murray, M.A., Légaré, F., Sandy, D., Menard, P., O’Connor, A.: Decision coaching to support shared decision making: A framework, evidence, and implications for nursing practice, education, and policy. Worldviews Evid. Based Nurs. 5(1), 25–35 (2008)CrossRefGoogle Scholar
  6. 6.
    American College of Cardiology Foundation/American Heart Association Task Force: 2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: A report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation 123(10), e269–e367 (2011)Google Scholar
  7. 7.
    Soares, M.O.: Is the QALY blind, deaf and dumb to equity? NICE’s considerations over equity. Br. Med. Bull. 101, 17–31 (2012)CrossRefGoogle Scholar
  8. 8.
    Bell, C.M., Chapman, R.H., Stone, P.W., Sandberg, E.A., Neumann, P.J.: An off-the-shelf help list: A comprehensive catalog of preference scores from published cost-utility analyses. Med. Decis. Making 21(4), 288–294 (2001)Google Scholar
  9. 9.
    CEA Registry website, https://research.tufts-nemc.org/cear4/ (last access March 13, 2013)
  10. 10.
    Bleichrodt, H., Johannesson, M.: An Experimental Test of a Theoretical Foundation for Rating-scale Valuations. Med. Decis. Making 17, 208–216 (1997)Google Scholar
  11. 11.
    Torrance, G.W., Thomas, W.H., Sackett, D.L.: A utility maximization model for evaluation of health care programs. Health Services Res. 7, 118–133 (1972)Google Scholar
  12. 12.
    Von Neumann, J., Morgenstern, O.: Theory of Games and Economic behavior. Princeton University Press (1944)Google Scholar
  13. 13.
    Gerzeli, S., Tarricone, R., Zolo, P., Colangelo, I., Busca, M.R., Gandolfo, C.: The economic burden of stroke in Italy. The EcLIPSE Study: Economic Longitudinal Incidence-based Project for Stroke Evaluation. Neurol. Sci. 26(2), 72–80 (2005)Google Scholar
  14. 14.
    Sonnenberg, F.A., Beck, J.R.: Markov models in medical decision making: A practical guide. Med. Decis. Making 13(4), 322–338 (1993)CrossRefGoogle Scholar
  15. 15.
    Liberato, N.L., Rognoni, C., Marchetti, M., Quaglini, S.: Cost-effectiveness of new oral anticoagulants for stroke prophylaxis in atrial fibrillation. To appear on: Internal and Emergency Medicine (2012)Google Scholar
  16. 16.
    Lip, G.Y.H.: Stroke in atrial fibrillation: Epidemiology and thromboprophylaxis. J. Thromb Haemost 9 (suppl. 1), 344–351 (2011)Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Lucia Sacchi
    • 1
  • Carla Rognoni
    • 1
    • 2
  • Stefania Rubrichi
    • 1
  • Silvia Panzarasa
    • 1
  • Silvana Quaglini
    • 1
  1. 1.Dipartimento di Ingegneria Industriale e dell’InformazioneUniversity of PaviaPaviaItaly
  2. 2.Centre for Research on Health and Social Care Management (CERGAS)Bocconi UniversityMilanItaly

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