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|Titolo:||From decision to shared-decision: Introducing patients' preferences into clinical decision analysis|
|Data di pubblicazione:||2015|
|Autori interni:||ROGNONI, CARLA|
|Autori:||Sacchi, Lucia; Rubrichi, Stefania; Rognoni, Carla; Panzarasa, Silvia; Parimbelli, Enea; Mazzanti, Andrea; Napolitano, Carlo; Priori, Silvia G.; Quaglini, Silvana|
|Rivista:||ARTIFICIAL INTELLIGENCE IN MEDICINE|
|Abstract:||Objective: Taking into account patients’ preferences has become an essential requirement in healthdecision-making. Even in evidence-based settings where directions are summarized into clinical prac-tice guidelines, there might exist situations where it is important for the care provider to involve thepatient in the decision. In this paper we propose a unified framework to promote the shift from a tra-ditional, physician-centered, clinical decision process to a more personalized, patient-oriented shareddecision-making (SDM) environment.Methods: We present the theoretical, technological and architectural aspects of a framework that encap-sulates decision models and instruments to elicit patients’ preferences into a single tool, thus enablingphysicians to exploit evidence-based medicine and shared decision-making in the same encounter.Results: We show the implementation of the framework in a specific case study related to the preven-tion and management of the risk of thromboembolism in atrial fibrillation. We describe the underlyingdecision model and how this can be personalized according to patients’ preferences. The application ofthe framework is tested through a pilot clinical evaluation study carried out on 20 patients at the Reha-bilitation Cardiology Unit at the IRCCS Fondazione Salvatore Maugeri hospital (Pavia, Italy). The resultspoint out the importance of running personalized decision models, which can substantially differ frommodels quantified with population coefficients.Conclusions: This study shows that the tool is potentially able to overcome some of the main barriersperceived by physicians in the adoption of SDM. In parallel, the development of the framework increasesthe involvement of patients in the process of care focusing on the centrality of individual patients.|
|Appare nelle tipologie:||01 - Articolo su rivista Scientifica|
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