Angioletti Carmen, de Mattia Egidio, Carloni Luca M, Morsella Alisha, Fabi Alessandra, Orlandi Armando, Tortora Giampaolo, de Belvis Antonio G
Critical Pathways and Outcomes Evaluation Unit Fondazione Policlinico Universitario Agostino Gemelli IRCCS Roma Lazio Italy.
Scuola Superiore Sant'Anna Istituto di Management Pisa Toscana Italy.
Health Sci Rep. 2022 Sep 13;5(5):e817. doi: 10.1002/hsr2.817. eCollection 2022 Sep.
In oncology, there is increasing talk of personalized treatment and shared decision-making (SDM), especially when multiple treatment options are available with different outcomes depending on patient preference. The present study aimed to define the set of main dimensions and relative tools to assess the Value brought to patients from a Breast Cancer's Clinical pathway structured according to a dynamic SDM framework.
Starting from our previous systematic review of the literature, a deep search of the main evidence-based and already validated questionnaires was carried out. In the second phase, to corroborate this grid, a Delphi survey was conducted to assess each questionnaire identified for each dimension, against the following seven value-based criteria: Clinical Benefit, Safety, Care Team Well Being, Patient Reported Outcomes Measures, Green Oncology, Impact on Health Budget, and Genomic Profile.
The resulting 7-dimension questionnaire is composed of 72 questions. Of these, some quantitatively and objectively assess the evolution of the patient's disease state, whereas others aim to ask patients about their active involvement in decisions affecting them and to investigate whether they were free to explore their preferences. Furthermore, to frame the analyzed phenomenon at the right time, for each questionnaire section, the specific, evidence-based timing of administration is indicated.
The resulting questionnaire is validated in its entirety and it is composed of a set of questions and relative time point for data collections to assess the Value brought to patients undertaking a Breast Cancer's Clinical pathway, structured according to a dynamic SDM framework. It constitutes a quantitative instrument to integrate patient centeredness with a personalized perspective in the care management of women with breast cancer.
在肿瘤学领域，个性化治疗和共同决策（SDM）的讨论日益增多，尤其是当有多种治疗方案可供选择，且不同方案的结果取决于患者偏好时。本研究旨在确定一套主要维度和相关工具，以评估根据动态SDM框架构建的乳腺癌临床路径为患者带来的价值。
从我们之前对文献的系统综述出发，对主要的循证且已验证的问卷进行了深入搜索。在第二阶段，为了证实这一框架，开展了一项德尔菲调查，根据以下七个基于价值的标准评估为每个维度确定的每份问卷：临床获益、安全性、护理团队福祉、患者报告结局测量、绿色肿瘤学、对健康预算的影响以及基因组概况。
最终形成的7维问卷由72个问题组成。其中一些问题定量且客观地评估患者疾病状态的演变，而其他问题旨在询问患者对影响自身决策的积极参与情况，并调查他们是否能够自由探索自己的偏好。此外，为了在正确的时间框定所分析的现象，针对每个问卷部分，都指明了基于证据的具体施测时间。
最终形成的问卷整体经过了验证，它由一组问题和数据收集的相关时间点组成，用于评估根据动态SDM框架构建的乳腺癌临床路径为患者带来的价值。它构成了一种定量工具，可将以患者为中心的理念与个性化视角整合到乳腺癌女性患者的护理管理中。
