jack dowie: deciding how to decide - and how to support decisions
TRANSCRIPT
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Deciding how to decide – and how to support decisions
Jack Dowie, PhD London School of Hygiene and Tropical Medicine
Honorary Professor, Sydney School of Public Health Mette Kjer Kaltoft, MPH RN
Odense University Hospital Svendborg Sygehus
Nuffield Webinar 21 November 2011
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Family spacing consultation in Timor-Leste
2 thanks to Lyndal Trevena, GP, Sydney School of Public Health
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• Informed • Shared • Evidence-based • Preference-sensitive • Cost-effective • Minimally-disruptive or maybe just …Better MDM
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The (r)evolution of the Patient Hippocrates c400 BC
“perform your duties calmly and adroitly, concealing most things from the patient while attending to him… revealing nothing of the patient’s future or present condition”
“NOTHING ABOUT ME, WITH ME”
Donald Berwick 2009 “The experience (to the extent the informed, individual patient desires it) of transparency, individualization, recognition, respect, dignity, and choice in all matters, without exception, related to one’s person, circumstances, and relationships in health care.” “NOTHING ABOUT ME, WITHOUT ME”
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Evidence
Expertise Values
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‘Taking Into Account and Bearing In Mind’ • Taking things into account • Giving considerations due weight • Establishing the right balance • Keeping things in proportion • Taking a measured view • Bringing everything into the equation • Seeking a degree of consensus • Gauging the impact • Making sure things add up • Summing up
Note how TIABIM discourse, basically qualitative, is given a quantitative flavour
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Interventional- Observational Border Conflicts
Qualitative- Quantitative Border Conflicts
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BELIEF SYNTHESIS
PREFER ENCE
SYNTHESIS
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Annalisa
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Decision Technologies
Not Decision- Aided
Decision- Aided
Not MCDA-based MCDA-based
Analytic Hierarchy Process,
HiView, Visa
MyOsteoScreenAL
Multi-Criteria Decision Analysis
Annalisa
TECHNIQUE
TEMPLATE
TOOL Jim Dolan’s AHP aids
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Adam Neate
What should we do?
What do we prefer? What do we know?
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The Annalisa screen
Evidence Base
Preference Base
Option Scores Options
Options
Attributes
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Thanks to my colleague Rebecca French for two following slides
http://www.brook.org.uk/contraception/my-contraception-tool
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Rachael’s results
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Link to survey 57
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Source: PROSPECT instrument
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Deciding how to decide
(and deciding how to aid deciding):
the Meta-decision
via MCDA/Annalisa
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Criteria for a good decision A personal selection of attributes, for illustrative purposes only (with set of hypothetical options)
• Time required (minimise) • Cheapness(maximise) • User-demands(minimise) • Transparency (maximise) • Separation of beliefs and preferences (maximise) • Comprehensiveness (maximise) • Recommendation produced (maximise) • Revision ease (maximise)
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Annalisa/Elicia Beyond ‘Tipping Point’
Level of complexity
Bene
fits o
f com
plex
ity
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Walking the talk à la Escher
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thanks for attending
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References
Berlin, I. (1953). The Hedgehog and the Fox: An Essay on Tolstoy’s View of History. London, Weidenfeld & Nicolson. Berwick, D. M. (2009). "What 'Patient-Centered' Should Mean: Confessions Of An Extremist." Health Affairs 28(4): w555-565. Davis, S. R., C. Kirby, et al. (2011). "Simplifying screening for osteoporosis in Australian primary care: the Prospective Screening for Osteoporosis; Australian Primary Care Evaluation of Clinical Tests (PROSPECT) study." Menopause 18(1): 53-59 10.1097/gme.1090b1013e3181e77468. Dolan, J. G. (2008). "Shared decision-making--transferring research into practice: the Analytic Hierarchy Process (AHP)." Patient Education and Counselling 73(3): 418-425. Dolan, J. G. (2010). "Multi-Criteria Clinical Decision Support: A Primer on the Use of Multiple-Criteria Decision-Making Methods to Promote Evidence-Based, Patient-Centered Healthcare." The Patient: Patient-Centered Outcomes Research 3(4): 229-248. Dowie, J. (2006). "JUDEMAKIA: a map of the world of judgment and decision-making in health." http://knol.google.com/k/judemakia-a-map-of-the-world-of-judgement-and-decision-making-in-health#. Dowie, J. (2007). "Decision Day with Annalisa: the Little Mermaid." http://knol.google.com/k/decision-day-with-annalisa-the-little-mermaid#. Dowie, J. (2008). "Decision Day with Annalisa: Hamlet, Prince of Denmark." http://knol.google.com/k/decision-day-with-annalisa-hamlet-prince-of-denmark#. Dowie, J. (2008). "Decision Resource-Decision Effectiveness Analysis." http://knol.google.com/k/decision-resource-effectiveness-analysis#. Dowie, J. (2009). "Decision Day with Annalisa: John Snow." http://knol.google.com/k/decision-day-with-annalisa-john-snow#. Dowie, J. (2009). "Decision Day with Annalisa: Sir Colenso Ridgeon." http://knol.google.com/k/decision-day-with-annalisa-sir-colenso-ridgeon#. Gould, S. J. (2003). The Hedgehog, the Fox, and the Magister's Pox: Mending the Gap Between Science and the Humanities. Hammond, K. R. (1996). Human Judgment and Social Policy: Irreducible Uncertainty, Inevitable Error, Unavoidable Injustice. New York, Oxford University Press. Keeney, R. L. and D. A. Vernik (2007). "Analysis of the Biological Clock Decision." Decision Analysis 4(3): 114-135. King, J. S. and B. W. Moulton (2006). "Rethinking Informed Consent: The Case for Shared Medical Decision-Making." American Journal of Law and Medicine 32(4): 429-501. Nelson, W. A. and K. Clay (2011). "Transitioning to "Perfected" Informed Consent." Healthcare Executive (July/August). Stacey, D., M. A. Murray, et al. (2008). "Decision Coaching to Support Shared Decision Making: A Framework, Evidence, and Implications for Nursing Practice, Education, and Policy." Worldviews on Evidence-Based Nursing 5(1): 25-35.
Software Full details and demo are available at http://elicia.org.uk