Pell, I., Dowie, J., Clarke, Aileen, 1955-, Kennedy, A. (Andrew D. M.) and Bhavnani, V.. (2002) Development and preliminary evaluation of a clinical guidance programme for the decision about prophylactic oophorectomy in women undergoing a hysterectomy. BMJ Quality and Safety, Vol.11 (No.1). pp. 32-38. ISSN 2044-5423

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Abstract

Objectives: To develop a decision analysis based and computerised clinical guidance programme (CGP) that provides patient specific guidance on the decision whether or not to undergo a prophylactic oophorectomy to reduce the risk of subsequent ovarian cancer and to undertake a preliminary pilot and evaluation. Subjects: Women who had already agreed to have a hysterectomy who otherwise had no ovarian pathology. Setting: Oophorectomy decision consultation at the outpatient or pre-admission clinic. Methods: A CGP was developed with advice from gynaecologists and patient groups, incorporating a set of Markov models within a decision analytical framework to evaluate the benefits of undergoing a prophylactic oophorectomy or not on the basis of quality adjusted life expectancy, life expectancy, and for varying durations of hormone replacement therapy. Sensitivity analysis and preliminary testing of the CGP were undertaken to compare its overall performance with established guidelines and practice. A small convenience sample of women invited to use the CGP were interviewed, the interviews were taped and transcribed, and a thematic analysis was undertaken. Results: The run time of the programme was 20 minutes, depending on the use of opt outs to default values. The CGP functioned well in preliminary testing. Women were able to use the programme and expressed overall satisfaction with it. Some had reservations about the computerised format and some were surprised at the specificity of the guidance given. Conclusions: A CGP can be developed for a complex healthcare decision. It can give evidence-based health guidance which can be adjusted to account for individual risk factors and reflects a patient’s own values and preferences concerning health outcomes. Future decision aids and support systems need to be developed and evaluated in a way which takes account of the variation in patients’ preferences for inclusion in the decision making process.

Item Type:	Journal Article
Subjects:	R Medicine > R Medicine (General) R Medicine > RD Surgery
Divisions:	Faculty of Medicine > Warwick Medical School > Warwick Evidence Faculty of Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH):	Hysterectomy, Ovariectomy, Clinical medicine -- Decision making -- Computer programs, Expert systems (Computer science)
Journal or Publication Title:	BMJ Quality and Safety
Publisher:	BMJ Group
ISSN:	2044-5423
Date:	2002
Volume:	Vol.11
Number:	No.1
Page Range:	pp. 32-38
Identification Number:	10.1136/qhc.11.1.32
Status:	Peer Reviewed
Access rights to Published version:	Open Access
Funder:	NHS Executive. Research and Development Directorate
References:	1 Emanuel EJ, Emanuel LL. Four models of the physician-patient relationship. JAMA 1992;267:2221–6. 2 Anonymous. What do we mean by appropriate health care? Report of a Working Group prepared for the Director of Research and Development of the NHS Management Executive. Qual Health Care 1993;2:117–23. 3 Fischer D, Stewart AL, Bloch DA, et al. Capturing the patient’s view of change as a clinical outcome measure. JAMA 1999;282:1157–62. 4 Greenhalgh J, Meadows K. The effectivenes of the use of patient-based measures of health in routine practice in improving the process and outcomes of patient care: a literature review. J Eval Clin Pract 1999;5:401–16. 5 Nease R, Kneeland T, O’Connor G, et al. Variation in patient utilities for outcomes of the management of chronic stable angina. JAMA 1995;273:1185–90. 6 Montgomery AA, Fahey T. How do patients’ treatment preferences compare with those of clinicians? Qual Health Care 2001;10(suppl I):i39–43. 7 Department of Health. The NHS plan. London: Stationery Office, 2000. 8 Department of Health. The expert patient: a new approach to chronic disease management for the 21st century. London: Department of Health, 2001. 9 Department of Health. Involving patients and the public in healthcare: a discussion document. London: Department of Health, 2001. 10 Department of Health. Patient and public involvement in the new NHS. London: Department of Health, 1999. 11 Caplan A. Clinton’s health care reforms: an unstoppable momentum for change. BMJ 1993;307:813–4. 12 Doyal L. Informed consent: moral necessity or illusion? Qual Health Care 2001;10(suppl I):i29–33. 13 Elwyn G, Edwards A. Evidence based patient choice. Oxford: Oxford University Press, 2001. 14 Gross PA, Greenfield S, Cretin S, et al. Optimal methods for guideline implementation: conclusions from Leeds Castle meeting. Med Care 2001;8:II85–92. 15 Elwyn G, Edwards A, Kinnersley P. Shared decision-making in primary care: the neglected second half of the consultation. Br J Gen Pract 1999;49:477–82. 16 Elwyn G, Edwards A, Gwyn R, et al. Towards a feasible model for shared decision making: focus group study with general practice registrars. BMJ 1999;319:753–6. 17 Pell I, Dowie J, Clarke A, et al. Development and preliminary evaluation of a clinical guidance programme for the decision about prophylactic oophorectomy in women undergoing a hysterectomy. Qual Saf Health Care 2002;11:32–9. 18 Thomson R, Robinson A, Greenaway J, et al. Development and description of a decision analysis based decision support tool for stroke prevention in atrial fibrillation. Qual Saf Health Care 2002;11:25–31. 19 O’Connor AM, Rostom A, Fiset V, et al. Decision aids for patients facing health treatment or screening decisions: systematic review. BMJ 1999;319:731–4.
URI:	http://wrap.warwick.ac.uk/id/eprint/4354

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