A patient decision aid for    bipolar disorder                                Full title:                         MCDA-Bas...
My affiliation  The community developing MCDA-  based, Annalisapatient decision aids
My affiliation
The Norwegian      Electronic Health           Library10/2/201                  4
• Free access                                            • for clinicians and                                             ...
My affiliation
The University of Oslo     (enhanced)
Menu
MenuContextThree problems (and solutions)Summary
Patient decision aids• Tools for personalised decisions• Many personalisation technologies• Very limited use of technologi...
Bipolar disorder• Singapore: 1,2 %• Cross-national 0.3 – 1.5% Chong SA, Abdin E, Vaingankar JA, Heng D, Sherbourne C, Yap ...
Bipolar disorder I• Chronic• Suicide risk• Relapses• ”Never well”• Impairment• Medication mainstay in treatment
Outpatient psychiatry in   Hamar, Norway
A challenging encounter
Why can´t I stop my medication?      It really bothers me.I would be much better without!               With permission. i...
You must continue taking it!If not, you will certainly have a         relapse again.You don´t remember how bad it         ...
(Not shared decision-       making)
New attempt!(shared decision-making)
Why can´t I stop my medication?      It really bothers me.I would be much better without!
Ok, lets try to find the best decision together What are the benefits and harms you care                      about? And h...
Three patient roles                                             Consumer                    Shared                decision...
The goal• Find - together• the best decision• for you
And to achieve the goal…• Find the: • options • attributes • probabilities • preferences
In example, hypothetical:Options    Suicide   Relapse   Nausea           risk      risk      riskMedicine A 2 %       25 %...
Four sources of knowledgeAll the research in the world Electronic medical record
Problem 1
Knowledge not tailored to          decisions• All options not directly comparable• Not personalised                       ...
A possible solution:Network meta-analysis
Top of the 6S model                       In                      EMRReadable           SummaryRelevantReliable         Ne...
A network of studies     Vergel YB, Dunn G, Palmer S, Beynon s, Woolacott N, Soares-Weiser K, Geddes J, Gilbody S.     A S...
Direct and indirect   comparisons    Vergel YB, Dunn G, Palmer S, Beynon s, Woolacott N, Soares-Weiser K, Geddes J, Gilbod...
Part 1 of the work• Complete two network meta-analyses
Problem 2
Knowledge not           operational• Information about the effects of medicines  taken is • not systematic                ...
A possible solution:An Annalisa decision aid
Enabling continuous    registration of attributes• Example: depressive symptoms • Patient registers level of depression we...
Will visualise changes over time
Part 2 of the work• Developing the Annalisa decision aid
Problem 3
How to evaluate apersonalised intervention?
The problem with group            designs• Take considerable time and resources• No improvement of intervention on-the-fly...
A possible solution:single-subject design
Single subject designs• Extensive use within behavioural sciences• Internal validity maintained• Mimics and feasible withi...
Benefits• Assesses effect in the individual patient• Identifies causal relationships• External validity comparable to grou...
ABAB design
Non-concurrent, multiple   baseline design
Combined
3 novelties in this work
Novelty 1:Complete NMAs and feed the values into the desicion aid
Novelty 2:• Continuous registration of attributes important  to the patient• in a decision aid    engineered for     distr...
Novelty 3:• Utilising a single subject research design…• to evaluate a patient decision aid
Flexible yet rigorousA personalisable: • decision aid • assessment tool • study design
Thank you
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An MCDA-based patient decision aid for patients with bipolar disorder

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How can patients be enabled to participate in decisions concerning their health? How can decisions be improved, concordent with patient values? A new patient decision aid will capitalise on network meta-analysis and single subject research designs to foster better decisions.

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An MCDA-based patient decision aid for patients with bipolar disorder

  1. 1. A patient decision aid for bipolar disorder Full title: MCDA-Based Support in Clinical Decision- Making Throughout the Patient Journey: The Use of ALBA in Bipolar Disorder Øystein Eiring, MD, specialist in psychiatry, cand. mag, PhDc. Editor Norwegian Electronic Library of Health/Mental Health Head of Department of Knowledge Services, Innlandet Hospital Trust
  2. 2. My affiliation The community developing MCDA- based, Annalisapatient decision aids
  3. 3. My affiliation
  4. 4. The Norwegian Electronic Health Library10/2/201 4
  5. 5. • Free access • for clinicians and patients • nation-wide Guidelines Journals DatabasesNylenna M, Eiring Ø, Strand G, Røttingen JA. TextbooksWiring a nation: Putting knowledge into action. Lancet 2010; 375: 1048–51 10/2/201 5
  6. 6. My affiliation
  7. 7. The University of Oslo (enhanced)
  8. 8. Menu
  9. 9. MenuContextThree problems (and solutions)Summary
  10. 10. Patient decision aids• Tools for personalised decisions• Many personalisation technologies• Very limited use of technologies Eiring Ø, Slaughter L. An Assessment of the Potential for Personalisation in Patient Decision Aids. Lecture Notes of The Institute for Computer Sciences, Social Informatics and Telecommunications Engineering Volume 91, 2012, pp 51 - 57
  11. 11. Bipolar disorder• Singapore: 1,2 %• Cross-national 0.3 – 1.5% Chong SA, Abdin E, Vaingankar JA, Heng D, Sherbourne C, Yap M, Lim YW, Wong HB, Ghosh- Dastidar B, Kwok KW, Subramaniam M. A population-based survey of mental disorders in Singapore. Ann Acad Med Singapore 2012 Feb;41(2):49-18
  12. 12. Bipolar disorder I• Chronic• Suicide risk• Relapses• ”Never well”• Impairment• Medication mainstay in treatment
  13. 13. Outpatient psychiatry in Hamar, Norway
  14. 14. A challenging encounter
  15. 15. Why can´t I stop my medication? It really bothers me.I would be much better without! With permission. iStockphoto. The person depicted has no relation to the subject and the picture is for illustrative purposes only.
  16. 16. You must continue taking it!If not, you will certainly have a relapse again.You don´t remember how bad it was, but I do
  17. 17. (Not shared decision- making)
  18. 18. New attempt!(shared decision-making)
  19. 19. Why can´t I stop my medication? It really bothers me.I would be much better without!
  20. 20. Ok, lets try to find the best decision together What are the benefits and harms you care about? And how likely are they, with and without medication?
  21. 21. Three patient roles Consumer Shared decision-makingDoctor knows best Stubblefield C, Mutha S. Provider-patient roles in chronic disease management. J Allied Health. 2002 Summer;31(2):87-92.
  22. 22. The goal• Find - together• the best decision• for you
  23. 23. And to achieve the goal…• Find the: • options • attributes • probabilities • preferences
  24. 24. In example, hypothetical:Options Suicide Relapse Nausea risk risk riskMedicine A 2 % 25 % 10 %Medicine B 1 % 35 % 1%
  25. 25. Four sources of knowledgeAll the research in the world Electronic medical record
  26. 26. Problem 1
  27. 27. Knowledge not tailored to decisions• All options not directly comparable• Not personalised All the research in the world• Not always reliable• Not always readable• Tells nothing in itself, without preferences
  28. 28. A possible solution:Network meta-analysis
  29. 29. Top of the 6S model In EMRReadable SummaryRelevantReliable Network m.a. Systematic reviews High quality single studies Single studies Dicenso A, Bayley L, Haynes RB. Accessing pre-appraised evidence: fine-tuning the 5S model into a 6S model. Evid Based Nurs. 2009 Oct;12(4):99-101
  30. 30. A network of studies Vergel YB, Dunn G, Palmer S, Beynon s, Woolacott N, Soares-Weiser K, Geddes J, Gilbody S. A Simultaneous Comparison of Multiple Treatments for Bipolar I: An Application of Bayesian Statistical Methods. Poster
  31. 31. Direct and indirect comparisons Vergel YB, Dunn G, Palmer S, Beynon s, Woolacott N, Soares-Weiser K, Geddes J, Gilbody S. A Simultaneous Comparison of Multiple Treatments for Bipolar I: An Application of Bayesian Statistical Methods. Poster
  32. 32. Part 1 of the work• Complete two network meta-analyses
  33. 33. Problem 2
  34. 34. Knowledge not operational• Information about the effects of medicines taken is • not systematic Electronic medical record • not quantified • (Often lacking) • not structured • not available to the patient
  35. 35. A possible solution:An Annalisa decision aid
  36. 36. Enabling continuous registration of attributes• Example: depressive symptoms • Patient registers level of depression weekly • Feeds into the decision aid• Assessment of the effect of the medication • continuously and in retrospect
  37. 37. Will visualise changes over time
  38. 38. Part 2 of the work• Developing the Annalisa decision aid
  39. 39. Problem 3
  40. 40. How to evaluate apersonalised intervention?
  41. 41. The problem with group designs• Take considerable time and resources• No improvement of intervention on-the-fly• Do not establish causality in the individual Kazdin AE. Single-Case Research Designs: Methods for Clinical and Applied Settings, 2nd Edition. New York, Oxford. 2009.
  42. 42. A possible solution:single-subject design
  43. 43. Single subject designs• Extensive use within behavioural sciences• Internal validity maintained• Mimics and feasible within clinical practice• Not the same as case studies!
  44. 44. Benefits• Assesses effect in the individual patient• Identifies causal relationships• External validity comparable to group designs• Determines efficacy in novel interventions• Helps optimalise the intervention• Design and intervention can be adjusted on the fly
  45. 45. ABAB design
  46. 46. Non-concurrent, multiple baseline design
  47. 47. Combined
  48. 48. 3 novelties in this work
  49. 49. Novelty 1:Complete NMAs and feed the values into the desicion aid
  50. 50. Novelty 2:• Continuous registration of attributes important to the patient• in a decision aid engineered for distributed decisions
  51. 51. Novelty 3:• Utilising a single subject research design…• to evaluate a patient decision aid
  52. 52. Flexible yet rigorousA personalisable: • decision aid • assessment tool • study design
  53. 53. Thank you
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