1,721,052 research outputs found
Methodological and cultural determinants in the valuation of health-related quality of life measures.
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219045.pdf (Publisher’s version ) (Open Access)Radboud University, 09 juni 2020Promotor : Wilt, G.J. van der Co-promotores : Stalmeier, P.F.M., Donders, A.R.T
When cure is not an option: Informing patients with advanced cancer about palliative treatment options
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140175.pdf (Publisher’s version ) (Open Access)Radboud Universiteit Nijmegen, 20 mei 2015Promotores : Graaf, W.T.A. van der, Wilt, G.J. van der Co-promotores : Stalmeier, P.F.M., Ottevanger, P.B
Shared Decision Making in women testing for a BRCA 1/2 mutation.
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19591_shardemai.pdf (Publisher’s version ) (Open Access)Women with a BRCA1/2 mutation have a high genetic risk of developing breast and ovarian cancer. They face the difficult choice between screening and prophylactic surgery for the breasts and ovaries. We have developed a shared decision making program to prepare these women for decision making. The shared decision making program consisted of two decision aids. The decision aids have been developed as adjuncts to standard genetic counselling and were evaluated in a randomized trial. The study included both women affected and unaffected with cancer testing for a BRCA1/2 mutation. The first decision aid consisted of a brochure and video providing information on screening and prophylactic surgery and their consequences. It was provided either before or after the DNA-test result. This decision aid had no impact on well-being neither on decision related outcomes. Beneficial effects were found on information related outcomes. These effects occurred irrespective whether the decision aid was presented before or after the DNA-test result. No interaction effect was found between the DA and the personal history of cancer. The second decision aid consisted of two value assessment sessions, using the time trade-off method, followed by individualized treatment information based on (quality adjusted) life expectancy derived form a decision model. This decision aid only had an effect on the long term (9 months after the test result). Women reported less intrusive thoughts about cancer, a better general health, and tended to be less depressed. Furthermore, the SDMI strengthened treatment preferences and increased the feeling of having weighed the pros and cons. A differential impact was found in women affected with cancer versus unaffected women. Unaffected women benefited from this decision aid, while affected women tended to experience detrimental effects. The effects of the two decision aids are complementary. Thus, preferably, the complete support package should be offered.KUN Katholieke Universiteit Nijmegen, 21 februari 2005Promotor : Daal, W.A.J. van Co-promotores : Stalmeier, P.F.M., Verhoef, C.G.141 p
Discrepancies between chained and classic utilities induced by anchoring with occasional adjustments.
No full textBACKGROUND: Classic utility assessment uses death and perfect health as end points. Chained utility assessment uses other health states as endpoints. It has been previously noted that these 2 assessment procedures lead to different utilities. PURPOSE: The author attempts to explain these discrepancies between chained and classic assessments. METHOD: Previous data are plotted in a uniform way to facilitate comparison. Using time trade-off and paired-comparison data, the author estimates the extent to which respondents adjust their responses when end points are varied. Data were obtained in various samples: in healthy volunteers from the general public, in students, and in women at high risk for breast cancer seeking genetic counseling. RESULTS: The author obtained 741 valid data records from a total of 106 participants. The data replicate the pattern found previously. When compared to classic utilities, (1) chained utilities are smaller (larger) when the best (worst) endpoint varies and (2) the discrepancies become smaller for utilities near 0 and 1. The data reveal that there is a distinct failure to adjust responses when the end points are varied, as if the responses anchor on some master health scale. The latter finding explains the robust pattern of discrepancies. CONCLUSION: Decision analyses that use a mix of classic and chained utilities are not on firm ground. One should be wary of normative interpretations of new value assessment procedures. Alternative interpretations of the findings are discussed
Utilities and patient preferences discrepancies between chained and classic utilities induced by anchoring with occasional adjustments
No full textItem does not contain fulltextBackground: Classic utility assessment uses death and perfect health as end points. Chained utility assessment uses other health states as end points. It has been previously noted that these two assessment procedures lead to different utilities. Purpose: To explain these discrepancies between chained and classic assessments. Methods: First, previous data are plotted in a uniform way to facilitate comparison. Second, using Time TradeOff and paired comparison data, we estimate the extent to which respondents adjust their responses when end points are varied. Data were obtained in various samples: in healthy volunteers from the general public, in students, and in women at high risk for breast cancer seeking genetic counseling. Results: We obtained 741 valid data records from a total of 106 participants. Our own data replicate the pattern found previously: when compared to classic utilities 1) Chained utilities are smaller (larger) when the best (worst) end point varies, 2) the discrepancies become smaller for utilities near 0 and 1. Our data reveal that there is a distinct failure to adjust responses when the end points are varied. The latter finding explains the robust pattern of discrepancies. Conclusions: Decision analyses that use a mix of classic and chained utilities are not on firm ground. One should be wary of normative interpretations of new value assessment procedures. Alternative interpretations of our findings are discussed
Adherence and decision AIDS: a model and a narrative review
No full textBACKGROUND: Patient adherence to medication or lifestyle interventions is a serious concern. Interventions to improve adherence exist, but their effects are usually small. Several authors suggested that decision aids may positively affect adherence. OBJECTIVE: . This presentation examines the role of decision aids in adherence research through development of a model and a narrative review. METHODS: and RESULTS: . I: A model was developed to organize pathways relating decision aids and adherence. There is clinical evidence for these pathways, suggesting that decision aids may potentially improve adherence. The model is helpful when considering measures to study decision aids and adherence. II: A narrative review of decision aids and adherence was done. A systematic search resulted in 11 randomized studies. Two studies, both in the hypertension management domain, were positive. Shortcomings were identified regarding the range of adherence measures, the sample size, and the STUDY DESIGN: It is argued that outcomes for the option "nonadherent" behavior should be described explicitly in the decision aid to inform patients about the costs and benefits of nonadherent behavior. CONCLUSIONS: . A relation between decision aids and adherence is plausible in view of the psychological and medical literature. A systematic search showed that experimental evidence relating decision aids and adherence is inconclusive. Rigorous trials on this topic are worthwhile. Such trials should employ adequate sample sizes, multiple adherence measures, and a control arm delivering usual care. The decision aid should describe the option "being nonadherent" and its outcomes
Maximal endurable time states and the standard gamble: more preference reversals
No full textItem does not contain fulltextBACKGROUND: The time trade off (TTO) method is not sensitive to maximal endurable time preferences, as preference reversals occur. The standard gamble (SG) method has not been tested regarding its sensitivity to maximal endurable time preferences. OBJECTIVE: This study investigates whether preference reversals occur for the SG method as well. METHODS: Fifty-nine respondents stated for several migraine health states their preference for living 10 or 20 years in that state. A migraine state was selected for which a respondent preferred 10-20 years, a maximal endurable time preference. Two probability equivalent gambles were obtained for the migraine states lasting 10 and 20 years, respectively. Preference reversals occurred when the gamble, equivalent to the longer duration, was preferred to the gamble equivalent to the shorter duration. RESULTS: Out of 59 respondents, 48 had maximal endurable time preferences. Of these 48 respondents, 34 (71 %) showed a preference reversal. This percentage differed significantly from chance, that is 50 % (P = 0.004), indicating that preference reversals occurred reliably. CONCLUSION: The observed reversal rate for the standard gamble is similar to rates observed previously with the TTO method. Utility measurement of poor health states is problematic, both with the TTO and standard gamble methods
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