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Multi-criteria Decision Analysis in Oncology: A Decision Support Framework
Başlık:
Multi-criteria Decision Analysis in Oncology: A Decision Support Framework
Yazar:
Adunlin, Georges, author.
ISBN:
9780438019461
Yazar Ek Girişi:
Fiziksel Tanımlama:
1 electronic resource (205 pages)
Genel Not:
Source: Dissertation Abstracts International, Volume: 79-10(E), Section: B.
Advisors: Vakaramoko Diaby; Hong Xiao Committee members: Ellen Campbell; George Dranitsaris; Alberto J. Montero.
Özet:
Decision-making processes that consider multiple factors, multiple stakeholders, and several criteria to aid health professionals make informed treatment decisions within a multidisciplinary context are needed. Therefore, the objective of this dissertation is to develop and test a multi-criteria decision analysis (MCDA) framework to aid health care professionals in the choice of optimal medical treatments, with special emphasis on oncology.
In chapter one, an introductory background of the research problem, the research objectives and contributions of the study are presented. The second chapter of the dissertation provides a systematic review of the literature on the application MCDA within the context of health care. This review showed that MCDA has been successfully applied to a broad range of health care decisions, with the application of a variety of methodological approaches. The third chapter offers the rational for MCDA to support clinical decision in oncology. The selection of an optimal oncology treatment among various alternatives plays a central role in improving patient health outcomes. Some decisions in oncology are straightforward, with clear evidence to support one approach while others are more complex, subjective, uncertain and multifaceted. Thus, there is a great need for a formalized decision-making approach to aid in the selection of the best treatment alternative in oncology. Chapter four identifies relevant decision criteria and the most suitable MCDA method for treatment selection in oncology. The relevance of the various criteria in decision-making for cancer treatments differs by the disease stage, current guidelines, patient history, the patient's quality of life and current progress versus prognosis. These criteria were grouped into three distinct categories: efficacy/effectiveness, safety, and economics. After conducting a comparative study of MCDA methods, an outranking method, the ELimination and Choice Translating REality 1S (ELECTRE 1S) model was identified as the best method to aid the selection of optimal oncology treatment. Chapter five includes a case study of the phase III CALGB/SWOG 80405 trial, which compared frontline therapy with bevacizumab or cetuximab combined with FOLFOX or FOLFIRI in patients with KRAS wild-type untreated metastatic colorectal cancer (mCRC) to illustrate the application of the proposed MCDA approach, namely the ELECTRE 1S. A 10-step process guided the application of the ELECTRE 1S model. Four treatment combinations were compared over three criteria (overall survival, cost, and quality-adjusted life-year). The model parameters included weights, decision thresholds and the optimization direction (maximize or minimize). To test the stability of the results, deterministic sensitivity analysis was conducted by varying the concordance levels, criteria weights, discrimination and veto thresholds. Based on the results of the case study, FOLFOX with cetuximab was recommended as the optimal combination of chemotherapy and biologic agents for the first-line treatment of patients with KRAS wild-type untreated mCRC . The proposed ELECTRE 1S method appeared to be well suited to the selection problematic because of its methodical computational procedures, ability to take into account stakeholder preference, ability to integrate quantitative and qualitative criteria, and the confirmation of results by means of robustness and sensitivity analysis. Nonetheless, further methodological applications are desirable before MCDA becomes an established decision-making tool in oncology.
A suggestion for future research is to define how MCDA compares to other decision-making support tools, generate a resource to select the most appropriate method depending on the research question, and assess its external validity. There is also a need for initiating and developing guidelines on good practice for MCDA and on the use of this method to support health care decision-making processes.
Notlar:
School code: 0872
Mevcut:*
Yer Numarası | Demirbaş Numarası | Shelf Location | Lokasyon / Statüsü / İade Tarihi |
---|---|---|---|
XX(677834.1) | 677834-1001 | Proquest E-Tez Koleksiyonu | Arıyor... |
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