The Development and Pilot Study of a Multiple Criteria Decision Analysis (MCDA) to Compare Patient and Provider Priorities around Amputation-Level Outcomes.
The Development and Pilot Study of a Multiple Criteria Decision Analysis (MCDA) to Compare Patient and Provider Priorities around Amputation-Level Outcomes.
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DOI：
10.1177/23814683221143765
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发表时间：
2022-07
影响因子：
--
通讯作者：
Devine, Beth
中科院分区：
文献类型：
--
作者：
Poehler, Diana;Czerniecki, Joseph;Norvell, Daniel;Henderson, Alison;Dolan, James;Devine, Beth
关键词：
背景资料。面临下肢截肢的慢性肢体威胁缺血患者通常需要接受经跖骨截肢(TMA)或经胫骨截肢(TTA)。TMA保留了患者更多的肢体，可以提供更好的活动能力，但与TTA相比，一期伤口愈合的可能性较低，可能会导致额外的截肢手术。了解患者和提供者如何确定关键结果的优先顺序的差异可能会加强截肢决策过程。目的。开发和试点测试多标准决策分析(MCDA)工具，以得出截肢水平选择周围的患者价值，并将这些价值与提供者对患者价值的看法进行比较。方法：研究方法。我们进行了文献综述，以确定和衡量对患者重要的标准的表现。由于定量文献稀少，我们开发了谢菲尔德启发式框架练习，以从主题专家那里获得标准表现。我们在患者和提供商中试行了我们的MCDA，以了解工具的可接受性，并初步评估患者和提供商优先考虑的差异。结果。确定了五个重要的标准：行走能力、截肢手术后的愈合、康复强度、肢体长度和假体/矫形器的易用性。患者和提供者成功地完成了MCDA，并确定了这样做的挑战。我们为这些挑战提出了潜在的解决方案。试点测试的结果表明，患者和提供者的结果优先顺序不同。限制。这项试验性测试研究招募了一小部分提供者和患者。结论。我们成功地向患者和提供者实施了试点研究，收到了有用的反馈，并确定了改进该工具的解决方案。这意味着什么。一旦修改，我们的MCDA工具将适用于更广泛的推广。患者和提供者已经成功地完成了我们的MCDA，患者认为MCDA可能在临床实践中有用。我们遇到了几个方法上的挑战，并确定了减轻参与者负担的方法。当数据稀少时，使用谢菲尔德启发框架有助于创建性能矩阵，尽管患者主要依赖于他们的截肢经验来完成练习。使替代方案失明可能有助于患者更好地了解这一过程。
Background. Patients with chronic limb-threatening ischemia who are facing a lower-limb amputation often require a transmetatarsal amputation (TMA) or a transtibial amputation (TTA). A TMA preserves more of the patient’s limb and may provide better mobility but has a lower probability of primary wound healing relative to a TTA and may result in additional amputation surgeries. Understanding the differences in how patients and providers prioritize key outcomes may enhance the amputation decisional process. Purpose. To develop and pilot test a multiple criteria decision analysis (MCDA) tool to elicit patient values around amputation-level selection and compare those with provider perceptions of patient values. Methods. We conducted literature reviews to identify and measure the performance of criteria important to patients. Because the quantitative literature was sparse, we developed a Sheffield elicitation framework exercise to elicit criteria performance from subject matter experts. We piloted our MCDA among patients and providers to understand tool acceptability and preliminarily assess differences in patient and provider priorities. Results. Five criteria of importance were identified: ability to walk, healing after amputation surgery, rehabilitation intensity, limb length, and prosthetic/orthotic device ease. Patients and providers successfully completed the MCDA and identified challenges in doing so. We propose potential solutions to these challenges. The results of the pilot test suggest differences in patient and provider outcome priorities. Limitations. The pilot test study enrolled a small sample of providers and patients. Conclusions. We successfully implemented the pilot study to patients and providers, received helpful feedback, and identified solutions to improve the tool. Implications. Once modified, our MCDA tool will be suitable for wider rollout. Patients and providers have successfully completed our MCDA, and patients feel the MCDA may be useful in clinical practice. We encountered several methodologic challenges and identified approaches to ease participant burden. When data are sparse, using the Sheffield elicitation framework is helpful in creating a performance matrix, although patients relied largely on their amputation experiences to complete the exercise. Blinding the alternatives may help patients better understand the process.
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影响因子：
2.9
作者：
Barg, Frances K.;Cronholm, Peter F.;Margolis, David J.
通讯作者：
Margolis, David J.
DOI：
10.2165/01312067-200801040-00008
发表时间：
2008-10-01
影响因子：
3.6
作者：
IJzerman, Maarten J.;van Til, Janine A.;Snoek, Govert J.
通讯作者：
Snoek, Govert J.
影响因子：
9.6
作者：
Norvell, D. C.;Thompson, M. L.;Czerniecki, J. M.
通讯作者：
Czerniecki, J. M.
影响因子：
1.7
作者：
Horne, Carolyn E.;Paul, Joanna
通讯作者：
Paul, Joanna
DOI：
10.1016/j.apmr.2012.03.019
发表时间：
2012-08-01
影响因子：
4.3
作者：
Czerniecki, Joseph M.;Turner, Aaron P.;Norvell, Daniel C.
通讯作者：
Norvell, Daniel C.