Shaping an Effective Health Information Website on Rare Diseases Using a Group Decision-Making Tool: Inclusion of the Perspectives of Patients, Their Family Members, and Physicians

A survey of group decision making methods in Healthcare Industry 4.0: bibliometrics, applications, and directions

Healthcare Industry 4.0 refers to intelligent operation processes in the medical industry. With the development of information technology, large-scale group decision making (GDM), which allows a larger number of decision makers (DMs) from different places or sectors to participate in decision making, has been rapidly developed and applied in Healthcare Industry 4.0 to help to make decisions efficiently and smartly. To make full use of GDM methods to promote the developments of the medical industry, it is necessary to review the existing relevant achievements. Therefore, this paper conducts an overview to generate a comprehensive understanding of GDM in Healthcare Industry 4.0 and to identify future development directions. Bibliometric analyses are conducted in order to learn the development trends from published papers. The implementations of GDM methods in Healthcare Industry 4.0 are reviewed in accordance with the paradigm of the general GDM process, which includes information representation, dimension reduction, consensus reaching, and result elicitation. We also provide current research challenges and future directions regarding medical GDM. It is hoped that our study will be helpful for researchers in the field of GDM in Healthcare Industry 4.0.

The information needs of internet users and their requirements for online health information-A scoping review of qualitative and quantitative studies

OBJECTIVE

This scoping review has been conducted to summarise the information needs of internet users and their requirements for online health information.

METHODS

We searched MEDLINE, Web of Science and Scopus up to July 2019. Qualitative, quantitative and mixed-method studies were included and a thematic synthesis with category formation and exact description of the items was carried out.

RESULTS

118 studies were included. To address all users' needs mentioned in the included studies, we grouped them into nine main categories: authority, comprehension, currency, evidence-based information, exchange with others, independence, purpose, services, user experience. The evaluation showed that website users wanted qualifications of authors to be cited. Users preferred health information that offered interactive elements and resources for relatives, whilst also providing an opportunity for online contact with others. The ease with which information was accessed and the intelligibility of texts were regarded as being very important to users.

CONCLUSION

Given the rapid evolvement and changes of online health information, it is crucial to provide up to date insights and a comprehensive overview of the range of criteria.

PRACTICE IMPLICATIONS

With the results obtained through this scoping review, the creators of online health information could be assisted in providing user-specific resources.

Patient-reported data informing early benefit assessment of rare diseases in Germany: A systematic review

BACKGROUND

Since the implementation of the Regulation on Patient Integration (2003), the Act on the Reorganization of the Pharmaceutical Market (2011), and the Patient Rights Law (2013), the inclusion of patient perspectives has been further anchored in the German early benefit assessment process. During the assessment of rare disease interventions, patient perspectives are particularly important, as clinical studies are often designed acknowledging small samples and patients suffering from severe symptoms and the chronic course of the disease. Therefore, our research question is whether patient perspectives are considered as part of early benefit assessments for rare diseases. We also strive to examine how patient perspectives are methodologically elicited and presented.

METHODS

Our empirical evidence comes from a systematic review of orphan drug value dossiers submitted to the German Federal Joint Committee as well as the corresponding evaluations conducted between January 1, 2011 and March 1, 2019 (n = 81). Data on patient perspective integration were extracted using the following patient-reported outcome subcategories: clinical patient-reported outcomes, health-related quality of life, patient preferences, and patient satisfaction.

RESULTS

The analysis demonstrates the specific relevance of patient-reported outcomes raised as part of the medical data set and presented during the early benefit assessment process. They are predominantly presented in the form of health-related quality of life data (n = 75%) and clinical outcomes (n = 49%). Preferences (n = 2%) and satisfaction (n = 1%) are still rarely presented, although the heated methodological discussion in Germany would suggest otherwise. While various methodologies for the integration of clinical outcomes and quality of life data were found, presenting data on satisfaction and preferences still lacks methodological rigor. The German Federal Joint Committee has not yet integrated these data in their decision text. Clinical outcomes and quality of life have been included in 46% and 73% of the cases, respectively.

CONCLUSIONS

The underlying analysis demonstrates that there is still a relative high potential for the regular and systematic inclusion of patient perspectives within the early benefit assessment process for rare diseases. In particular, patient preferences and patient satisfaction are still rarely included suggesting the need for a clear-cut methodological foundation and incentives.

Integrating patient perspectives in medical decision-making: a qualitative interview study examining potentials within the rare disease information exchange process in practice

BACKGROUND

Many European countries have recently implemented national rare disease plans. Although the network is strengthening, especially on the macro and meso levels, patients still go a long way through healthcare systems, with many health professionals involved and scarce evidence to gather. Specifically, patient involvement in the form of shared decision-making can offer further potential to increase healthcare systems' efficiency on a micro level. Therefore, we examine the implementation of the shared decision-making concept thus far, and explore whether efficiency potentials exist-which are particularly relevant within the rare disease field-and how they can be triggered.

METHODS

Our empirical evidence comes from 101 interviews conducted from March to September 2014 in Germany; 55 patients, 13 family members, and 33 health professionals participated in a qualitative interview study. Transcripts were analyzed using a directed qualitative content analysis.

RESULTS

The interviews indicate that the decision-making process is increasingly relevant in practice. In comparison, however, the shared decision-making agreement itself was rarely reported. A majority of interactions are dominated by individual, informed decision-making, followed by paternalistic approaches. The patient-physician relationship was characterized by a distorted trust-building process, which is affected by not only dependencies due to the diseases' severity and chronic course, but an often-reported stigmatization of patients as stimulants. Moreover, participation was high due to a pronounced engagement of those affected, diminishing as patients' strength vanish during their odyssey through health care systems. The particular roles of "expert patients" or "lay experts" in the rare disease field were revealed, with further potential in integrating the gathered information.

CONCLUSIONS

The study reveals the named efficiency potentials, which are unique for rare diseases and make the further integration of shared decision-making very attractive, facilitating diagnostics and disease management. It is noteworthy that integrating shared decision-making in the rare disease field does not only require strengthening the position of patients but also that of physicians. Efforts can be made to further integrate the concept within political frameworks to trigger the identified potential and assess the health-economic impact.

Outcomes of patient self-referral for the diagnosis of several rare inherited kidney diseases

Purpose

To evaluate self-referral from the Internet for genetic diagnosis of several rare inherited kidney diseases.

Methods

Retrospective study from 1996–2017 analyzing data from an academic referral center specializing in autosomal dominant tubulo-interstitial kidney disease (ADTKD). Individuals were referred by academic health care providers (HCPs) non-academic HCPs, or directly by patients/families.

Results

Over 21 years, there were 665 referrals, with 176(27%) directly from families, 269(40%) from academic HCPs, and 220(33%) from non-academic HCPs. 42(24%) of direct family referrals had positive genetic testing vs 73(27%) of families from academic HCPs and 55(25%) from non-academic HCPs (P=.72). 99% of direct family contacts were white and resided in zip code locations with a mean median income of $77,316±34,014 vs. US median income $49,445.

Conclusions

Undiagnosed families with Internet access bypassed their physicians and established direct contact with an academic center specializing in inherited kidney disease to achieve a diagnosis. Twenty-five per cent of all families diagnosed with ADTKD were the result of direct family referral and would otherwise have been un-diagnosed. If patients suspect a rare disorder that is un-diagnosed by their physicians, actively pursuing self-diagnosis using the Internet can be successful. Centers interested in rare disorders should consider improving direct access to families.

"As If Neck Injuries Did Not Exist": An Interview Study of Patients' and Relatives' Perceptions of Web Information on and Management of Whiplash Injuries in Sweden

BACKGROUND

If purposefully designed, patient information can help individuals make well-founded health care decisions. This study was initiated to improve the information on whiplash injuries found in the national health care portal Healthcare Guide 1177, operated by the Swedish government.

OBJECTIVE

The objective of this study was to describe the thoughts of patients and relatives on (1) information about whiplash injuries presented in the portal and (2) the Swedish health care system's management of whiplash injuries.

METHODS

A total of 5 interviews were conducted with patients (n=10) who had experienced a whiplash injury and with relatives (n=3) of such patients. The interviews were taped, transcribed verbatim, and analyzed by means of conventional content analysis.

RESULTS

The following two themes emerged from the latent content analysis: (1) confidence and trust in the public health care system and (2) a disappointment with health care encounters.

CONCLUSIONS

We found that most of the study participants felt distress due to insufficient information; respondents perceived a discrepancy between the public health care system's authority and the information provided. The Web information on whiplash injuries may greatly impact patients' care decisions as well as their physical, mental, and social well-being. We would recommend detailed patient information on whiplash injuries, with less emphasis on psychology and more data on pathophysiology, prognosis, and treatment.

Clinical utility in infants with suspected monogenic conditions through next-generation sequencing

Background

Rare diseases are complex disorders with huge variability in clinical manifestations. Decreasing cost of next‐generation sequencing (NGS) tests in recent years made it affordable. We witnessed the diagnostic yield and clinical use of different NGS strategies on a myriad of monogenic disorders in a pediatric setting.

Methods

Next‐generation sequencing tests are performed for 98 unrelated Chinese patients within their first year of life, who were admitted to Xin Hua Hospital, affiliated with Shanghai Jiao Tong University School of Medicine, during a 2‐year period.

Results

Clinical indications for NGS tests included a range of medical concerns. The mean age was 4.4 ± 4.2 months of age for infants undergoing targeting specific (known) disease‐causing genes (TRS) analysis, and 4.4 ± 4.3 months of age for whole‐exome sequencing (WES) (p > 0.05). A molecular diagnosis is done in 72 infants (73.47%), which finds a relatively high yield with phenotypes of metabolism/homeostasis abnormality (HP: 0001939) (odds ratio, 1.83; 95% CI, 0.56–6.04; p = 0.32) and a significantly low yield with atypical symptoms (without a definite HPO term) (odds ratio, 0.08; 95% CI, 0.01–0.73; p = 0.03). TRS analysis provides molecular yields higher than WES (p = 0.01). Ninety‐eight different mutations are discovered in 72 patients. Twenty‐seven of them have not been reported previously. Nearly half (43.06%, 31/72) of the patients are found to carry 11 common disorders, mostly being inborn errors of metabolism (IEM) and neurogenetic disorders and all of them are observed through TRS analysis. Eight positive cases are identified through WES, and all of them are sporadic, of highly variable phenotypes and severity. There are 26 patients with negative findings in this study.

Conclusion

This study provides evidence that NGS can yield high success rates in a tertiary pediatric setting, but suggests that the scope of known Mendelian conditions may be considerably broader than currently recognized.