Abstract:In 2006, the European Parliament designated hepatocellular carcinoma (HCC) a serious public health problem, recognizing it as both a complex and deadly cancer. The authors conducted the first comparative needs assessment for HCC across five European countries. One hundred HCC experts assessed ten dimensions of HCC control. Common needs exist for lifestyle risk factor management (p 5 0.001), political awareness (p 5 0.001) and public awareness (p 5 0.001). Discordances were found on funding for treatment (p ¼ 0… Show more
“…Surveys using this approach ask respondents to choose the best and worst item from a series of sets containing different combinations of items from a master list (see example in Figure 1 ). BWS has been recently successfully applied to understand how experts view emerging technologies for hepatocellular carcinoma [ 11 ], elicit patients’ preferences for colorectal cancer screening [ 12 ], examine barriers to integrating personalized medicine into clinical practice [ 13 ], and to develop preference-based quality of life scales [ 14 ]. Figure 1 Example of a Best-Worst Question.…”
BackgroundReasons underlying the variability of physicians’ preferences for non-selective beta-blockers (BBs) and endoscopic variceal ligation (EVL) to prevent a first variceal bleed have not been empirically studied. Our aims were to examine whether 1) gastroenterologists can be classified into distinct subgroups based on how they prioritize specific treatment attributes and 2) physician characteristics are associated with treatment preference.MethodsWe surveyed physicians to determine their preferred treatment for a standardized patient with large varices and examined the influence of treatment characteristics on physicians’ decision making using best-worst scaling. Latent class analysis was used to examine whether physicians could be classified into groups with similar decision-making styles.Results110 physicians were interviewed (participation rate 39%). The majority spent two or more days a week performing endoscopies and had practices comprising less than 25% of patients with liver disease. Latent class analysis demonstrated that physicians could be classified into at least two distinct groups. Most (n = 80, Group 1) were influenced solely by the ability to visually confirm eradication of varices. In contrast, members of Group 2 (n = 30) were influenced by the side effects and mechanism of action of BBs. Group 1 members were more likely to have practices that included fewer patients with liver disease and more likely to choose options including EVL (p = 0.01 for both).ConclusionsAmong physicians, where the majority performs endoscopy on two or more days per week, most prefer prevention strategies which include EVL. This may be due to the strong appeal of being able to visualize eradication of varices.
“…Surveys using this approach ask respondents to choose the best and worst item from a series of sets containing different combinations of items from a master list (see example in Figure 1 ). BWS has been recently successfully applied to understand how experts view emerging technologies for hepatocellular carcinoma [ 11 ], elicit patients’ preferences for colorectal cancer screening [ 12 ], examine barriers to integrating personalized medicine into clinical practice [ 13 ], and to develop preference-based quality of life scales [ 14 ]. Figure 1 Example of a Best-Worst Question.…”
BackgroundReasons underlying the variability of physicians’ preferences for non-selective beta-blockers (BBs) and endoscopic variceal ligation (EVL) to prevent a first variceal bleed have not been empirically studied. Our aims were to examine whether 1) gastroenterologists can be classified into distinct subgroups based on how they prioritize specific treatment attributes and 2) physician characteristics are associated with treatment preference.MethodsWe surveyed physicians to determine their preferred treatment for a standardized patient with large varices and examined the influence of treatment characteristics on physicians’ decision making using best-worst scaling. Latent class analysis was used to examine whether physicians could be classified into groups with similar decision-making styles.Results110 physicians were interviewed (participation rate 39%). The majority spent two or more days a week performing endoscopies and had practices comprising less than 25% of patients with liver disease. Latent class analysis demonstrated that physicians could be classified into at least two distinct groups. Most (n = 80, Group 1) were influenced solely by the ability to visually confirm eradication of varices. In contrast, members of Group 2 (n = 30) were influenced by the side effects and mechanism of action of BBs. Group 1 members were more likely to have practices that included fewer patients with liver disease and more likely to choose options including EVL (p = 0.01 for both).ConclusionsAmong physicians, where the majority performs endoscopy on two or more days per week, most prefer prevention strategies which include EVL. This may be due to the strong appeal of being able to visualize eradication of varices.
“…Similar targeted comprehensive cancer control plans have been advocated and programs implemented for breast, cervical, and colorectal cancer cancer [14-16]. To successfully implement CLCC, plans should reflect current needs [17,18] and incorporate the views of a wide array of stakeholders [13]. …”
Section: Introductionmentioning
confidence: 99%
“…The self-explicated methods, which combine ratings and rankings in a multiplicative way in an attempt to minimize the biases of rating and ranking alone, is one method that has potential for priority setting, especially in the presence of a large number of factors [17,18,44]. …”
BackgroundLiver cancer is a complex and burdensome disease, with Asia accounting for 75% of known cases. Comprehensive cancer control requires the use of multiple strategies, but various stakeholders may have different views as to which strategies should have the highest priority. This study identified priorities across multiple strategies for comprehensive liver cancer control (CLCC) from the perspective of liver cancer clinical, policy, and advocacy stakeholders in China, Japan, South Korea and Taiwan. Concordance of priorities was assessed across the region and across respondent roles.MethodsPriorities for CLCC were examined as part of a cross-sectional survey of liver cancer experts. Respondents completed several conjoint-analysis choice tasks to prioritize 11 strategies. In each task, respondents judged which of two competing CLCC plans, consisting of mutually exclusive and exhaustive subsets of the strategies, would have the greatest impact. The dependent variable was the chosen plan, which was then regressed on the strategies of different plans. The restricted least squares (RLS) method was utilized to compare aggregate and stratified models, and t-tests and Wald tests were used to test for significance and concordance, respectively.ResultsEighty respondents (69.6%) were eligible and completed the survey. Their primary interests were hepatitis (26%), hepatocellular carcinoma (HCC) (58%), metastatic liver cancer (10%) and transplantation (6%). The most preferred strategies were monitoring at-risk populations (p<0.001), clinician education (p<0.001), and national guidelines (p<0.001). Most priorities were concordant across sites except for three strategies: transplantation infrastructure (p=0.009) was valued lower in China, measuring social burden (p=0.037) was valued higher in Taiwan, and national guidelines (p=0.025) was valued higher in China. Priorities did not differ across stakeholder groups (p=0.438).ConclusionsPriorities for CLCC in Asia include monitoring at-risk populations, clinician education, national guidelines, multidisciplinary management, public awareness and centers of excellence. As most priorities are relatively concordant across the region, multilateral approaches to addressing comprehensive liver cancer would be beneficial. However, where priorities are discordant among sites, such as transplantation infrastructure, strategies should be tailored to local needs.
“…Moreover, scalerelated response bias is not a concern with BWS [13]. This approach has recently been successfully applied to understand how experts view emerging technologies for hepatocellular carcinoma [15], elicit parents' priorities related to initiating medications for the treatment of attentiondeficit hyperactivity disorder in their children [16], elicit patients' priorities for colorectal cancer screening [17], examine barriers to integrating personalized medicine into clinical practice [18], and to develop preference-based quality-of-life scales [19].…”
Patients' priorities vary significantly. Preference studies should consider including methods to determine whether distinct clusters of priorities and/or concerns exist in order to accurately inform end users' decision making.
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