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Towards Improved Decision Quality in Person-Centred Healthcare: Exploring the Implications of Decision Support Via Multi-Criteria Decision Analysis Phd Thesis

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Towards Improved Decision Quality in Person-Centred Healthcare: Exploring the Implications of Decision Support Via Multi-Criteria Decision Analysis Phd Thesis Towards improved decision quality in person-centred healthcare: exploring the implications of decision support via Multi-Criteria Decision Analysis PhD Thesis Mette Kjer Kaltoft 2015 Department of Public Health & Research Unit for General Practice Faculty of Health Sciences PhD thesis by Mette Kjer Kaltoft MPH, Health Visitor, RN Title: Towards improved decision quality in person-centred healthcare: exploring the implications of decision support via Multi-Criteria Decision Analysis Public Defence September 11, 2015, Faculty of Health Sciences at the University of Southern Denmark Official opponents: Margaret Miers, PhD, Professor Emerita of Nursing and Social Science, University of The West of England, United Kingdom Ole J. Hartling, MD, Dr. Med., Adjunct Professor at Health Promotion, Department of Environmental, Social and Spatial Change, Roskilde University; Chief consultant, Vejle Hospital Jette Ammentorp, PhD, Professor, Head of Unit for Health Services Research, Institute for Regional Health Research, University of Southern Denmark (Chair) Supervision team: Project supervisor: o Jack Dowie, PhD, Professor Emeritus of Health Impact Analysis, London School of Hygiene and Tropical Medicine, UK Co-supervisors: o Christine Norton, PhD, Professor of Clinical Nursing Research, King's College London, UK o Glenn Salkeld, PhD, Professor of Health Economics and Head of School of Public Health, University of Sydney, Australia Main supervisor: o Jesper Bo Nielsen, PhD, Professor of Risk Communication, Head of Department of Public Health, Odense, University of Southern Denmark Funding bodies and disclosures: The Region of Southern Denmark The University of Southern Denmark The Health Foundation/Helsefonden OUH Odense University Hospital & Svendborg Hospital, Department of Medicine They had no influence on the design or conduct of the studies or on the publications from them. The project supervisor has a financial interest in the Annalisa© software, but has not benefitted from its use in any of the research reported in this thesis. The Elicia© and Annalisa© software was used by courtesy of the University of Sydney, School of Public Health, on whose server it is installed. Correspondence & cover illustrations: +45 2729 1123 Mette Kjer Kaltoft DK - 5230 Odense M [email protected] [email protected] [email protected] [email protected] Print: Print & Sign, SDU 1 Table of Contents Acknowledgements and prologue ................................................................................................... 5 List of included papers [I-V] ............................................................................................................. 7 List of abbreviations ........................................................................................................................ 8 List of figures ................................................................................................................................ 10 1.0 Aim and Outline of the thesis................................................................................................... 12 1.1 The Changing Context ....................................................................................................................... 13 1.2 Related papers [A-G] ......................................................................................................................... 15 2.0 Background ............................................................................................................................. 16 2.1 Mapping the world of Judgment and Decision Making: Judemakia ..................................................... 17 2.2 Multi-Criteria Decision Analysis (MCDA) ............................................................................................ 20 2.3 The translation question ................................................................................................................... 21 2.4 The involvement question ................................................................................................................. 22 2.5 Health decision literacy ..................................................................................................................... 26 2.5 Decision quality and concordance ..................................................................................................... 27 2.6 The feedback question ...................................................................................................................... 27 2.7 Case study: Inflammatory Bowel Disease (IBD) .................................................................................. 29 2.8 The resources: the bottom line .......................................................................................................... 31 3.0 Objectives and Methods ........................................................................................................ 32 3.1 Aims and Objectives ......................................................................................................................... 32 3.2 Methods ........................................................................................................................................... 33 4.0 Results, Findings, and Outputs ................................................................................................. 37 4.1 The framework and technique ................................................................................................. 37 4.1.1 Decision technologies and their location ......................................................................................... 37 4.1.2 Connecting informatics and ethics .................................................................................................. 39 4.1.3 An example: the disclosure dilemma .............................................................................................. 40 4.1.4 Implications for training and practice ............................................................................................. 41 4.2 Developing a decision aid template within the MCDA technique .............................................. 43 4.2.1 The target: a practical generic MCDA template ............................................................................... 44 4.2.2 The key principles .......................................................................................................................... 46 4.2.3 The visual picture provided by a completed Annalisa ...................................................................... 46 4.2.4 Evaluating decision aids ................................................................................................................. 48 2 4.3 Developing a measure of decision quality ................................................................................ 49 4.3.1 Assessing decision quality .............................................................................................................. 49 4.3.2 MyDecisionQuality (MDQ).............................................................................................................. 50 4.3.3 The criteria .................................................................................................................................... 51 4.3.4 Priorities for decision quality improvement .................................................................................... 53 4.3.5 MDQ as a generic decision aid ........................................................................................................ 54 4.3.6 Conclusion ..................................................................................................................................... 54 4.4 MDQ as a component of routine feedback to providers ........................................................... 55 4.4.1 Feedback in healthcare systems ..................................................................................................... 55 4.4.2 The piloting experience .................................................................................................................. 56 4.4.3 Results ........................................................................................................................................... 57 4.4.4 Outline of a protocol for the revised and resumed research ............................................................ 60 4.4.4.1 Objectives .......................................................................................................................................... 60 4.4.4.2 Methods ............................................................................................................................................ 60 4.4.4.3 Ethics.................................................................................................................................................. 61 4.4.4.4 Conclusion ......................................................................................................................................... 61 4.5 MCDA-based decision support for IBD patients ........................................................................ 62 4.5.1 London .......................................................................................................................................... 62 4.5.2 Sydney ........................................................................................................................................... 63
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