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Adapting to waiting lists for coronary revascularization. Do Canadian specialists agree on which patients come first?

https://arctichealth.org/en/permalink/ahliterature224256
Source
Chest. 1992 Mar;101(3):715-22
Publication Type
Article
Date
Mar-1992
Author
C D Naylor
C M Levinton
R S Baigrie
Author Affiliation
Clinical Epidemiology Unit, Sunnybrook Health Science Centre, Toronto, Ontario, Canada.
Source
Chest. 1992 Mar;101(3):715-22
Date
Mar-1992
Language
English
Publication Type
Article
Keywords
Attitude of Health Personnel
Cardiac Surgical Procedures
Cardiology
Coronary Disease - classification - surgery
Data Collection
Emergencies
Humans
Myocardial Revascularization
Ontario
Risk factors
Waiting Lists
Abstract
To assess specialists' adaptation to long waiting lists for coronary revascularization, and their acceptance of a formal queue-ordering schema proposed by an expert panel.
Mail survey of practitioners in referral centers using 49 hypothetical case scenarios. Scenarios were rated for maximum acceptable delay prior to coronary surgery, on a scale with seven interventional time frames graded from emergency to three to six months' permissible delay. The survey included the proposed schema and rating system; respondents were invited to differ as they saw fit. HYPOTHETICAL PATIENTS: Assumed uniformly to be middle aged with typical angina, but clinical factors varied, eg, severity and stability of angina, response to medical therapy, coronary anatomy, and noninvasive test results. PHYSICIAN SUBJECTS: There were 122 respondents, for a 60 percent response rate, including a majority of cardiac surgeons and invasive cardiologists on staff in Ontario teaching hospitals.
Fifty-seven percent rated some scenarios for acceptable waiting times of three to six months; another 39 percent rated their least urgent scenarios to wait six weeks to three months. Interpractitioner agreement was high: for 48/49 scenarios, at least 75 percent of urgency ratings fell within two contiguous points on the scale. Symptom status was the dominant determinant of waiting time, with mean maximum acceptable wait of 74 days for patients with mild-moderate stable angina but three days for those receiving parenteral nitroglycerin (p less than 0.00001). About half the ratings matched those predicted based on the original panel's consensus criteria; 90 percent were within one scale point.
Specialist practitioners in Ontario have adapted to waiting lists for coronary artery bypass surgery/percutaneous transluminal coronary angioplasty, and assess the priority of hypothetical patients in similar ways and in reasonable accord with formal queue-ordering criteria. This behavior may help mitigate the impact of resource constraints, allowing delay of services for those with less acute need--a potential contrast to delayed access in America based on low income or lack of insurance.
PubMed ID
1541137 View in PubMed
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Analysis of deaths while waiting for cardiac surgery among 29,293 consecutive patients in Ontario, Canada. The Steering Committee of the Cardiac Care Network of Ontario.

https://arctichealth.org/en/permalink/ahliterature205467
Source
Heart. 1998 Apr;79(4):345-9
Publication Type
Article
Date
Apr-1998
Author
C D Morgan
K. Sykora
C D Naylor
Author Affiliation
Department of Medicine, Sunnybrook Health Science Centre, University of Toronto, Ontario, Canada.
Source
Heart. 1998 Apr;79(4):345-9
Date
Apr-1998
Language
English
Publication Type
Article
Keywords
Age Factors
Aged
Coronary Artery Bypass
Coronary Disease - mortality
Female
Heart Valve Diseases - mortality - surgery
Humans
Logistic Models
Male
Middle Aged
Ontario - epidemiology
Prospective Studies
Risk factors
Sex Factors
Time Factors
Ventricular Dysfunction, Left
Waiting Lists
Abstract
To assess death rates among patients waiting for cardiac valve surgery or isolated coronary artery bypass surgery (CABG), and to determine independent risk factors for death while waiting for isolated CABG.
Prospective cohort analysis based on an inclusive registry.
Nine cardiac surgical units in Ontario, Canada.
29,293 consecutive patients scheduled for cardiac surgery between October 1991 and June 1995.
Death rates while waiting for surgery were determined among patients scheduled for isolated CABG, isolated valve surgery, or combined procedures. Predictors of death among patients with isolated CABG were determined from multivariate analysis.
There were 141 deaths (0.48%) among 29,293 patients. Adjusting for age, sex, and waiting time, patients waiting for valve surgery had a significantly increased risk of death compared with patients waiting for CABG alone (adjusted odds ratio 1.88, 95% confidence interval (CI) 1.23 to 2.88, p = 0.004). Results were similar for patients waiting for combined valve and CABG procedures compared with those who were waiting for isolated CABG. Independent risk factors for death while waiting for isolated CABG included: impaired left ventricular function (odds ratio 2.47, 95% CI 1.59 to 3.84, p
Notes
Cites: Lancet. 1990 May 5;335(8697):1070-31970377
Cites: Health Aff (Millwood). 1991 Fall;10(3):110-281748371
Cites: Eur Heart J. 1992 Feb;13(2):238-421555622
Cites: J Gen Intern Med. 1992 Sep-Oct;7(5):492-81403204
Cites: CMAJ. 1993 Oct 1;149(7):955-628402424
Cites: N Engl J Med. 1993 Nov 11;329(20):1442-88413454
Cites: Health Policy. 1997 Oct;42(1):15-2710173490
Cites: J Am Coll Cardiol. 1994 Nov 15;24(6):1431-87930272
Cites: Qual Health Care. 1994 Dec;3(4):221-410172214
Cites: Circulation. 1995 Mar 15;91(6):1659-687882472
Cites: Lancet. 1995 Dec 16;346(8990):1605-97500756
Cites: Eur Heart J. 1996 Dec;17(12):1846-518960427
Cites: Lancet. 1994 Aug 27;344(8922):563-707914958
PubMed ID
9616340 View in PubMed
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Appropriateness of primary total hip and knee replacements in regions of Ontario with high and low utilization rates.

https://arctichealth.org/en/permalink/ahliterature211046
Source
CMAJ. 1996 Sep 15;155(6):697-706
Publication Type
Article
Date
Sep-15-1996
Author
C V van Walraven
J M Paterson
M. Kapral
B. Chan
M. Bell
G. Hawker
J. Gollish
J. Schatzker
J I Williams
C D Naylor
Author Affiliation
Institute for Clinical Evaluative Sciences in Ontario (ICES), North York.
Source
CMAJ. 1996 Sep 15;155(6):697-706
Date
Sep-15-1996
Language
English
Publication Type
Article
Keywords
Chi-Square Distribution
Female
Hip Prosthesis - statistics & numerical data - utilization
Humans
Knee Prosthesis - statistics & numerical data - utilization
Male
Medical Audit - statistics & numerical data
Middle Aged
Ontario
Outcome and Process Assessment (Health Care) - statistics & numerical data
Patient Discharge - statistics & numerical data
Random Allocation
Regional Health Planning - statistics & numerical data
Abstract
To compare the appropriateness of case selection for primary hip and knee replacements between two regions in Ontario: one with a high population-based utilization rate and one with a low rate.
Random audit of medical records sampled from hospital discharge abstracts, with subsequent implicit and explicit criteria-based assessments of the appropriateness of surgery.
People aged 60 years or over who underwent elective, single-joint, non-fracture-related, primary hip or knee replacement between Apr. 1, 1992, and Mar. 31, 1993, at one of seven hospitals in a high-rate region (comprising Brant, Huron and Oxford countries) or one of eight hospitals in a low-rate region (comprising the cities of Scarborough and Toronto).
Structured review of hospital medical records, with additional review of information from surgeons and family physicians' office charts if necessary. Three physicians reviewed patient data and rated the preoperative pain level and functional status of patients, with agreement among at least two reviewers. The proportion of inappropriate cases was then assessed according to explicit criteria defined by a multidisciplinary panel using the delphi process. Profiles of each case were also subjected to independent implicit review by two rheumatologists and two orthopedic surgeons.
Proportion of joint replacements deemed inappropriate in the high- and low-rate regions according to either the explicit criteria or the implicit review, as well as preoperative pain levels and functional status of patients in the high- and low-rate regions.
Hip replacements were more common among patients sampled in the low-rate region than among those in the high-rate region (57.3% v. 39.3%; p
Notes
Cites: J Bone Joint Surg Am. 1990 Oct;72(9):1286-932229102
Cites: Control Clin Trials. 1991 Aug;12(4 Suppl):189S-203S1663855
Cites: N Engl J Med. 1977 Aug 18;297(7):360-5876328
Cites: N Engl J Med. 1986 Jan 30;314(5):285-903510394
Cites: JAMA. 1987 Nov 13;258(18):2533-73312655
Cites: JAMA. 1990 Feb 2;263(5):669-722404147
Cites: J Clin Epidemiol. 1990;43(6):543-92348207
Cites: Med Care. 1992 May;30(5 Suppl):MS240-521583936
Cites: Med Care. 1992 Oct;30(10):917-251405797
Cites: N Engl J Med. 1993 Oct 21;329(17):1241-58413392
Cites: J Bone Joint Surg Am. 1993 Nov;75(11):1619-268245054
Cites: BMJ. 1994 Sep 17;309(6956):730-37950529
Cites: Qual Health Care. 1996 Mar;5(1):20-3010157268
Comment In: CMAJ. 1996 Dec 1;155(11):1549-508956828
PubMed ID
8823215 View in PubMed
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Are the marginal returns of coronary artery surgery smaller in high-rate areas? The Steering Committee of the Provincial Adult Cardiac Care Network of Ontario.

https://arctichealth.org/en/permalink/ahliterature210596
Source
Lancet. 1996 Nov 2;348(9036):1202-7
Publication Type
Article
Date
Nov-2-1996
Author
J E Hux
C D Naylor
Author Affiliation
Institute for Clinical Evaluative Sciences in Ontario, University of Toronto, Ontario, Canada.
Source
Lancet. 1996 Nov 2;348(9036):1202-7
Date
Nov-2-1996
Language
English
Publication Type
Article
Keywords
Aged
Coronary Artery Bypass
Coronary Disease - mortality - surgery - therapy
Female
Humans
Male
Middle Aged
Ontario
Outcome and Process Assessment (Health Care)
Registries
Retrospective Studies
Survival Rate
Abstract
Population-based rates of surgery vary within and between health-care systems, causing concern that case selection is less appropriate in high-rate areas. This inverse relationship has not been shown with appropriateness criteria generated by expert panels. We applied a trials-based measure of the potential survival benefit of coronary artery bypass graft surgery (CABG) to patients in a provincial registry, to determine the relationship between survival gains and rates of CABG.
We did a population-based retrospective review of linked registry and administrative datasets. 5058 patients in the linked datasets underwent isolated CABG in Ontario between April 1, 1992, and March 31, 1993. Potential survival benefit of surgery was scored with an algorithm derived from a published overview of trials comparing CABG to medical treatment, analysed by county and by referral regions.
Overall, case selection was appropriate whether assessed clinically (96.3% had either severe disease as judged on the coronary arteries affected or moderate to severe angina) or on the basis of survival benefit scores (94.0% predicted to obtain moderate or high benefit). There was significant variation in benefit scores across referral regions (p
PubMed ID
8898037 View in PubMed
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Assessing the outcomes of coronary artery bypass graft surgery: how many risk factors are enough? Steering Committee of the Cardiac Care Network of Ontario.

https://arctichealth.org/en/permalink/ahliterature207414
Source
J Am Coll Cardiol. 1997 Nov 1;30(5):1317-23
Publication Type
Article
Date
Nov-1-1997
Author
J V Tu
K. Sykora
C D Naylor
Author Affiliation
Institute for Clinical Evaluative Sciences in Ontario, Sunnybrook Health Science Centre, North York, Canada. tu@ices.on.ca
Source
J Am Coll Cardiol. 1997 Nov 1;30(5):1317-23
Date
Nov-1-1997
Language
English
Publication Type
Article
Keywords
Aged
Coronary Artery Bypass - mortality
Female
Hospital Mortality
Humans
Male
Middle Aged
Models, Statistical
Odds Ratio
Ontario - epidemiology
Outcome Assessment (Health Care) - methods
ROC Curve
Registries
Risk assessment
Risk factors
Abstract
We sought to determine whether more comprehensive risk-adjustment models have a significant impact on hospital risk-adjusted mortality rates after coronary artery bypass graft surgery (CABG) in Ontario, Canada.
The Working Group Panel on the Collaborative CABG Database Project has categorized 44 clinical variables into 7 core, 13 level 1 and 24 level 2 variables, to reflect their relative importance in determining short-term mortality after CABG.
Using clinical data for all 5,517 patients undergoing isolated CABG in Ontario in 1993, we developed 12 increasingly comprehensive risk-adjustment models using logistic regression analysis of 6 of the Panel's core variables and 6 of the Panel's level 1 variables. We studied how the risk-adjusted mortality rates of the nine cardiac surgery hospitals in Ontario changed as more variables were included in these models.
Incorporating six of the core variables in a risk-adjustment model led to a model with an area under the receiver operating characteristic (ROC) curve of 0.77. The ROC curve area slightly improved to 0.79 with the inclusion of six additional level 1 variables (p = 0.063). Hospital risk-adjusted mortality rates and relative rankings stabilized after adjusting for six core variables. Adding an additional six level 1 variables to a risk-adjustment model had minimal impact on overall results.
A small number of core variables appear to be sufficient for fairly comparing risk-adjusted mortality rates after CABG across hospitals in Ontario. For efficient interprovider comparisons, risk-adjustment models for CABG could be simplified so that only essential variables are included in these models.
PubMed ID
9350934 View in PubMed
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Assessment of priority for coronary revascularisation procedures. Revascularisation Panel and Consensus Methods Group.

https://arctichealth.org/en/permalink/ahliterature229092
Source
Lancet. 1990 May 5;335(8697):1070-3
Publication Type
Conference/Meeting Material
Article
Date
May-5-1990
Author
C D Naylor
R S Baigrie
B S Goldman
A. Basinski
Author Affiliation
Sunnybrook Health Science Centre, North York, Ontario, Canada.
Source
Lancet. 1990 May 5;335(8697):1070-3
Date
May-5-1990
Language
English
Publication Type
Conference/Meeting Material
Article
Keywords
Adult
Aged
Angina Pectoris - radiography - therapy
Angina, Unstable - radiography - therapy
Coronary Disease - classification - radiography - surgery
Emergencies
Emergency Medical Services - standards
Evaluation Studies as Topic
Heart Function Tests
Humans
Models, Statistical
Myocardial Revascularization - methods
Observer Variation
Ontario
Questionnaires
Reference Standards
Regression Analysis
Risk factors
Severity of Illness Index
Time Factors
Triage - standards
Abstract
To develop guidelines for ranking the urgency with which patients with angiographically proven coronary disease need revascularisation procedures, factors that a panel of cardiac specialists agreed were likely to affect urgency were incorporated into 438 fictitious case-histories. Each panelist then rated the cases on a 7-point scale based on maximum acceptable waiting time for surgery; 1 on the scale represented emergency surgery and 7 delays of up to 6 months. For only 1% of cases was there agreement on a single rating by at least 12/16 panelists. Results of this ranking exercise were used by the panel to draw up triage guidelines. The three main urgency determinants were severity and stability of symptoms of angina, coronary anatomy from angiographic studies, and results of non-invasive tests for risk of ischaemia. Together these three factors generally gave an urgency rating for any given case to within less than 0.25 scale points of the value predicted with all factors. A numerical scoring system was derived to permit rapid estimation of the panel's recommended ratings.
Notes
Comment In: Lancet. 1990 Aug 4;336(8710):310-11973994
PubMed ID
1970377 View in PubMed
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Assigning priority to patients requiring coronary revascularization: consensus principles from a panel of cardiologists and cardiac surgeons.

https://arctichealth.org/en/permalink/ahliterature226284
Source
Can J Cardiol. 1991 Jun;7(5):207-13
Publication Type
Conference/Meeting Material
Article
Date
Jun-1991
Author
C D Naylor
R S Baigrie
B S Goldman
J A Cairns
D S Beanlands
N. Berman
D. Borts
D H Fitchett
A. Haq
A. Hess
Author Affiliation
Clinical Epidemiology Unit, Sunnybrook Health Science Centre, Toronto, Ontario.
Source
Can J Cardiol. 1991 Jun;7(5):207-13
Date
Jun-1991
Language
English
Publication Type
Conference/Meeting Material
Article
Keywords
Canada
Coronary Artery Bypass
Coronary Disease - epidemiology - surgery
Health Care Rationing
Humans
Risk factors
Waiting Lists
Abstract
In light of lengthy waiting lists for coronary surgery in Canada, a panel of 16 cardiologists and cardiac surgeons was convened to derive guiding principles for ranking how urgently diverse patients with angiographically proven coronary disease require revascularization. Factors likely to affect urgency were agreed upon by the panelists and incorporated into a case scenario questionnaire. Each panelist then rated 438 case scenarios with respect to maximum acceptable waiting time on a scale with seven time frames ranging from emergency surgery ('level 1') to delays of up to six months ('level 7'). The scenario rating process facilitated attainment of a panel consensus. The purpose of the principles is to assist in assigning priorities to patients according to both symptoms and risk of death or additional morbidity from ischemic events. The pattern or severity of the patient's anginal symptoms and the response of those symptoms to medical therapy emerged as the single most important determinant of the level of urgency. Anatomy and noninvasive tests of ischemic risk were the other key determinants of priority. All other factors were less important, and operated largely within a given level of urgency on the seven-point scale. The principles, including explicit ranking criteria divided according to angina class, are outlined in this final report. The panel specifically cautioned that adoption of such principles is not designed to countenance delays in treatment, but if necessary, should help form more rational queues for coronary revascularization.
PubMed ID
1860092 View in PubMed
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Benchmarking the provision of coronary artery surgery.

https://arctichealth.org/en/permalink/ahliterature205619
Source
CMAJ. 1998 May 5;158(9):1151-3
Publication Type
Article
Date
May-5-1998
Author
C D Naylor
Source
CMAJ. 1998 May 5;158(9):1151-3
Date
May-5-1998
Language
English
Publication Type
Article
Keywords
Benchmarking
Canada
Coronary Artery Bypass - trends
Health Services Needs and Demand - trends
Humans
Patient Selection
Time Factors
Waiting Lists
Notes
Cites: N Engl J Med. 1997 May 22;336(21):1500-59154770
Cites: Lancet. 1996 Nov 2;348(9036):1202-78898037
Cites: J Am Coll Cardiol. 1996 May;27(6):1365-738626945
Cites: JAMA. 1996 May 8;275(18):1435-98618371
Cites: Lancet. 1995 Dec 16;346(8990):1605-97500756
Cites: Lancet. 1995 Apr 1;345(8953):840-27898234
Cites: Qual Health Care. 1994 Dec;3(4):221-410172214
Cites: N Engl J Med. 1994 Oct 27;331(17):1130-57935638
Cites: CMAJ. 1994 Sep 1;151(5):575-808069802
Cites: Lancet. 1994 Aug 27;344(8922):563-707914958
Cites: Can J Cardiol. 1994 Jan-Feb;10(1):41-88111670
Cites: N Engl J Med. 1993 Mar 18;328(11):779-848123063
Cites: Health Aff (Millwood). 1991 Fall;10(3):110-281748371
Cites: Lancet. 1990 May 5;335(8697):1070-31970377
Comment On: CMAJ. 1998 May 5;158(9):1137-429597964
PubMed ID
9597966 View in PubMed
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Benchmarking the vital risk of waiting for coronary artery bypass surgery in Ontario.

https://arctichealth.org/en/permalink/ahliterature198983
Source
CMAJ. 2000 Mar 21;162(6):775-9
Publication Type
Article
Date
Mar-21-2000
Author
C D Naylor
J P Szalai
M. Katic
Author Affiliation
Department of Medicine, University of Toronto, Ont. david.naylor@utoronto.ca
Source
CMAJ. 2000 Mar 21;162(6):775-9
Date
Mar-21-2000
Language
English
Publication Type
Article
Keywords
Aged
Benchmarking
Cohort Studies
Coronary Artery Bypass - mortality
Coronary Disease - mortality - surgery
Female
Humans
Male
Middle Aged
Myocardial Infarction - mortality - surgery
Ontario
Risk
Waiting Lists
Abstract
Deaths among patients awaiting coronary artery bypass grafting (CABG) are a source of private grief and public concern in Canada. However, some deaths are expected over time among patients with coronary artery disease. Methods of benchmarking the burden of delayed care may be useful in understanding and managing waiting lists for CABG and other health services. The authors therefore determined the vital risk among people waiting for CABG in Ontario and compared it with the risk in the general population and among people living with coronary artery disease.
Patients registered to undergo CABG in Ontario between 1991 and 1995 were followed to ascertain numbers and dates of preoperative deaths or completed operations. Linking hospital discharge abstract data to vital statistics for 1991 to 1994, the authors defined a cohort of people who had survived 6 months after an acute myocardial infarction (AMI) and followed them for an additional 6 months to determine numbers and dates of deaths. They matched patients by age and sex and then calculated the standardized mortality ratio for each cohort (i.e., the ratio of observed deaths to those expected based on age- and sex-specific daily probabilities of death for the provincial population).
Among 21,220 patients awaiting CABG, there were 82 preoperative deaths over a median follow-up of 18 days; the standardized mortality ratio was 2.92 (95% confidence limit [CL] 2.29-3.55). Among 21,220 matched 6-month survivors of an AMI, there were 663 deaths over a median follow up of 185 days; the standardized mortality ratio was 3.84 (95% CI 3.54-4.14).
Patients awaiting CABG in Ontario are at a much greater risk of death than the general population. However, when compared with thousands of other patients living with coronary artery disease, they are at similar or decreased vital risk.
Notes
Cites: JAMA. 1999 Jul 14;282(2):145-5210411195
Cites: J Health Serv Res Policy. 1999 Apr;4(2):65-7210387409
Cites: Can J Cardiol. 1999 Jul;15(7):777-8210411616
Cites: CMAJ. 1989 Feb 15;140(4):389-952492446
Cites: Lancet. 1990 May 5;335(8697):1070-31970377
Cites: JAMA. 1991 Aug 28;266(8):1108-111865544
Cites: Health Aff (Millwood). 1991 Fall;10(3):110-281748371
Cites: Soc Sci Med. 1993 Jul;37(1):61-78332926
Cites: Lancet. 1995 Dec 16;346(8990):1605-97500756
Cites: J Am Coll Cardiol. 1996 May;27(6):1365-738626945
Cites: Circulation. 1996 Nov 15;94(10):2429-338921784
Cites: N Engl J Med. 1997 May 22;336(21):1500-59154770
Cites: CMAJ. 1998 May 5;158(9):1137-429597964
Cites: Heart. 1998 Apr;79(4):345-99616340
Comment In: CMAJ. 2000 Mar 21;162(6):794-510750468
PubMed ID
10750462 View in PubMed
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Breast cancer patients' attitudes about rationing postlumpectomy radiation therapy: applicability of trade-off methods to policy-making.

https://arctichealth.org/en/permalink/ahliterature207523
Source
J Clin Oncol. 1997 Oct;15(10):3192-200
Publication Type
Article
Date
Oct-1997
Author
V A Palda
H A Llewellyn-Thomas
R G Mackenzie
K I Pritchard
C D Naylor
Author Affiliation
St Michael's Hospital, University of Toronto, Canada.
Source
J Clin Oncol. 1997 Oct;15(10):3192-200
Date
Oct-1997
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Attitude
Breast Neoplasms - psychology - radiotherapy - surgery
Canada
Combined Modality Therapy
Female
Health Care Rationing
Humans
Mastectomy, Segmental
Middle Aged
Patient Acceptance of Health Care
Patient satisfaction
Policy Making
Risk factors
Time Factors
Waiting Lists
Abstract
Along with evidence, clinical policies must take patients' values into account. Particularly where evidence is limited and where assumptions of utility-maximizing behavior may not be valid, new methods such as trade-off techniques (TOTs), which allow elicitation of patients' treatment alternatives, might be useful in policy formulation. We used TOTs to assess breast cancer patients' attitudes toward two clinical policies designed to ration adjuvant postlumpectomy breast radiation therapy.
Cross-sectional interviews were performed in a tertiary cancer center. A total of 102 patients were presented with information about the side effects and benefits associated with two hypothetical decisions: (1) willingness to receive treatment elsewhere to shorten the wait for radiation therapy, and (2) foregoing radiation therapy in the face of small marginal benefits. For each scenario, a TOT was used to identify the maximal acceptable wait time (MAWT) for therapy and the benefit threshold at which the patient would forego therapy. Associations of clinical and demographic factors with these decisions were determined by regression analysis.
Patients would be willing to wait, on average, 7 weeks before wanting to leave their city for radiation therapy, less than the 13-week delay our patients actually faced. Older patients were less willing to wait (P = .013); 46% of patients would not give up radiation therapy, even in the face of no stated benefit. Willingness to give up radiation therapy was predicted by willingness to accept delay (odds ratio [OR], 1.84; 95% confidence interval [CI], 1.05 to 3.37) and being employed (OR, 2.61; 95% CI, 1.08 to 6.54). Patients with larger tumors were less willing to give up radiation therapy (OR, 0.57; 95% CI, 0.31 to 0.97).
Even in difficult decisions such as rationing postlumpectomy breast cancer radiation therapy, TOTs can inform policy formulation by indicating the distributions of patients' preferences.
PubMed ID
9336355 View in PubMed
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83 records – page 1 of 9.