Shared decision-making--transferring research into practice: the Analytic Hierarchy Process (AHP)

Abstract

Objective: To illustrate how the Analytic Hierarchy Process (AHP) can be used to promote shared decision-making and enhance clinician-patient communication.

Methods: Tutorial review.

Results: The AHP promotes shared decision-making by creating a framework that is used to define the decision, summarize the information available, prioritize information needs, elicit preferences and values, and foster meaningful communication among decision stakeholders.

Conclusions: The AHP and related multi-criteria methods have the potential for improving the quality of clinical decisions and overcoming current barriers to implementing shared decision-making in busy clinical settings. Further research is needed to determine the best way to implement these tools and to determine their effectiveness.

Practice implications: Many clinical decisions involve preference-based trade-offs between competing risks and benefits. The AHP is a well-developed method that provides a practical approach for improving patient-provider communication, clinical decision-making, and the quality of patient care in these situations.

Figure 1. A model of clinical decision-making

Footnote: Adapted from Haynes and Devereaux. Other stakeholders may include: other health care providers, family members, friends, health care system administrators, and health care policy makers. See text for details.

Figure 2. AHP decision model with optional variations showing different perspectives and how to explore the effects of uncertainty

Footnote: The basic AHP model is shown in the clear boxes on levels 1, 3 and 4. The model can be enlarged to explore the effects of different perspectives by performing separate analyses from different points of view. This is illustrated by adding the upper part of the shaded boxes on level two. In this model separate analyses would be performed from the perspective of both the patient and the clinician. Similarly the model can be enlarged to explore the effects of future uncertainty. This is illustrated using the lower part of the shaded boxes on level 2. This model would compare the options under two different scenarios: benign disease and aggressive disease. See text for further details. Abbreviations: Admin = Ease of Administration.

Figure 3. AHP gastrointestinal bleeding diagnosis model.

Figure 4. AHP Management of neonatal group B streptococcal sepsis model.

Figure 5. AHP model used in colorectal cancer screening decision aid study.