Methods Inf Med 2019; 58(01): 024-030
DOI: 10.1055/s-0039-1692416
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Eliciting and Exploiting Utility Coefficients in an Integrated Environment for Shared Decision-Making

Elisa Salvi
1  Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
,
Enea Parimbelli
2  MET Research Group, Telfer School of Management, University of Ottawa, Ottawa, Canada
,
Silvana Quaglini
1  Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
,
Lucia Sacchi
1  Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
› Author Affiliations
Further Information

Publication History

10 October 2018

15 April 2019

Publication Date:
05 July 2019 (online)

Abstract

Background In shared decision-making, a key step is quantifying the patient's preferences in relation to all the possible outcomes of the compared clinical options. According to utility theory, this can be done by eliciting utility coefficients (UCs) from the patient. The obtained UCs are then used in decision models (e.g., decision trees). The elicitation process involves the choice of one or more elicitation methods, which is not easy for decision-makers who are unfamiliar with the theoretical framework. Moreover, to our knowledge there are no tools that integrate functionalities for UC elicitation with functionalities to run decision models that include the elicited values.

Objectives The first aim of this work is to provide decision support to the clinicians for the selection of the elicitation method. The second aim is to bridge the gap between UC elicitation and the exploitation of those UCs in shared decision-making.

Methods Based on evidence from the utility theory literature, we developed a set of production rules that recommend the optimal elicitation method(s) according to the patient's profile and health state. We then complemented this decision support tool with a functionality for quantifying and running decision trees defined through the commercial software TreeAge.

Results The result is an integrated framework for shared decision-making. Given the primary aim of this work, we focus for result evaluation on the elicitation tool. It was tested on 51 volunteers, who expressed UCs for four purposely selected health states. The insights on the collected UCs validated the rules included in the decision support system. The usability of the tool was assessed through the System Usability Scale, obtaining positive results.

Conclusion We developed an integrated environment to facilitate shared decision-making in the clinical practice. The next step is the validation of the entire framework and its use besides shared decision-making. As a matter of fact, it may also be exploited to target cost-utility analysis to a specific patient population.

Supplementary Material