Medical decision making : an international journal of the Society for Medical Decision Making
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Decisions about clinical practice change, that is, which guidelines to adopt and how to implement them, can be made sequentially or simultaneously. Decision makers adopting a sequential approach first compare the costs and effects of alternative guidelines to select the best set of guideline recommendations for patient management and subsequently examine the implementation costs and effects to choose the best strategy to implement the selected guideline. In an integral approach, decision makers simultaneously decide about the guideline and the implementation strategy on the basis of the overall value for money in changing clinical practice. ⋯ More importantly, it may lead to different choices of guidelines and implementation strategies for clinical practice change. The differences in decision making and decision analysis between the alternative approaches are comprehensively illustrated using 2 hypothetical examples. We argue that, in most cases, an integral approach to deciding about change in clinical practice is preferred, as this provides more efficient use of scarce health-care resources.
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To estimate the cost-effectiveness of universal childhood rotavirus vaccination in Belgium, taking into account the impact of caregiver burden and the burden of sick children for whom no medical care is sought ("no medical care'' ). ⋯ For the Belgian health care payer, at current vaccine prices, universal childhood rotavirus vaccination is unlikely to be judged cost-effective versus no vaccination but would be a more efficient and equitable choice than continuing with current practice.
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Decisional conflict is defined as personal uncertainty about which course of action to take when choice among competing options involves risk, regret, or challenge to personal life values. It is influenced by inadequate knowledge, unclear values, inadequate support, and the perception that an ineffective decision has been made. Until recently, it has been studied at the individual level, which ignores the interpersonal system between patients and physicians. ⋯ Personal uncertainty of patients and physicians is influenced not only by their respective deficits but also by the deficits of the other member of the dyad. Our results indicate that the more unclear the expression of their own values and the more they perceive that an ineffective choice had been made, the more both physicians and patients experience personal uncertainty. They also indicate that the less uninformed they feel, the more both physicians and patients experience personal uncertainty.
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The treatment tradeoff method (TTM) has been developed specifically for decision making at the level of the individual patient. The task is tailored to the clinical decision problem at hand and may therefore be more relevant to patients than methods of outcome valuation. Despite its wide use in oncology research, few methodological studies regarding validity have been conducted. ⋯ Patients indeed use their valuations of treatment outcomes states, especially those they are less familiar with, in determining their preference for one treatment over another. In clinical practice, the TTM may be used to obtain an indication of the treatment preference of an individual patient and may also be helpful to detect patients' motives to choose one treatment over another.