Involving patients in decisions regarding preventive health interventions using the analytic hierarchy process

Abstract

Practice guidelines that recommend active patient involvement in decisions about preventive health interventions are becoming increasingly common. These decisions frequently involve difficult trade-offs between competing risks and benefits that require easily accessible information about the expected outcomes, superb doctor-patient communication, and effective integration of objective outcome data with individual values and preferences. Successful implementation of recommendations for shared decision-making in preventive health care will require the development of efficient methods for making these complex decisions in busy practice settings. This article describes how the analytic hierarchy process, a multiple criteria decision-making method, could facilitate successful implementation of shared decision-making regarding preventive health care in clinical practice. The method is illustrated using recent guidelines for colorectal cancer screening for average risk patients issued by the American Gastroenterological Association.

Figure 1

The basic AHP model format.

Figure 2

Example AHP model regarding the selection of a colorectal cancer screening programme. Prep = test preparation; FOBT = annual faecal occult blood tests; Flex Sig = flexible sigmoidoscopy every 5 years; DCBE = double contrast barium enema every 5 years; and Cscope = colonoscopy every 10 years.