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WheredoesOverdiagnosisfitinaMulti-CriteriaDecisionAnalysis?
JackDowieLondonSchoolofHygieneandTropicalMedicine
MetteKjerKaltoft,OdenseUniversityHospitalSvendborgJesperBoNielsen,UniversityofSouthernDenmark
GlennSalkeld,UniversityofWollongong
Poster53
Multi-CriteriaDecisionAnalysishealthliterature
HealthPolicyliterature
EthicalDMliterature
SDMliterature
ODliterature
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Searchforterm‘Overdiagnosis’
WHY?
Evidence Base
Preference Base
Option ScoresOptions
Options
Criteria
BestEstimatesAvailableNow
aMulti-CriteriaDecisionAnalysis(MCDA)involvesthethreethingsweneedtomakeagooddecisionShowingwedon’tneedadiagnosis
Overdiagnosis- andUnderdiagnosis - canonlyexistifthereisDiagnosis.
Diagnosiscreatesthem.
Diagnosisfacilitatesandencouragestheveryserious‘Overs’:
Over-CertaintyandOver-Confidence
Nodecisionaboutmewithoutme
Nodiagnosisaboutmewithoutme– orwithme
ThegrowingconcernwithOverdiagnosisinindividualhealthcare,especiallyinmedicine,hasoccurredsimultaneouslywithincreasinginterestinMulti-CriteriaDecisionAnalysis(MCDA)asawayofsupportingthepreference-sensitivedecisionsthatmustbetaken. Butwefoundvirtually
nouseoftheterms‘overdiagnosis’,‘overdetection’,or‘overtreatment’inareviewof30MCDApublicationsfrom2006-2016.
Nodecisionaboutmewithoutme
Nodiagnosisaboutmewithoutme– orwithme
A: Tomakeagooddecisioninperson-centredcareweneed,andneedonly,3things:• theBEANS(theBestEstimatesAvailableNow,atPointofDecision)oftheperformanceratesoftheoptionsonthecriteriaimportanttotheperson• therelativeimportanceweightsattachedtothosecriteria• adefensiblewayofsynthesisingtheseontologicallyandepistemologicallydistinctinputsintoa'score'foreachoption.
anMCDAinvolvesallthese,showingthatwedonotneedadiagnosistomakeagooddecision
Q:WhyistherelittleornoattentiontoOverdiagnosisinMulti-CriteriaDecisionAnalysis(MCDA)?
OverdiagnosisandUnderdiagnosis canonlyexistwherethereisDiagnosis.Diagnosiscreatesthem.
Where doesOverdiagnosis fitinaMulti-CriteriaDecisionAnalysis?MetteKjerKaltoft13 Jack Dowie23,,JesperBoNielsen3,GlennSalkeld4
1OdenseUniversityHospitalSvendborg; 2LondonSchoolofHygieneandTropicalMedicine,London,UK;3 UniversityofSouthernDenmark,Odense,Denmark;4 UniversityofWollongong,Australia
Providingadiagnosticlabel cangeneratepsychological/emotionalbenefitsorharms,butitdistractsfromalwayskeepingthedecisionethicallyframedasinvolvingmultipleuncertaintiesandtrade-offs.Therebyfosteringthereallyserious 'overs’:over-certainty andover-confidence
EvidenceRatings:FraxassessmentwithoutBMDfor3ClinicalRiskFactors;person-supplied
treatmentburdens[www.shef.ac.uk/FRAX/tool.aspx?country=29]
PreferenceWeightings:Person-supplied.Left:’Noaction’isoptimal.Right:withincreased
weighttoavoidingfractureandsameratingsamedicationwins
Nodiagnosisneeded,ofa‘statisticaldisease’likeosteoporosis.BMDmeasurementisnotamong
theoptionsduetonoevidenceofBMDenhancingFrax*
Bonehealthdecision14options;6criteria
Bonehealthinteractivedecisions
*LinktoPosterwithFraxdataforUK,Denmark,Australia,andreferencesincludingNICE
Furtherinformation:[email protected];[email protected]
60yoWoman
LinktointeractiveMCDA-baseddecisionaidatcafeannalisa.org.uk
60yoWoman
*Noactionbestupto34.4%avoid fractureweight
LinkTo
Thisposter
*Bestfrom34.5%avoid fractureweight
60yoWoman
