Medical decision making : an international journal of the Society for Medical Decision Making
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Primary Care Physicians' Support of Shared Decision Making for Different Cancer Screening Decisions.
Despite its widespread advocacy, shared decision making (SDM) is not routinely used for cancer screening. To better understand the implementation barriers, we describe primary care physicians' (PCPs') support for SDM across diverse cancer screening contexts. ⋯ Our results highlight the need to document SDM benefits and consider the specific contextual challenges, such as the level of uncertainty or whether evidence supports recommending/not recommending screening, when implementing SDM across an array of cancer screening contexts.
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Randomized Controlled Trial
Risk Stratification and Shared Decision Making for Colorectal Cancer Screening: A Randomized Controlled Trial.
Eliciting patient preferences within the context of shared decision making has been advocated for colorectal cancer (CRC) screening, yet providers often fail to comply with patient preferences that differ from their own. ⋯ Providers perceived risk stratification to be useful in their decision making but often failed to comply with patient preferences for tests other than colonoscopy, even among those deemed to be at low risk of ACN.
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. Parameter uncertainty in EQ-5D value sets is routinely ignored. Sources of parameter uncertainty include uncertainty in the estimated regression coefficients of the scoring algorithm and uncertainty that arises from the need to use a nonsaturated functional form when creating the scoring algorithm. We hypothesize that this latter source is the major contributor to parameter uncertainty in the value sets. ⋯ . EQ-5D-3L value sets are estimated subject to considerable parameter uncertainty; the median credible interval width is large compared with reported values of the minimum important difference for the EQ-5D-3L, which have been reported to be as small as 0.03. Other countries' scoring algorithms are based on smaller studies and are hence subject to greater uncertainty. This uncertainty should be accounted for when using EQ-5D health utilities in economic evaluations.
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. Recent proposals for value-based assessment, made by the National Institute of Health and Care Excellence (NICE) in the United Kingdom, recommended that burden of illness (BOI) should replace end of life (EOL) as a factor for consideration when deciding on new health technologies. This article reports on a study eliciting societal preferences for 1) BOI from a medical condition, defined as quality-adjusted life year (QALY) loss due to premature mortality and prospective morbidity, and 2) EOL, defined as expected life expectancy of less than 2 years and expected life expectancy gain from new treatment of 3 months or more. ⋯ . The social value of a QALY gain is not equal between recipients but depends on whether they are end of life, and it may depend on the prospective burden of illness.
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While increasingly popular among mid- to large-size employers, using financial incentives to induce health behavior change among employees has been controversial, in part due to poor quality and generalizability of studies to date. Thus, fundamental questions have been left unanswered: To generate positive economic returns on investment, what level of incentive should be offered for any given type of incentive program and among which employees? ⋯ Our generalizable framework integrates individual differences in behavior and risk to systematically estimate the incentive level that optimizes marginal return on investment.