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Can reflective multicriteria be the new paradigm for healthcare decision-making? The EVIDEM journey

BACKGROUND: Multiple technologies, procedures and programs call for fairly-based decisions for prioritization of healthcare interventions. There is a diversity of perspectives of what constitutes a legitimate decision, which depends on both the process and the reasoning applied. Current approaches f...

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Autores principales: Goetghebeur, Mireille M., Cellier, Marjo S.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6225552/
https://www.ncbi.nlm.nih.gov/pubmed/30455613
http://dx.doi.org/10.1186/s12962-018-0116-9
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author Goetghebeur, Mireille M.
Cellier, Marjo S.
author_facet Goetghebeur, Mireille M.
Cellier, Marjo S.
author_sort Goetghebeur, Mireille M.
collection PubMed
description BACKGROUND: Multiple technologies, procedures and programs call for fairly-based decisions for prioritization of healthcare interventions. There is a diversity of perspectives of what constitutes a legitimate decision, which depends on both the process and the reasoning applied. Current approaches focus on technical aspects while methods to support alignment of decisions with the compassionate impetus of healthcare systems is lacking. METHODS: The framework was developed based on an analysis of the foundations of healthcare systems, the reasoning underlying decisions and fair processes. The concept of reflective multicriteria was created: it assumes that decisionmakers guided by a generic interpretative frame rooted in the compassionate impetus of healthcare systems, can sharpen their reasoning, raise awareness of their motivation and increase legitimacy of decisions. The initial framework was made available through a not for profit organization (the EVIDEM Collaboration, 2006–2017) to stimulate its development with thought leaders and stakeholders in an open source philosophy. Development was tailored to the real-life needs of decisionmakers and drew on several domains of knowledge including healthcare ethics, evidenced-based medicine, health economics, health technology assessment and multicriteria approaches. RESULTS: The 10th edition framework builds on four dimensions: (1) the universal impetus of healthcare systems, (2) reasoning, values and ethics, (3) evidence and knowledge on interventions, and (4) a transformative process. Mathematical aspects of the framework are designed to help clarify, express and share individual reasoning; this non-conventional use of numbers requires a cultural change and needs to be phased in slowly. The framework includes four tools for easy adaptation and operationalization: (a) concepts and operationalization, (b) adapt and pilot, (c) evidence matrix, (d) mathematical representation of reasoning. Application is useful throughout all types of healthcare interventions, for all levels of decision, and across the globe. CONCLUSION: By clarifying their reasoning while keeping decisionmakers aware of the impetus of healthcare systems, reflective multicriteria provides an effective approach to increase the legitimacy of decisions. Beyond a tool, reflective multicriteria pioneered by EVIDEM is geared to transform our vision of the value of healthcare interventions and how they might contribute to relevant, equitable and sustainable healthcare systems. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12962-018-0116-9) contains supplementary material, which is available to authorized users.
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spelling pubmed-62255522018-11-19 Can reflective multicriteria be the new paradigm for healthcare decision-making? The EVIDEM journey Goetghebeur, Mireille M. Cellier, Marjo S. Cost Eff Resour Alloc Review BACKGROUND: Multiple technologies, procedures and programs call for fairly-based decisions for prioritization of healthcare interventions. There is a diversity of perspectives of what constitutes a legitimate decision, which depends on both the process and the reasoning applied. Current approaches focus on technical aspects while methods to support alignment of decisions with the compassionate impetus of healthcare systems is lacking. METHODS: The framework was developed based on an analysis of the foundations of healthcare systems, the reasoning underlying decisions and fair processes. The concept of reflective multicriteria was created: it assumes that decisionmakers guided by a generic interpretative frame rooted in the compassionate impetus of healthcare systems, can sharpen their reasoning, raise awareness of their motivation and increase legitimacy of decisions. The initial framework was made available through a not for profit organization (the EVIDEM Collaboration, 2006–2017) to stimulate its development with thought leaders and stakeholders in an open source philosophy. Development was tailored to the real-life needs of decisionmakers and drew on several domains of knowledge including healthcare ethics, evidenced-based medicine, health economics, health technology assessment and multicriteria approaches. RESULTS: The 10th edition framework builds on four dimensions: (1) the universal impetus of healthcare systems, (2) reasoning, values and ethics, (3) evidence and knowledge on interventions, and (4) a transformative process. Mathematical aspects of the framework are designed to help clarify, express and share individual reasoning; this non-conventional use of numbers requires a cultural change and needs to be phased in slowly. The framework includes four tools for easy adaptation and operationalization: (a) concepts and operationalization, (b) adapt and pilot, (c) evidence matrix, (d) mathematical representation of reasoning. Application is useful throughout all types of healthcare interventions, for all levels of decision, and across the globe. CONCLUSION: By clarifying their reasoning while keeping decisionmakers aware of the impetus of healthcare systems, reflective multicriteria provides an effective approach to increase the legitimacy of decisions. Beyond a tool, reflective multicriteria pioneered by EVIDEM is geared to transform our vision of the value of healthcare interventions and how they might contribute to relevant, equitable and sustainable healthcare systems. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12962-018-0116-9) contains supplementary material, which is available to authorized users. BioMed Central 2018-11-09 /pmc/articles/PMC6225552/ /pubmed/30455613 http://dx.doi.org/10.1186/s12962-018-0116-9 Text en © The Author(s) 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Review
Goetghebeur, Mireille M.
Cellier, Marjo S.
Can reflective multicriteria be the new paradigm for healthcare decision-making? The EVIDEM journey
title Can reflective multicriteria be the new paradigm for healthcare decision-making? The EVIDEM journey
title_full Can reflective multicriteria be the new paradigm for healthcare decision-making? The EVIDEM journey
title_fullStr Can reflective multicriteria be the new paradigm for healthcare decision-making? The EVIDEM journey
title_full_unstemmed Can reflective multicriteria be the new paradigm for healthcare decision-making? The EVIDEM journey
title_short Can reflective multicriteria be the new paradigm for healthcare decision-making? The EVIDEM journey
title_sort can reflective multicriteria be the new paradigm for healthcare decision-making? the evidem journey
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6225552/
https://www.ncbi.nlm.nih.gov/pubmed/30455613
http://dx.doi.org/10.1186/s12962-018-0116-9
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