Can Streamlined Multicriteria Decision Analysis Be Used to Implement Shared Decision Making for Colorectal Cancer Screening?
Can Streamlined Multicriteria Decision Analysis Be Used to Implement Shared Decision Making for Colorectal Cancer Screening?
复制标题
DOI：
10.1177/0272989x13513338
复制
发表时间：
2014-08-01
影响因子：
3.6
通讯作者：
Imperiale, Thomas F.
中科院分区：
文献类型：
--
作者：
Dolan, James G.;Boohaker, Emily;Imperiale, Thomas F.
背景资料。目前的美国结直肠癌筛查指南呼吁在几个推荐的筛查选项中做出共同决定，但很难实施。多准则决策分析(MCDA)是一种适合于支持共享决策的成熟方法。我们的研究目标是确定简化形式的MCDA是否可以准确地评估患者的结直肠癌筛查优先顺序。方法：研究方法。在先前的研究中，我们使用层次分析法(AHP)从484名平均风险患者中获得了关于结直肠癌筛查的4个决策标准和3个子标准的优先顺序，并使用排名顺序质心将优先顺序转换为基于排名顺序的优先顺序。我们使用Spearman等级相关和非参数Bland-Altman一致性极限分析对两组优先级进行了比较。我们比较了3种目前推荐的结直肠癌筛查策略，评估了基于排序的优先顺序和基于AHP的优先顺序对全面MCDA结果的不同影响。利用蒙特卡罗模拟对结果的泛化能力进行了评估。结果。7项标准的两套优先事项之间的相关性在0.55至0.92之间。基于排名的优先顺序和基于AHP的优先顺序之间的差异超过+/-0.15的比例从1%到16%不等。完整的MCDA结果的差异很小，3种筛查选项的相对排名超过88%的时间是相同的。蒙特卡罗模拟的结果是相似的。结论。基于排序的MCDA可能是一种简单、实用的方法来指导个人决策和评估关于结直肠癌筛查策略的人群决策优先顺序。有必要进行更多的研究，以进一步探索使用这些方法来促进共同决策。
Background. Current US colorectal cancer screening guidelines that call for shared decision making regarding the choice among several recommended screening options are difficult to implement. Multicriteria decision analysis (MCDA) is an established method well suited for supporting shared decision making. Our study goal was to determine whether a streamlined form of MCDA using rank-order-based judgments can accurately assess patients' colorectal cancer screening priorities. Methods. We converted priorities for 4 decision criteria and 3 subcriteria regarding colorectal cancer screening obtained from 484 average-risk patients using the analytic hierarchy process (AHP) in a prior study into rank-order-based priorities using rank order centroids. We compared the 2 sets of priorities using Spearman rank correlation and nonparametric Bland-Altman limits of agreement analysis. We assessed the differential impact of using the rank-order-based versus the AHP-based priorities on the results of a full MCDA comparing 3 currently recommended colorectal cancer screening strategies. Generalizability of the results was assessed using Monte Carlo simulation. Results. Correlations between the 2 sets of priorities for the 7 criteria ranged from 0.55 to 0.92. The proportions of differences between rank-order-based and AHP-based priorities that were more than +/- 0.15 ranged from 1% to 16%. Differences in the full MCDA results were minimal, and the relative rankings of the 3 screening options were identical more than 88% of the time. The Monte Carlo simulation results were similar. Conclusions. Rank-order-based MCDA could be a simple, practical way to guide individual decisions and assess population decision priorities regarding colorectal cancer screening strategies. Additional research is warranted to further explore the use of these methods for promoting shared decision making.