DSAM’s publikationsinformation om seneste resultater inden for almenmedicinsk forskning i Danmark.

Association of maternal self-medication and over-the counter analgesics for children

Jensen FJ, Gottschau M, Siersma VD, Graungaard AH, Holstein BE, Knudsen LE  

OBJECTIVE: Self-medication with over-the-counter (OTC) analgesics, such as paracetamol (PCM), among children and adolescents is increasing and constitutes an important public health issue internationally. Reasons for this development are unclear; parental influence is suggested. Our objective was to examine whether self-medication with OTC analgesics among school-aged children is influenced by maternal self-reported health and medicine use, taking the child’s frequency of pain into account.

METHODS: A quantitative cross-sectional survey was conducted on 131 children aged 6 to 11 years and their mothers in the framework of the Demonstration Of A Study To Coordinate And Perform Human Biomonitoring On A European Scale (DEMOCOPHES) European project. Participants were selected from 1 urban and 1 rural area of Denmark, and equally distributed in age and gender. Data were collected through structured interviews with all children and self-report questionnaires for mothers regarding health, pain, and medicine use.

RESULTS: After adjusting for several sociodemographic and health parameters, maternal use of OTC analgesics was significantly associated with self-medication with OTC analgesics, particularly PCM, in our population of schoolchildren, even when the child’s pain was adjusted for (odds ratio 3.00, P= .008). A clear association between child pain and OTC analgesic use was not found. Additionally, maternal health (self-rated health, chronic pain, chronic disease, daily medicine intake) did not significantly influence child use of OTC analgesics.

CONCLUSIONS: Maternal self-medication with OTC analgesics is associated with self-medication of OTC analgesics, predominantly PCM, among school-aged children, perhaps more than the child’s pain. Maternal health seems of less importance. Information to parents about pain self-management is important to promote appropriate PCM use among schoolchildren.

Pediatrics. Published on-line 6-1-2014

Health-related quality of life predicts major amputation and death, but not healing, in people with diabetes presenting with foot ulcers: the eurodiale study

Siersma V1, Thorsen H, Holstein PE, Kars M, Apelqvist J, Jude EB, Piaggesi A, Bakker K, Edmonds M, Jirkovská A, Mauricio D, Ragnarson Tennvall G, Reike H, Spraul M, Uccioli L, Urbancic V, van Acker K, van Baal J, Schaper NC.

OBJECTIVE: Low health-related quality of life (HRQoL) has been consistently reported to be associated with poor prognosis for a variety of health outcomes in various settings. We aimed to evaluate whether HRQoL in patients presenting with new diabetic foot ulcers (DFUs) has prognostic significance for ulcer healing, major amputation, and death.

RESEARCH DESIGN AND METHODS: We followed 1,088 patients with new DFUs presenting for treatment at one of the 14 centers in 10 European countries participating in the Eurodiale (European Study Group on Diabetes and the Lower Extremity) study, prospectively until healing (76.9%), major amputation (4.6%), or death (6.4%) up to a maximum of 1 year. At baseline, patient and ulcer characteristics were recorded as well as EQ-5D, a standardized instrument consisting of five domains and a visual analog scale for use as a measure of HRQoL. The prognostic influence of the EQ-5D domains was evaluated in multivariable Cox regression analyses on the time-to-event data, adjusting for baseline clinical characteristics of the ulcer and comorbidities.

RESULTS: While predictive effects of HRQoL, adjusted for possible confounders, were absent for healing, decreased HRQoL, especially in the physical domains, was statistically significant for major amputation (mobility, self-care, usual activities) and death (self-care, usual activities, pain/discomfort).

CONCLUSIONS: Low HRQoL appears to be predictive for major amputation and death, but high HRQoL does not increase healing. Future studies into the influence of HRQoL on ulcer outcome are important in attempts to decrease treatment failure and mortality.

Diabetes Care, doi: 10 2337/dc13-1212

Marked differences in GPs' diagnosis of pneumonia between Denmark and Spain: a cross-sectional study

Christensen SF, Jørgensen LC, Cordoba G, Llor C, Siersma V, Bjerrum L

BACKGROUND: In patients with lower respiratory tract infections (LRTIs) it is a challenge to identify who should be treated with antibiotics. According to international guidelines, antibiotics should be prescribed to patients with suspected pneumonia while acute bronchitis is considered a viral infection and should, generally, not be treated with antibiotics. Overdiagnosis of pneumonia in patients with LRTIs may lead to antibiotic overprescribing.

AIMS: To investigate the prevalence of presumed pneumonia in patients with LRTI in two countries with different antibiotic prescribing rates (Denmark and Spain) and to compare which symptoms and clinical tests are of most importance for the GP when choosing a diagnosis of pneumonia rather than acute bronchitis.

METHODS: A cross-sectional study including GPs from Denmark and Spain was conducted as part of the EU-funded project HAPPY AUDIT. A total of 2,698 patients with LRTI were included.

RESULTS: In Denmark, 47% of the patients with LRTI were classified with a diagnosis of pneumonia compared with 11% in Spain. In Spain, fever and a positive x-ray weighted significantly more in the diagnosis of pneumonia than in Denmark. Danish GPs, however, attached more importance to dyspnoea/polypnoea and C-reactive protein levels >50mg/L. None of the other typical symptoms of pneumonia had a significant influence.

CONCLUSIONS: Our results indicate that GPs' diagnostic criteria for pneumonia differ substantially between Denmark and Spain. The high prevalence of pneumonia among Danish patients with LRTI may indicate overdiagnosis of pneumonia which, in turn, may lead to antibiotic overprescribing.

Prim Care Respir J. 2013 Dec;22(4):454-8. doi: 10.4104/pcrj.2013.00093

A systematic review of controlled interventions to reduce overweight and obesity in people with schizophrenia

Hjorth P, Davidsen AS, Kilian R, Skrubbeltrang C.

OBJECTIVE:  Overweight and obesity are generally found among patients with schizophrenia. This may lead to serious implications for health and wellbeing. The aim was to review controlled intervention studies on reducing overweight/obesity and/or reducing physical illness in patients with schizophrenia.

METHOD: A systematic literature search was carried out in the bibliographic databases PubMed (MEDLINE), Embase (Ovid), PsycInfo (Ovid) and Cinahl (Ebsco). We included all randomised and non-randomised clinically controlled studies that compared a non-pharmacological intervention, aimed at weight reduction and/or reducing physical illness, with standard care for patients with schizophrenia.

RESULTS: All 1713 references were evaluated for inclusion in the review. Twenty-three met the inclusion criteria and were categorised into four subgroups according to tested interventions: diet, exercise and cognitive behavioural therapy, or mixed combinations of the three. In this review, interventions showed efficacy in reducing weight and improving physical health parameters confirming that physical health improvement was possible in patients with schizophrenia.

CONCLUSION: The included studies indicate that the interventions reduced weight and improved physical health parameters in patients with schizophrenia.

Acta Psychiatr Scand. 2014 Jan 17. doi: 10.1111/acps.12245. [Epub ahead of print]

Increased number of applications for late termination of pregnancy in Denmark

Theibel SS, Petersson BH, Christensen AV

INTRODUCTION:  Last year, it was 40 years since the introduction of legal abortion until the 12th week of gestation and the possibility of late termination of pregnancy in Denmark. The aim of this study was to describe the development in applications for late termination of pregnancy in the 1986-2011-period focusing on indications related to the women's conditions.

MATERIAL AND METHODS: All applications for late termination of pregnancy in 1986 were reviewed by Nordentoft et al, and access to all applications from 2011 was granted by the abortion committees and the Appeals Board. All applications were reviewed in order to explore the development since 1986.

RESULTS: The total number of applications for late termination of pregnancy has increased by 45% from 1986 to 2011 with 594 and 862 applications, respectively. Despite this increase, the number of permissions granted with reference to the women's conditions has decreased. In 1986 and 2011, 488 and 382 women, respectively, applied for late termination of pregnancy with reference to the women's conditions. Of the 519 women who were granted permission in 1986, 31% were ≤ 20 years of age. In 2011 this age group represented only 12%.

CONCLUSION: Significant changes in the women's age and the reasons they provide when applying for late termination of pregnancy have been observed from 1986 to 2011. Further investigation of this subject will contribute to securing the best possible conditions for women going through late termination of pregnancy.

Dan Med J. 2014 Feb;61(2):A4782

High Antibiotic Consumption: A Characterisation of Heavy Users in Spain

Malo S(1), Rabanaque MJ, Feja C, Lallana MJ, Aguilar I, Bjerrum L.

Heavy antibiotic users are those individuals with the highest exposure to antibiotics. They play an important role as contributors to the increasing risk of antimicrobial resistance. We applied different methods to identify and characterise the group of heavy antibiotic users in Spain as well as their exposure to antibiotics. Data on outpatient prescribing of antimicrobials (ATC J01) in 2010 were obtained from a prescription database covering Aragón (northeastern Spain). The antimicrobial consumption at the individual level was analysed both according to the volume of DDD and the number of packages purchased per year. Heavy antibiotic users were identified according to Lorenz curves and characterised by age, gender and their antimicrobial prescription profile. Lorenz curves demonstrated substantial differences in the individual use of antimicrobials. Heavy antibiotic users (5% of individuals with highest consumption) were responsible for 21% of the total DDD consumed and received ≥6 packages per year. Elderly adults (≥60 years) and small children (0-9 years) were those exposed to the highest volume of antibiotics and with the most frequent exposure, respectively. Heavy users received a high proportion of antibiotics not 
recommended as first choice in primary health care. In conclusion, heavy antibiotic users consisted mainly of children and old adults. Inappropriate overuse of antibiotics (high quantity, high frequency and inappropriate antibiotic choice) lead to a substantial risk for the emergence and spread of resistant bacteria and interventions to reduce overuse of antibiotics should therefore primarily be targeted children and elderly people. This article is protected by copyright. All rights reserved.

Basic Clin Pharmacol Toxicol. 2014 Feb 11 doi: 10.1111/bcpt.12211. [Epub ahead of print]

The quality of outpatient antimicrobial prescribing: a comparison between two areas of northern and southern Europe

Malo S, Bjerrum L, Feja C, Lallana MJ, Abad JM, Rabanaque-Hernández MJ

PURPOSE: The aim of the study was to analyse and compare the quality of outpatient antimicrobial prescribing in Denmark and Aragón (in northeastern Spain), with the objective of assessing inappropriate prescribing.

METHODS: Outpatient antimicrobial prescription data were obtained from the National Institute for Health Data and Disease Control in Denmark, and from the Aragón Information System of Drug Consumption. The number of Defined Daily Doses  (DDD) of the different substances were calculated, and the quality of the antimicrobial prescription was analysed using the 'Drug Utilization 90 %' method and the European Surveillance of Antimicrobial Consumption (ESAC) quality indicators for outpatient antimicrobial use.

RESULTS: The majority of the prescriptions (90 % of total DDD) were comprised of 14 (of 39) different antimicrobials in Denmark, based mainly on narrow spectrum penicillin, and 11 (of 59) antimicrobials in Aragón, principally broad spectrum penicillins. The quality indicators described an elevated consumption of antimicrobials and an important seasonal variation in Aragón. In Denmark, the values obtained reflected a more moderate use with minor seasonal variation.

CONCLUSIONS: The results showed important differences between the two study areas in relation to quantity and quality of outpatient antimicrobial prescription. The data indicate an overuse (and/or misuse) of antimicrobials in the Spanish region, despite national and local guidelines. The pattern of prescription in Denmark reflects a better adherence to recommendations.

Eur J Clin Pharmacol. 2014 Mar;70(3):347-53

Complicated grief – a challenge in bereavement support in palliative care: an update of the field

Guldin M-B

Når livet slutter, påvirker det ikke blot den døende, men hele familien. Derfor omfatter den palliative behandling også støtte til de nærmeste gennem sygdomsforløbet og efter patientens død. Alligevel er der først for nylig udarbejdet forslag til kliniske guidelines om, hvordan man bedst støtter pårørende efter tab, og der er kun er begrænset viden om, hvilke tiltag der virker bedst. De seneste års forskningsresultater har peget på, at nogle mennesker oplever så smertelige tab, at det er svært at komme på fode igen, og man er begyndt at tale om ”kompliceret sorg” som klinisk fænomen. I den seneste udgave af den amerikanske diagnose­manual (DSM-V) er sorg ikke blevet anerkendt som diagnostisk kategori. I stedet diagnosticeres sorgen som depression, men dette giver nogle kliniske problemstillinger i forhold til intervention. Denne artikel ser nærmere på kompliceret sorg som en tabsrelateret lidelse. Et særligt fokus rettes mod aktuelle udfordringer i forskningsfeltet, hvor den akademiske verden kræver systematisk og evidensbaseret viden, mens de fagprofessionelle efterlyser effektive interventioner, som kan hjælpe de hårdest ramte pårørende. Hvis de to foci ikke møder hinanden, kan det i sig selv blive en komplicerende faktor for mennesker i sorg. 

Progress in Palliative Care. 2014 Jan [Epub ahead of print]

Identification of patients with incident cancers using administrative registry data

Larsen MB, Jensen H, Hansen RP, Olesen F, Vedsted P

Hurtig identifikation af patienter, der for første gang diagnosticeres med kræft, er ikke alene afgørende for patienten, men har også stor betydning for kvalitetsudviklingen af hele patient-forløbet fra symptom-debut til diagnose, behandling og revalidering eller palliativ indsats. Alligevel er det en udfordring at identificere nye kræftpatienter hurtigt og løbende i den danske sundhedssektor, for cancerregisteret opdateres kun én gang om året. Dette studie beskriver udviklingen af en valid og omkostningsbesparende algoritme, der kan identificere nydiagnosticerede (incidente) kræftpatienter. Algoritmen blev udviklet i 2008 og yderligere finjusteret i 2010. Begge udgaver viste gode egenskaber til at identificere nydiagnosticerede kræft­patienter, men algoritmen fra 2010 fungerede generelt en anelse bedre. Algoritmen fra 2010 identificerede over 95 % af kræftpatienterne i løbet af fire måneder efter diagnosen. Den nye algoritme har stort potentiale for fremtidig kvalitetssikring og forskning på området. Brugen kræver dog en afvejning mellem tidlig identifikation og høj validitet af diagnosen. Identifikation af patienterne efter en måned resulterer i en komplethedsgrad på 60 % mod 95 % efter fire måneder. Studiet, som bygger på data fra nationale registre og spørgeskemaer fra patienternes praktiserende læge, inkluderer 12.747 patienter, som blev diagnosticeret med kræft for første gang i 2008 (2008-kohorten), og 7.996 patienter, som blev diagnosticeret i 2010 (2010-kohorten). 

Dan Med J 2014 Feb;61(2):A4777

Kompliceret sorg

Guldin M-B

Sorg er et livsvilkår, som opstår efter tab. De fleste sorgreaktioner medfører psykisk smerte, belastning og forhøjet stress­niveau i en kortere eller længere periode. Men hvor invaliderende skal sorgreaktionen være for at blive klassificeret som en lidelse, der kræver behandling? Hvordan skelner man en normal fra en kompliceret sorgtilstand? Og hvordan identificerer man de komplicerede reaktioner, der tyder på, at tilstanden kan udvikle sig til en langvarig lidelse? Denne artikel ser nærmere på, om sorg kan klassificeres som en mental lidelse, og de grundlæggende kliniske udfordringer ved etableringen af en sorgdiagnose diskuteres. Diagnosticering af sorg har ikke alene stor betydning for behandlingen, men også for ressourcefordelingen i sundhedsvæsenet. Derfor er diagnosticering af sorg ikke alene et klinisk og fag­politisk emne, men også et samfundsmæssigt og økonomisk anliggende. Udvikling af kliniske retningslinjer kan være med til at sikre evidensbaseret behandling til de sværeste sorgtilstande. Det er også vigtigt, at hjælpen koordineres på tværs af sundhedssystemet, så behandlingen tilgår de sværeste tilstande, fx via palliativ indsats til den praktiserende læge og videre til praktiserende psykologer og psykiatere.

Psykolog Nyt 2014(4): 4-7

Position paper: Breast cancer screening, diagnosis, and treatment in Denmark

Christensen P, Vejborg IMM, Kroman NT, Holten IW, Garne JP, Vedsted P, Møller S, Lynge E

Diagnosticering, behandling og prognosen for brystkræft er gennem de seneste to årtier blevet væsentligt bedre i Danmark. Det første mammografiprogram blev indført i 1991, og frem til 2008-2010 var det ca. 20 % af de danske kvinder i alderen 50-69, der blev tilbudt screening. Dette studie undersøger, hvad indførelsen af mammografiscreeningprogrammerne betyder for patienterne. Resultaterne viser, at færre patienter får konstateret alvorlige stadier af brystkræft, at der sjældnere foretages mastektomi, og at der oftere foretages brystbevarende indgreb. Samtidig ser det ud til, at dødeligheden kan reduceres med 25 % for kvinder, der gennem en tiårig periode er blevet tilbudt screening. Studiet er baseret på danske data, og artiklen gennemgår status for både diagnosticering og behandling (herunder overdiagnosticering og overbehandling) i forbindelse med indførsel af screeningprogrammer for brystkræft.

Acta Oncol 2014 Feb 5 [Epub ahead of print]

Prevalence of depression, quality of life and antidepressant treatment in the Danish General Suburban Population Study

Ellervik C, Kvetny J, Christensen KS, Vestergaard M, Bech P

De danske praktiserende læger beskyldes ofte for at være for hurtige til at give diagnosen depression og at ordinere antidepressiv medicin på for løst et grundlag. De fleste læger anvender i dag spørgeskemaet Major Depression Inventory (MDI) i kombination med andre undersøgelser til at diagnosticere depression. Dette studie viser, at lægernes foretrukne værktøj næppe over­diagnosticerer depression, og at det er de mest deprimerede danskere, der får mest medicin. Studiet hviler på data fra knap 15.000 danskere, som indgik i Danish General Suburban Population Study (GESUS), Region Sjællands Befolkningsundersøgelse. Formålet med studiet var at estimere prævalensen af depression i baggrundsbefolkningen ved hjælp af MDI og undersøge sammenhængen med subjektivt velbefindende ved hjælp af WHO-5. Kun 2,3 % af de danskere, der indgik i undersøgelsen, viste tegn på depression efter at have besvaret MDI-skemaet, mens tallet for et lignende studie fra 2003 var 2,8 %. Begge målinger viser relativt lave prævalenstal, og forekomsten af depression ser altså ikke ud til at være steget gennem de seneste ti år. Forfatterne til artiklen anbefaler, at MDI-skemaet valideres på en population af patienter i almen praksis. 

Nord J Psychiatry. 2014 Jan 29 [Epub ahead of print]

Psychological distress, cardiovascular complications and mortality among people with screen-detected type 2 diabetes: follow-up of the ADDITION-Denmark trial

Dalsgaard EM, Vestergaard M, Skriver MV, Maindal, HT, Lauritzen T, Borch-Johnsen K, Witte D, Sandbæk A

Dette studie undersøger, om psykologisk belastning øger risikoen for kardiovaskulær sygdom og død blandt personer med type 2-diabetes. Forfatterne ser også nærmere på, om forskelle i metabolisk kontrol og indtag af ordineret medicin kan forklare dele af en eventuel sammenhæng. Studiet fandt, at 18 % af personer, som blev fundet med type 2-diabetes ved screening, led af psykisk belastning. Studiet viser, at psykisk belastede personer har 70 % højere risiko for at få CVD-event i 8,7 års follow-up og 80 % højere dødelighed i 10,9 års follow-up sammenlignet med personer med type 2-diabetes uden psykisk belastning. Psykisk belastning synes derimod ikke generelt at påvirke evnen til at opnå de opsatte mål for HbA1c, kolesterol og blodtryk. Studiet bygger på data fra 1533 personer i alderen 40-69 år, som fik konstateret type 2-diabetes ved screening i almen praksis i 2001-2006. Undersøgelsen udgør en del af ADDITION-studiet, der er et samarbejde mellem Storbritannien, Holland og Danmark med fokus på type 2-diabetes i almen praksis. Resultaterne indikerer, at det er vigtigt, at praktiserende læger også er opmærksomme på det mentale helbred blandt deres patienter med type 2-diabetes.

Diabetologia 2014 Jan 18

Psykiske reaktioner efter en blodprop i hjertet – et dårligt mentalt helbred kan have betydning for prognosen

Jepsen Nielsen T.

En blodprop i hjertet er en alvorlig livsbegivenhed, og mange mennesker reagerer efterfølgende med et nedsat psykisk velbefindende. Et nyt studie viser, at AMI-patienter, som får det psykisk dårligt – uden nødvendigvis at have depressionssymptomer – har en dårligere prognose end patienter med et godt psykisk helbred. De har både en højere risiko for at få nye hjerte-kar-tilfælde og en højere risiko for at dø. Resultaterne understreger, at AMI-patienter med et svækket mentalt helbred er en særligt sårbar patientgruppe. Derfor bør de sundhedsprofessionelle tage højde for både hjertesygdom og psykisk sårbarhed, når behandlingen skal tilrettelægges. Frem for at behandle én tilstand for at forbedre prognosen af den anden, skal begge behandles på samme tid. Det er også afgørende at se det hele menneske i behandlingen – bag al den moderne teknologi og de avancerede behandlingsmuligheder – og at spørge ind til patientens tanker om sygdommen og generelle psykiske tilstand.

BestPractice – Sygeplejersken i Almen Praksis 2014 7(2):36-37

The importance of contextualisation. Anthropological reflections on descriptive analysis, its limitations and implications

Andersen RS, Risør MB

Denne artikel ser nærmere på analyser af interviewdata. Forfatterne diskuterer kvaliteten af de analyser, som laves på basis af kvalitative interviews i nogle dele af den sundhedsvidenskabelige forskningsverden. Diskussionen tager afsæt i kvalitative retrospektive studier af kræft­patienter og forsinket lægesøgning og berører en række overordnede overvejelser i forbindelse med analyser af de ”verbaliserede forklaringer”, som naturligt konstrueres i en interviewsituation. Forfatternes ærinde er primært at belyse, hvilke begrænsninger der ligger i ’deskriptive  analyser’. De argumenterer for en mere kontekst- og proces­orienteret analytisk tilgang, hvor 1) forskningsfænomenets indlejring i sociale og kulturelle omgivelser samt 2) omgivelsernes mulige indflydelse på interviewsituationen tages til indtægt i analysen. 

Anthropology & Medicine 2014 Feb 3 [Epub ahead of print]

Information on risk of constipation for Danish users of opioids and their laxative use

Anton Pottegård, Thomas Bøllingtoft Knudsen, Kim van Heesch, Hassan Salmasi, Simon Schytte-Hansen, Jens Søndergaard

Background: While it is well known that use of opioids often cause constipation, little is known about the information given to patients regarding this potential sideeffect and their use of laxatives to prevent it.

Objective: To assess the degree of information provided by the prescriber to users of opioids by the time of the first prescription regarding the risk of constipation.

Method: Interviews with patients filling an opioid at a community pharmacy were performed by the dispensing pharmacist or pharmaconomist at the pharmacy. Information collected concerned the patient, the opioid, information received regarding constipation, current constipation and current laxative treatment.

Results: A total of 286 interviews were completed. Overall, 28.3 % remembered having received information about the risk of constipation by the time of the first prescription. Excluding 49 first-time opioid users, we found 91 laxative users and 146 non-laxative users, of whom 73.6 and 4.8 %, respectively, currently experienced constipation.

Conclusion: Only a small proportion of patients with a prescription for opioids remembered having had information on potential constipation caused by opioids and having received any recommendation on how to use laxatives to prevent constipation. Interventions should focus on whether constipation is present and on rational use of laxatives.

Int J Clin Pharm

Large cohort study finds a statistically significant association between excessive crying in early infancy and subsequent ear symptoms

Lise Hestbaek, Marianne Myhre Sannes, Jørgen Lous

Aim: The diagnosis of infantile colic is based on excessive crying. However, several causal factors can account for this disconcerting, nonspecific symptom. The main aim of this study was to investigate a possible association between excessive crying during the first 6 months of life and subsequent ear problems.

Methods: Data from a cohort study of 26 983 Danish children were used. Mothers participated in four telephone interviews and one questionnaire and provided information on crying in the first 6 months of life and ear symptoms at the ages of 6 months, 18 months and 7 years.

Results: There was a statistically significant association between excessive crying in infancy and subsequent ear symptoms. A gradual increase in subsequent ear problems was seen with increasing crying time at all the data collection times.

Conclusions: The results of this study suggest a possible link between excessive crying and ear infections. Whether such a link is causal or due to common underlying factors is still unknown. We recommend thorough ear examinations in children with symptoms compatible with infantile colic.

Acta Pædiatrica

Assessing decision quality in patient-centred care requires a preference-sensitive measure

Mette Kaltoft, Michelle Cunich, Glenn Salkeld, Jack Dowie

Abstract: A theory-based instrument for measuring the quality of decisions made using any form of decision technology, including both decision-aided and unaided clinical consultations is required to enable person- and patient-centred care and to respond positively to individual heterogeneity in the value aspects of decision making. Current instruments using the term 'decision quality' have adopted a decision- and thus condition-specific approach. We argue that patient-centred care requires decision quality to be regarded as both preference-sensitive across multiple relevant criteria and generic across all conditions and decisions. MyDecisionQuality is grounded in prescriptive multi criteria decision analysis and employs a simple expected value algorithm to calculate a score for the quality of a decision that combines, in the clinical case, the patient's individual preferences for eight quality criteria (expressed as importance weights) and their ratings of the decision just taken on each of these criteria (expressed as performance rates). It thus provides an index of decision quality that encompasses both these aspects. It also provides patients with help in prioritizing quality criteria for future decision making by calculating, for each criterion, the Incremental Value of Perfect Rating, that is, the increase in their decision quality score that would result if their performance rating on the criterion had been 100%, weightings unchanged. MyDecisionQuality, which is a web-based generic and preference-sensitive instrument, can constitute a key patient-reported measure of the quality of the decision-making process. It can provide the basis for future decision improvement, especially when the clinician (or other stakeholders) completes the equivalent instrument and the extent and nature of concordance and discordance can be established. Apart from its role in decision preparation and evaluation, it can also provide real time and relevant documentation for the patient's record.

J Health Serv Res Policy

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