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Quantifying patient preferences for symptomatic breast clinic referral: a decision analysis study

OBJECTIVES: Decision analysis study that incorporates patient preferences and probability estimates to investigate the impact of women’s preferences for referral or an alternative strategy of watchful waiting if faced with symptoms that could be due to breast cancer. SETTING: Community-based study....

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Autores principales: Quinlan, Aisling, O’Brien, Kirsty K, Galvin, Rose, Hardy, Colin, McDonnell, Ronan, Joyce, Doireann, McDowell, Ronald D, Aherne, Emma, Keogh, Claire, O’Sullivan, Katriona, Fahey, Tom
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5988058/
https://www.ncbi.nlm.nih.gov/pubmed/29858402
http://dx.doi.org/10.1136/bmjopen-2017-017286
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author Quinlan, Aisling
O’Brien, Kirsty K
Galvin, Rose
Hardy, Colin
McDonnell, Ronan
Joyce, Doireann
McDowell, Ronald D
Aherne, Emma
Keogh, Claire
O’Sullivan, Katriona
Fahey, Tom
author_facet Quinlan, Aisling
O’Brien, Kirsty K
Galvin, Rose
Hardy, Colin
McDonnell, Ronan
Joyce, Doireann
McDowell, Ronald D
Aherne, Emma
Keogh, Claire
O’Sullivan, Katriona
Fahey, Tom
author_sort Quinlan, Aisling
collection PubMed
description OBJECTIVES: Decision analysis study that incorporates patient preferences and probability estimates to investigate the impact of women’s preferences for referral or an alternative strategy of watchful waiting if faced with symptoms that could be due to breast cancer. SETTING: Community-based study. PARTICIPANTS: Asymptomatic women aged 30–60 years. INTERVENTIONS: Participants were presented with 11 health scenarios that represent the possible consequences of symptomatic breast problems. Participants were asked the risk of death that they were willing to take in order to avoid the health scenario using the standard gamble utility method. This process was repeated for all 11 health scenarios. Formal decision analysis for the preferred individual decision was then estimated for each participant. PRIMARY OUTCOME MEASURE: The preferred diagnostic strategy was either watchful waiting or referral to a breast clinic. Sensitivity analysis was used to examine how each varied according to changes in the probabilities of the health scenarios. RESULTS: A total of 35 participants completed the interviews, with a median age 41 years (IQR 35–47 years). The majority of the study sample was employed (n=32, 91.4%), with a third-level (university) education (n=32, 91.4%) and with knowledge of someone with breast cancer (n=30, 85.7%). When individual preferences were accounted for, 25 (71.4%) patients preferred watchful waiting to referral for triple assessment as their preferred initial diagnostic strategy. Sensitivity analysis shows that referral for triple assessment becomes the dominant strategy at the upper probability estimate (18%) of breast cancer in the community. CONCLUSIONS: Watchful waiting is an acceptable strategy for most women who present to their general practitioner (GP) with breast symptoms. These findings suggest that current referral guidelines should take more explicit account of women’s preferences in relation to their GPs initial management strategy.
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spelling pubmed-59880582018-06-07 Quantifying patient preferences for symptomatic breast clinic referral: a decision analysis study Quinlan, Aisling O’Brien, Kirsty K Galvin, Rose Hardy, Colin McDonnell, Ronan Joyce, Doireann McDowell, Ronald D Aherne, Emma Keogh, Claire O’Sullivan, Katriona Fahey, Tom BMJ Open Evidence Based Practice OBJECTIVES: Decision analysis study that incorporates patient preferences and probability estimates to investigate the impact of women’s preferences for referral or an alternative strategy of watchful waiting if faced with symptoms that could be due to breast cancer. SETTING: Community-based study. PARTICIPANTS: Asymptomatic women aged 30–60 years. INTERVENTIONS: Participants were presented with 11 health scenarios that represent the possible consequences of symptomatic breast problems. Participants were asked the risk of death that they were willing to take in order to avoid the health scenario using the standard gamble utility method. This process was repeated for all 11 health scenarios. Formal decision analysis for the preferred individual decision was then estimated for each participant. PRIMARY OUTCOME MEASURE: The preferred diagnostic strategy was either watchful waiting or referral to a breast clinic. Sensitivity analysis was used to examine how each varied according to changes in the probabilities of the health scenarios. RESULTS: A total of 35 participants completed the interviews, with a median age 41 years (IQR 35–47 years). The majority of the study sample was employed (n=32, 91.4%), with a third-level (university) education (n=32, 91.4%) and with knowledge of someone with breast cancer (n=30, 85.7%). When individual preferences were accounted for, 25 (71.4%) patients preferred watchful waiting to referral for triple assessment as their preferred initial diagnostic strategy. Sensitivity analysis shows that referral for triple assessment becomes the dominant strategy at the upper probability estimate (18%) of breast cancer in the community. CONCLUSIONS: Watchful waiting is an acceptable strategy for most women who present to their general practitioner (GP) with breast symptoms. These findings suggest that current referral guidelines should take more explicit account of women’s preferences in relation to their GPs initial management strategy. BMJ Publishing Group 2018-05-31 /pmc/articles/PMC5988058/ /pubmed/29858402 http://dx.doi.org/10.1136/bmjopen-2017-017286 Text en © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted. This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/
spellingShingle Evidence Based Practice
Quinlan, Aisling
O’Brien, Kirsty K
Galvin, Rose
Hardy, Colin
McDonnell, Ronan
Joyce, Doireann
McDowell, Ronald D
Aherne, Emma
Keogh, Claire
O’Sullivan, Katriona
Fahey, Tom
Quantifying patient preferences for symptomatic breast clinic referral: a decision analysis study
title Quantifying patient preferences for symptomatic breast clinic referral: a decision analysis study
title_full Quantifying patient preferences for symptomatic breast clinic referral: a decision analysis study
title_fullStr Quantifying patient preferences for symptomatic breast clinic referral: a decision analysis study
title_full_unstemmed Quantifying patient preferences for symptomatic breast clinic referral: a decision analysis study
title_short Quantifying patient preferences for symptomatic breast clinic referral: a decision analysis study
title_sort quantifying patient preferences for symptomatic breast clinic referral: a decision analysis study
topic Evidence Based Practice
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5988058/
https://www.ncbi.nlm.nih.gov/pubmed/29858402
http://dx.doi.org/10.1136/bmjopen-2017-017286
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