THETA (Toronto Health Economics and Technology Assessment) collaborative, University of Toronto, Toronto, Ontario,Canada.
Int J Technol Assess Health Care. 2013 Jul;29(3):290-300. doi: 10.1017/S0266462313000329.
We conducted a systematic review of quantitative research regarding patients' preferences, perspectives and values for ventilation among chronic obstructive pulmonary disease (COPD) patients. Our objective was to explore the feasibility and desirability of incorporating patient preferences within the health technology assessment (HTA) process by working through a case study.
Medical and economic databases were searched for studies published in English from 1990 through March 4, 2011. Studies were selected based on title and abstract. Due to the heterogeneity of the studies, data were analyzed using a narrative synthesis approach.
Among 1833 identified citations, twelve studies met our inclusion criteria. Ten of these studies pertained to COPD patient preferences for ventilation. Results indicate that a significant proportion of COPD patients are willing to forgo ventilation, particularly when it is expressed as "indefinite life support" (60-78 percent) rather than as temporary modality. Results indicate that patient preferences for mechanical or noninvasive ventilation cannot be predicted by covariates (e.g., age, quality of life) or by others who are frequently called upon to make decisions are their behalf.
We found that it is indeed feasible to conduct a systematic review of quantitative preference-related evidence for an HTA topic. However, the process of conducting this preference-related case study also revealed several challenges because there is a high degree of variation in taxonomy, instrumentation, and study design. Therefore, we do not recommend it as a routine part of the HTA process, but we suggest that it is a promising area to pursue for preference-sensitive technological decisions.
我们对慢性阻塞性肺疾病（COPD）患者的通气偏好、观点和价值观的定量研究进行了系统评价。我们的目的是通过案例研究探索将患者偏好纳入卫生技术评估（HTA）过程的可行性和可取性。
从 1990 年至 2011 年 3 月 4 日，在医学和经济数据库中搜索发表的英文研究。研究根据标题和摘要进行选择。由于研究的异质性，使用叙述性综合方法对数据进行分析。
在 1833 条鉴定引文中有 12 项研究符合我们的纳入标准。其中 10 项研究涉及 COPD 患者对通气的偏好。结果表明，相当一部分 COPD 患者愿意放弃通气，尤其是当它被表述为“无限期生命支持”（60-78%）而不是临时模式时。结果表明，患者对机械或无创通气的偏好不能由协变量（如年龄、生活质量）或其他经常被要求代表他们做出决策的人来预测。
我们发现，对 HTA 主题的定量偏好相关证据进行系统评价确实是可行的。然而，进行这种偏好相关案例研究的过程也揭示了一些挑战，因为分类、仪器和研究设计存在高度的变化。因此，我们不建议将其作为 HTA 过程的常规部分，但我们建议将其作为偏好敏感技术决策的一个有前途的领域。
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