How can patients be enabled to participate in decisions concerning their health? How can decisions be improved, concordent with patient values? A new patient decision aid will capitalise on network meta-analysis and single subject research designs to foster better decisions.
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An MCDA-based patient decision aid for patients with bipolar disorder
1. A patient decision aid for
bipolar disorder
Full title:
MCDA-Based Support
in Clinical Decision-
Making Throughout the
Patient Journey: The
Use of ALBA in Bipolar
Disorder
Øystein Eiring, MD, specialist in psychiatry, cand. mag, PhDc.
Editor Norwegian Electronic Library of Health/Mental Health
Head of Department of Knowledge Services, Innlandet Hospital Trust
2. My affiliation
The community
developing MCDA-
based, Annalisa
patient decision aids
10. Patient decision aids
• Tools for personalised decisions
• Many personalisation technologies
• Very limited use of technologies
Eiring Ø, Slaughter L. An Assessment of the Potential for Personalisation
in Patient Decision Aids. Lecture Notes of The Institute for Computer Sciences,
Social Informatics and Telecommunications Engineering Volume 91, 2012, pp 51 - 57
11. Bipolar disorder
• Singapore: 1,2 %
• Cross-national 0.3 – 1.5%
Chong SA, Abdin E, Vaingankar JA, Heng D, Sherbourne C, Yap M, Lim YW, Wong HB, Ghosh-
Dastidar B, Kwok KW, Subramaniam M. A population-based survey of mental disorders in
Singapore. Ann Acad Med Singapore 2012 Feb;41(2):49-18
15. Why can´t I stop my medication?
It really bothers me.
I would be much better without!
With permission. iStockphoto. The person depicted has no relation
to the subject and the picture is for illustrative purposes only.
16. You must continue taking it!
If not, you will certainly have a
relapse again.
You don´t remember how bad it
was, but I do
19. Why can´t I stop my medication?
It really bothers me.
I would be much better without!
20. Ok, lets try to find the best decision together
What are the benefits and harms you care
about?
And how likely are they, with and without
medication?
21. Three patient roles
Consumer
Shared
decision-making
Doctor knows best
Stubblefield C, Mutha S. Provider-patient roles in chronic disease
management. J Allied Health. 2002 Summer;31(2):87-92.
27. Knowledge not tailored to
decisions
• All options not directly comparable
• Not personalised
All the research in the world
• Not always reliable
• Not always readable
• Tells nothing in itself, without preferences
29. Top of the 6S model
In
EMR
Readable Summary
Relevant
Reliable Network m.a.
Systematic reviews
High quality single studies
Single studies
Dicenso A, Bayley L, Haynes RB. Accessing pre-appraised evidence: fine-tuning
the 5S model into a 6S model. Evid Based Nurs. 2009 Oct;12(4):99-101
30. A network of studies
Vergel YB, Dunn G, Palmer S, Beynon s, Woolacott N, Soares-Weiser K, Geddes J, Gilbody S.
A Simultaneous Comparison of Multiple Treatments for Bipolar I: An Application of Bayesian Statistical Methods. Poster
31. Direct and indirect
comparisons
Vergel YB, Dunn G, Palmer S, Beynon s, Woolacott N, Soares-Weiser K, Geddes J, Gilbody S.
A Simultaneous Comparison of Multiple Treatments for Bipolar I: An Application of Bayesian Statistical Methods. Poster
32. Part 1 of the work
• Complete two network meta-analyses
34. Knowledge not
operational
• Information about the effects of medicines
taken is
• not systematic
Electronic medical record
• not quantified
• (Often lacking)
• not structured
• not available to the patient
36. Enabling continuous
registration of attributes
• Example: depressive symptoms
• Patient registers level of depression weekly
• Feeds into the decision aid
• Assessment of the effect of the medication
• continuously and in retrospect
41. The problem with group
designs
• Take considerable time and resources
• No improvement of intervention on-the-fly
• Do not establish causality in the individual
Kazdin AE. Single-Case Research Designs: Methods for
Clinical and Applied Settings, 2nd Edition. New York, Oxford. 2009.
43. Single subject designs
• Extensive use within behavioural sciences
• Internal validity maintained
• Mimics and feasible within clinical practice
• Not the same as case studies!
44. Benefits
• Assesses effect in the individual patient
• Identifies causal relationships
• External validity comparable to group designs
• Determines efficacy in novel interventions
• Helps optimalise the intervention
• Design and intervention can be adjusted on the fly