Explaining Distortions in Utility Elicitation through the Rank-Dependent Model for Risky Choices

The standard gamble (SG) method has been accepted as the gold standard for the elicitation of utility when risk or uncertainty is involved in decisions, and thus for the measurement of utility in medical decisions. Unfortunately, the SG method is distorted by a general dislike for gambles, the "gambling effect," leading to an overestimation of risk aversion and of utility of impaired health. This problem does not occur for visual analogue scales or the time tradeoff method. For risky decisions, however, the latter methods lack validity. This paper shows how "rank-dependent utility" theory, a newly developed theory in the decision science literature, can provide a new explanation for the gambling effect. Thus it provides a means to correct the SG method and to improve the assessments of quality adjusted life years for medical decisions in which there is uncertainty about outcomes

The Utility of Health States After Stroke: A Systematic Review of the Literature

Background—: To perform decision analyses that include stroke as one of the possible health states, the utilities of stroke states must be determined. We reviewed the literature to obtain estimates of the utility of stroke and explored the impact of the study population and the elicitation method. Summary of Review—: We searched various databases for articles reporting empirical assessment of utilities. Mean utilities of major stroke (Rankin Scale 4 to 5) and minor stroke (Rankin Scale 2 to 3) were calculated, stratified by study population and elicitation method. Additionally, the modified Rankin Scale was mapped onto the EuroQol classification system. Utilities were obtained from 23 articles. Patients at risk for stroke assigned utilities of 0.26 and 0.55 to major and minor stroke, respectively. Stroke survivors assigned higher utilities to both major (0.41) and minor stroke (0.72). The EuroQol completed by stroke survivors revealed a utility of 0.32 and 0.71 for major and minor stroke, respectively. Utilities elicited by the Standard Gamble were generally higher, while those obtained by the Visual Analogue Scale were lower than the Time Trade Off values. Remaining variation between utilities may be caused by differences in definitions of the health states. The mapped EuroQol indicated a utility of 0.64 for minor stroke and a value just below zero for majo

The use of multi-criteria decision methods in health care:Which method is most suitable for healthy and cognitively impaired population?

OBJECTIVES: To select the best multi-criteria decision making method for use with cognitively impaired patients. Population. A convenience sample of 28 subjects, 12 healthy and 16 cognitively impaired. METHODS: Based on a literature review, 5 multicriteria methods were chosen for comparison including: Kepner-tregoe analysis (KTA), simple multi attribute rating technique (SMART), SMART using swing weights (SWING), Analytic Hierarchy Process (AHP) and Conjoint Analysis (CA). Four attributes of treatment were identified (impact, duration, and end-result of treatment and associated risks). Subjects were asked to both rank and rate the importance of these attributes. After using the methods to establish preferences for treatment, subjects were asked to judge the overall difficulty of the techniques on 1–10 score, and answer questions regarding clarity of explanation of method, difficulty in answering questions, understanding method in relation to goal, and use of the method in health care situations. Subjects were interviewed either once (n = 14) or twice (n = 14) (Only the results of the first measurement are presented) RESULTS: In the overall rating of methods CA scored best (mean score 3.65), followed by SMART (3.70), AHP (4.00), SWING (4.40) and KTA (4.67). CA also scored best on verbal/written explanation, understanding of method in relation to goal second and usefulness in health care situations, and scored second place on difficulty in answering questions. In the impaired population, AHP was rated best on the overall difficulty score. CONCLUSIONS: In this pilot study, conjoint analysis was the most preferred method of preference elicitation. Our main concern regarding CA is the time it takes to fill out a CA questionnaire and the fact that data analysis is most complicated of all methods included. Another concern regarding the use of multicriteria methods needing further study is the rate of rank-reversal between methods in the cognitively impaired population

The effect of information on preferences stated in a choice-based conjoint analysis

Objective: The objective of the study was to investigate the effect of a priori information on preferences for treatment elicited in a discrete choice experiment. - Methods: A convenience sample of 100 subjects was randomly split into two groups. The groups received minimal or extensive information on the treatment of ankle and foot impairment in stroke. Then, they participated in a discrete choice experiment. Possible treatment was described using eight decision criteria with two to four levels each. Part-worth utility coefficients for the criteria levels, criteria importance and overall treatment preference were estimated. It was tested whether the amount of information that was received influenced the outcome of the discrete choice experiment. - Results: \ud In the extensively informed group fewer reversals in the expected order of part-worth utilities were found. Criteria importance for four of the eight criteria and criteria importance ranking between the minimally and extensively informed subject groups were significantly different. The difference in part-worth utility of the levels had a minor effect on the predicted utility of the available treatments. - Conclusion: The lower number of level rank reversals in the extensively informed subjects indicates a better understanding of outcome desirability and thus a better understanding of the decision task. The effect of more extensive information on predicted treatment preference was minimal. - \ud Practice implications: While interpreting the results of a discrete choice experiment, the effect of prior knowledge on the decision problem has to be taken into account. Although information seems to increase the understanding of the decision task, outcomes valuation can also be directed by information and more extensive information increases the cognitive burden which is placed on the subjects. Future research should focus on the exact nature and size of the effects and the results of this study should be clinically validated

Implicit persuasion in medical decision-making An overview of implicitly steering behaviors and a reflection on explanations for the use of implicitly steering behaviors

Analysis and support of clinical decision makin

COVID-19 and systemic anticancer therapy: exploiting uncertainty

Immunobiology of allogeneic stem cell transplantation and immunotherapy of hematological disease

Response rate of patient reported outcomes: the delivery method matters

Background Patient Reported Outcomes (PROs) are subjective outcomes of disease and/or treatment in clinical research. For effective evaluations of PROs, high response rates are crucial. This study assessed the impact of the delivery method on the patients' response rate. Methods A cohort of patients with a unilateral vestibular schwannoma (a condition with substantial impact on quality of life, requiring prolonged follow-up) was assigned to three delivery methods: email, regular mail, and hybrid. Patients were matched for age and time since the last visit to the outpatient clinic. The primary outcome was the response rate, determinants other than delivery mode were age, education and time since the last consultation. In addition, the effect of a second reminder by telephone was evaluated. Results In total 602 patients participated in this study. The response rates for delivery by email, hybrid, and mail were 45, 58 and 60%, respectively. The response rates increased after a reminder by telephone to 62, 67 and 64%, respectively. A lower response rate was associated with lower level of education and longer time interval since last outpatient clinic visit. Conclusion The response rate for PRO varies by delivery method. PRO surveys by regular mail yield the highest response rate, followed by hybrid and email delivery methods. Hybrid delivery combines good response rates with the ease of digitally returned questionnaires.Analysis and support of clinical decision makin

What makes a patient ready for shared decision making?: A qualitative study

Objectives: Shared decision making (SDM) requires an active role from patients, which might be difficult for some. We aimed to identify what patients need to be ready (i.e., well-equipped and enabled) to participate in SDM about treatment, and what patient- and decision-related characteristics may influence readiness.Methods: We conducted semi-structured interviews with patients and professionals (physicians, nurses, general practitioners, and researchers). Interviews were analyzed inductively.Results: We identified five elements of patient readiness: 1) understanding of and attitude towards SDM, 2) health literacy, 3) skills in communicating and claiming space, 4) self-awareness, and 5) consideration skills. We identified 10 characteristics that may influence elements of readiness: 1) age, 2) cultural background, 3) educational background, 4) close relationships, 5) mental illness, 6) emotional distress, 7) acceptance of diagnosis, 8) clinician-patient relationship, 9) decision type, and 10) time.Conclusions: We identified a wide range of elements that may constitute patient readiness for SDM. Readiness might vary between and within patients. This variation may result from differences in patientand decision-related characteristics.Practice implications: Clinicians should be aware that not all patients may be ready for SDM at a given moment and may need support to enhance their readiness. (C) 2020 The Authors. Published by Elsevier B.V.Analysis and support of clinical decision makin

Tradeoffs of Life: between Quality and Quantity Development of the QQ Questionnaire for Cancer Patient Attitudes

The patient's perspective is of prime concern in weighing the benefits and side effects of oncologic treatment. Little is known about patients' preference and attitudes. The authors developed a short questionnaire to assess patient attitudes concerning trade-offs between quality of life and length, or quantity, of life (the QQ Questionnaire). The questionnaire turned out to be feasible for use in various groups of cancer patients. In a factor analysis, the questionnaire was shown to consist of two factors, a Q(uality) and a L(ength) factor. Values of Cronbach's alpha for the Q and L scales (consisting of four items each) were 0.68 and 0.79, respectively. Younger patients and patients who have children assigned relatively more importance to striving for prolonged survival. Contrary to our expectation, no association was found between scores on the two scales and time tradeoff utility scores. The QQ Questionnaire can be used in research settings to study patient attitudes and the stability and determinants of patients' preference