Linkov Faina, Valappil Benita, McAfee Jacob, Goughnour Sharon L, Hildrew Douglas M, McCall Andrew A, Linkov Igor, Hirsch Barry, Snyderman Carl
Magee-Womens Research Institute, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA; Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA.
Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA.
Am J Otolaryngol. 2017 Jan-Feb;38(1):57-64. doi: 10.1016/j.amjoto.2016.09.019. Epub 2016 Sep 30.
To integrate multiple sources of clinical information with patient feedback to build evidence-based decision support model to facilitate treatment selection for patients suffering from vestibular schwannomas (VS).
This was a mixed methods study utilizing focus group and survey methodology to solicit feedback on factors important for making treatment decisions among patients. Two 90-minute focus groups were conducted by an experienced facilitator. Previously diagnosed VS patients were recruited by clinical investigators at the University of Pittsburgh Medical Center (UPMC). Classical content analysis was used for focus group data analysis. Providers were recruited from practices within the UPMC system and were surveyed using Delphi methods. This information can provide a basis for multi-criteria decision analysis (MCDA) framework to develop a treatment decision support system for patients with VS.
Eight themes were derived from these data (focus group + surveys): doctor/health care system, side effects, effectiveness of treatment, anxiety, mortality, family/other people, quality of life, and post-operative symptoms. These data, as well as feedback from physicians were utilized in building a multi-criteria decision model.
The study illustrated steps involved in the development of a decision support model that integrates evidence-based data and patient values to select treatment alternatives.
Studies focusing on the actual development of the decision support technology for this group of patients are needed, as decisions are highly multifactorial. Such tools have the potential to improve decision making for complex medical problems with alternate treatment pathways.
整合多种临床信息来源与患者反馈，构建基于证据的决策支持模型，以促进前庭神经鞘瘤（VS）患者的治疗选择。
这是一项混合方法研究，利用焦点小组和调查方法征求患者对治疗决策重要因素的反馈。由一名经验丰富的主持人主持了两个90分钟的焦点小组。匹兹堡大学医学中心（UPMC）的临床研究人员招募了先前诊断为VS的患者。采用经典内容分析法对焦点小组数据分析。从UPMC系统内的医疗机构招募提供者，并使用德尔菲法进行调查。这些信息可为多标准决策分析（MCDA）框架提供基础，以开发VS患者的治疗决策支持系统。
从这些数据（焦点小组+调查）中得出了八个主题：医生/医疗保健系统、副作用、治疗效果、焦虑、死亡率、家庭/其他人、生活质量和术后症状。这些数据以及医生的反馈被用于构建多标准决策模型。
该研究阐述了开发决策支持模型所涉及的步骤，该模型整合基于证据的数据和患者价值观以选择治疗方案。
由于决策具有高度多因素性，需要开展针对该组患者决策支持技术实际开发的研究。此类工具有可能改善具有替代治疗途径的复杂医疗问题的决策。
