Hélène E Aschmann1, Cynthia M Boyd2, Craig W Robbins3, Wiley V Chan4, Richard A Mularski5, Wendy L Bennett6, Orla C Sheehan2, Renée F Wilson7, Elizabeth A Bayliss8, Bruce Leff2, Karen Armacost2, Carol Glover2, Katie Maslow9, Suzanne Mintz10, Milo A Puhan11. 1. Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland. 2. Division of Geriatric Medicine and Gerontology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA. 3. Center for Clinical Information Services, Kaiser Permanente Care Management Institute, Oakland, CA, USA; Kaiser Permanente National Guideline Program, Oakland, CA, USA; Colorado Permanente Medical Group, Denver, CO, USA; Guidelines International Network, Board of Trustees, Denver, CO, USA; Permanente Federation, Clinical Education MOC Portfolio, Oakland, CA, USA. 4. Kaiser Permanente Northwest National Guideline Program, Portland, OR, USA. 5. The Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA; Department of Pulmonary & Critical Care Medicine, Northwest Permanente, Portland, OR, USA; Oregon Health & Science University, Portland, OR, USA. 6. Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA. 7. Department of Health Policy and Management, The Johns Hopkins University School of Public Health, Baltimore, MD, USA. 8. Institute for Research Health, Kaiser Permanente, Denver, CO, USA; University of Colorado School of Medicine, Aurora, CO, USA. 9. Division of Geriatric Medicine and Gerontology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; Gerontological Society of America, Washington, DC, USA. 10. Division of Geriatric Medicine and Gerontology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; Family Caregiver Advocacy, Kensington, MD, USA. 11. Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland. Electronic address: miloalan.puhan@uzh.ch.
Abstract
OBJECTIVES: In a previous project aimed at informing patient-centered care for people with multiple chronic conditions, we performed highly stratified quantitative benefit-harm assessments for 2 top priority questions. In this current work, our goal was to describe the process and approaches we developed and to qualitatively glean important elements from it that address patient-centered care. METHODS: We engaged patients, caregivers, clinicians, and guideline developers as stakeholder representatives throughout the process of the quantitative benefit-harm assessment and investigated whether the benefit-harm balance differed based on patient preferences and characteristics (stratification). We refined strategies to select the most applicable, valid, and precise evidence. RESULTS: Two processes were important when assessing the balance of benefits and harms of interventions: (1) engaging stakeholders and (2) stratification by patient preferences and characteristics. Engaging patients and caregivers through focus groups, preference surveys, and as co-investigators provided value in prioritizing research questions, identifying relevant clinical outcomes, and clarifying the relative importance of these outcomes. Our strategies to select evidence for stratified benefit-harm assessments considered consistency across outcomes and subgroups. By quantitatively estimating the range in the benefit-harm balance resulting from true variation in preferences, we clarified whether the benefit-harm balance is preference sensitive. CONCLUSIONS: Our approaches for engaging patients and caregivers at all phases of the stratified quantitative benefit-harm assessments were feasible and revealed how sensitive the benefit-harm balance is to patient characteristics and individual preferences. Accordingly, this sensitivity can suggest to guideline developers when to tailor recommendations for specific patient subgroups or when to explicitly leave decision making to individual patients and their providers.
OBJECTIVES: In a previous project aimed at informing patient-centered care for people with multiple chronic conditions, we performed highly stratified quantitative benefit-harm assessments for 2 top priority questions. In this current work, our goal was to describe the process and approaches we developed and to qualitatively glean important elements from it that address patient-centered care. METHODS: We engaged patients, caregivers, clinicians, and guideline developers as stakeholder representatives throughout the process of the quantitative benefit-harm assessment and investigated whether the benefit-harm balance differed based on patient preferences and characteristics (stratification). We refined strategies to select the most applicable, valid, and precise evidence. RESULTS: Two processes were important when assessing the balance of benefits and harms of interventions: (1) engaging stakeholders and (2) stratification by patient preferences and characteristics. Engaging patients and caregivers through focus groups, preference surveys, and as co-investigators provided value in prioritizing research questions, identifying relevant clinical outcomes, and clarifying the relative importance of these outcomes. Our strategies to select evidence for stratified benefit-harm assessments considered consistency across outcomes and subgroups. By quantitatively estimating the range in the benefit-harm balance resulting from true variation in preferences, we clarified whether the benefit-harm balance is preference sensitive. CONCLUSIONS: Our approaches for engaging patients and caregivers at all phases of the stratified quantitative benefit-harm assessments were feasible and revealed how sensitive the benefit-harm balance is to patient characteristics and individual preferences. Accordingly, this sensitivity can suggest to guideline developers when to tailor recommendations for specific patient subgroups or when to explicitly leave decision making to individual patients and their providers.
Authors: Henock G Yebyo; Sofia Zappacosta; Hélène E Aschmann; Sarah R Haile; Milo A Puhan Journal: BMC Cardiovasc Disord Date: 2020-09-17 Impact factor: 2.298
Authors: Kyriakos Souliotis; Theodoros V Giannouchos; Chistina Golna; Evangelos Liberopoulos Journal: Qual Life Res Date: 2021-06-22 Impact factor: 3.440