Sommer Isolde, Titscher Viktoria, Szelag Monika, Gartlehner Gerald
Department for Evidence-Based Medicine and Evaluation, Danube University Krems, Krems, Austria.
RTI International, Research Triangle Park, Raleigh, NC, USA.
Patient Prefer Adherence. 2021 Jan 18;15:57-68. doi: 10.2147/PPA.S281466. eCollection 2021.
Despite evidence from clinical guideline development that physicians and patients show discordance in what they consider important in outcome selection and prioritization, it is unclear to what extent outcome preferences are concordant between experts and citizens when it comes to the context of primary prevention. Therefore, the objective of this study was to assess whether expert judgments about the importance of beneficial and harmful outcomes differ from citizen preferences when considering intervention options for a periodic health examination (PHE) program.
We conducted an online survey using a modified Delphi approach. The target population for the survey consisted of citizens who had attended the PHE (n=18) and experts who made evidence-based recommendations (n=11). Citizens and experts assigned a score on a 9-point Likert scale for each outcome of 14 interventions. We analyzed the intragroup agreement based on Krippendorff's alpha and the intergroup agreement using the cube root product measure (CRPm). We further tested for significant differences between the groups using the Mann -test.
Agreements within the groups of citizens and experts varied across the interventions and tended to be poor (α ≤0 to 0.20) or fair (α = 0.21 to 0.40), with three exceptions showing moderate agreement (α = 0.44 to 0.55). The agreements between the citizens and experts across the interventions was fair (CRPm = 0.28) during the first Delphi rating round. The mean differences between the citizens and experts on the Likert scale ranged from 0.0 to 3.8 during the first rating round and from 0.0 to 3.3 during the second. Across interventions, the citizens rated the outcomes as more important than the experts did (p<0.01). Individual participants' ratings varied substantially.
Because experts generally underestimated the outcomes' importance to citizens, the involvement of citizens in guideline panels for preventive services is important.
尽管临床指南制定的证据表明，医生和患者在结果选择和优先级的重要性方面存在不一致，但在初级预防背景下，专家和公民之间的结果偏好一致程度尚不清楚。因此，本研究的目的是评估在考虑定期健康检查（PHE）计划的干预选项时，专家对有益和有害结果重要性的判断是否与公民偏好不同。
我们采用改良的德尔菲法进行了一项在线调查。调查的目标人群包括参加过PHE的公民（n = 18）和做出循证建议的专家（n = 11）。公民和专家对14种干预措施的每种结果在9点李克特量表上进行评分。我们基于克里彭多夫阿尔法系数分析了组内一致性，并使用立方根乘积度量（CRPm）分析了组间一致性。我们进一步使用曼恩检验来检验两组之间的显著差异。
公民组和专家组内的一致性在不同干预措施中有所不同，且往往较差（α≤0至0.20）或一般（α = 0.21至0.40），有三个例外显示出中等一致性（α = 0.44至0.55）。在第一轮德尔菲评级中，公民和专家在不同干预措施上的一致性一般（CRPm = 0.28）。在第一轮评级中，公民和专家在李克特量表上的平均差异在0.0至3.8之间，在第二轮中在0.0至3.3之间。在所有干预措施中，公民对结果的评分比专家更高（p<0.01）。个体参与者的评分差异很大。
由于专家通常低估了结果对公民的重要性，因此公民参与预防性服务指南小组很重要。
