The online survey was conducted from 2018 November 20th to 2019 June 30th. At the point of closing the online system on 2019 June 30th, we had received valid data from 105 participants in total. Of all these participants, there are 31 physicians, 48 patients who have or ever had thyroid diseases, and 26 normal citizens who had no thyroid diseases, we called citizens in this study (See Table 2).
Table 2
Sociodemographic data of participants
Characteristic
|
Frequency
|
Percentage
|
Gender
|
Male
|
55
|
52.4%
|
Female
|
50
|
47.6%
|
Age (years)
|
< 20
|
0
|
0
|
20–29
|
2
|
1.9%
|
30–39
|
5
|
4.8%
|
40–49
|
15
|
14.3%
|
50–59
|
20
|
19%
|
60–69
|
28
|
26.7%
|
> 70
|
35
|
33.3%
|
Stakeholders
|
Physician
|
31
|
29.5%
|
Patient
|
48
|
45.7%
|
Neither physician nor patient
|
26
|
24.8%
|
Medical specialists of Physicians
|
General practice
|
18
|
58.1%
|
Internal medicine
|
6
|
19.4%
|
Surgery
|
3
|
9.6%
|
Radiology
|
1
|
3.2%
|
Otolaryngology
|
1
|
3.2%
|
Other fields
|
2
|
6.4%
|
3.1 Perspectives of participants on decision criteria
Regarding weights provided by participants, Fig. 1 shows that the most important criteria was “Comparative effectiveness (0.088 ± 0.010)”, followed by “Type of therapeutic benefit (0.086 ± 0.010)”, and then “Disease severity (0.086 ± 0.011)”. Normalized weight across criteria was summing up to 1.0, higher weight indicates that the criterion is more important from participants’ view. As Fig. 1 shows, the least important criteria were three cost consequences of intervention relative criteria. The largest variations in weights were observed for “Cost of non-medical intervention (SD, 0.022)”, “Size of population (SD, 0.021)” and “Unmet needs (SD, 0.020)”. The smallest variations were “Quality of life (SD, 0.008)”, “Comparative effectiveness (SD, 0.010)”, “Type of therapeutic benefit (SD, 0.010)”.
Mean normalized weights were also calculated assigned to each criterion by three groups as physicians’ group, patients’ group and citizens’ group (Fig. 2). Physicians weighted “Safety of intervention” higher than the other two groups, for the physicians’ group 0.086 ± 0.011, for patients’ group 0.079 ± 0.014 and citizens’ group 0.079 ± 0.017. Large variance was also showed in ‘Type of preventive benefits’, for citizens’ group was 0.082 ± 0.011, for patients’ group was 0.084 ± 0.012, however, in the physicians’ group, the weight was much lower than in the other two groups with a weight of 0.072 ± 0.018. Similar situation also happened to the criterion of” Comparative patient perceived health”, the weights given by physicians 0.074 ± 0.021 lower than the other two groups, for patients 0.085 ± 0.008 and for citizens’ group 0.089 ± 0.009.
3.2 Scores
As Fig. 3 shows, for non-comparative criteria, “Type of preventive benefit” received the highest score (0.682 ± 0.261), which shows most participants gave highest performances score on the preventive methods for thyroid disease. Followed by “Type of therapeutic benefit”, this was scored 0.636 ± 0.188. Especially this criterion had the smallest SD, which indicates most participants have an agreement on therapeutic methods are highly useful for treating thyroid disease. For the category “Need of intervention”, “Unmet needs” received the smallest score 0.408 ± 0.251, followed by “Disease Severity”, with a score of 0.488 ± 0.211. But “Size of affected population” in the same category received a higher score 0.533 ± 0.196.
For comparative criteria, “Comparative effectiveness” received the highest score, 0.634 ± 0.402. However, in the meantime, the SD is also very high, which indicates some participants gave a very low score. This was also the case to other comparative criteria, all five comparative criteria got relatively higher SD compared to non-comparative criteria. “Comparative safety” in the same category “Treatment Interventions” got a low score of 0.299 ± 0.446. We designed this question as “How do you assess the safety of surgical treatments of TN?” In this category, the criterion “Comparative patient perceived health” got a very low score 0.006 ± 0.435. The question is: “How do you assess the influence of the diagnosis of TN on the quality of life of those affected?”
As shown in Fig. 4, we also calculated mean (SD) standardized scores by different stakeholders as physicians’ group, patients’ group and citizens’ group. The physicians’ group viewed the impact on ‘comparative effectiveness’ and ‘Quality of evidence’ higher than other criteria, however, the patients’ group and the citizens’ group gave ‘Type of preventive benefit’ and ‘Type of therapeutic benefit’ highest scores, respectively. Three criteria that also need to be highlighted are ‘Disease severity’, ‘Comparative safety’ and ‘Clinical practice guidelines’. Referring to ‘Disease severity’, the score of physicians’ group (0.419 ± 0.209) was smaller than in the patients’ group (0.479 ± 0.192), and much smaller than in the citizens’ group (0.585 ± 0.219). Referring to ‘Comparative safety’, the score of the physicians’ group (0.174 ± 0.534) was smaller than patients’ group (0.388 ± 0.432) and citizens’ group (0.285 ± 0.319). Another interesting criterion was ‘Clinical practice guidelines’, the score of the physicians’ group (0.420 ± 0.215) was also smaller than the other two groups (patients 0.583 ± 0.206, citizens 0.569 ± 0.185).
3.3 Value contribution
Figure 5 shows the mean (SD) value contribution of intervention on TN from all participants after adjusting the performance scores to the weights for each criterion. The mean value estimate of all criteria by all participants was 0.359 on a scale of 0 to 1. The highest value contributors were the ‘Comparative effectiveness’ (0.056 ± 0.004) and the ‘Type of preventive benefits’ (0.056 ± 0.025). The criteria of the ‘Comparative cost consequences-other medical costs’ (-0.018 ± 0.027), the ‘Comparative cost consequences-cost of intervention’ (-0.012 ± 0.028) and the ‘Comparative patients perceived health’ (-0.001 ± 0.037) were negatively contributed to the value.
As shown in Fig. 6, the highest value estimate of the intervention on TN reached 0.401 for citizens’ group and lowest value of 0.287 was reported for physicians’ group. The patients’ group reported a value of 0.368. This figure shows very clear that different stakeholders’ preferences and thoughts are different. In the physicians’ group, the highest value contributors were the ‘Comparative effectiveness’ (0.058 ± 0.042) and the ‘Quality of evidence’ (0.048 ± 0.022). In the patients’ group, the highest value contributors were the ‘Type of preventive benefits’ (0.059 ± 0.022) and the ‘Comparative effectiveness’ (0.058 ± 0.033). In the citizens’ group, the highest value contributors were the ‘Type of preventive benefits’ (0.066 ± 0.021) and the ‘Type of therapeutic benefits’ (0.061 ± 0.019).
3.4 Impacts of contextual criteria
Figure 7 illustrates qualitative contextual criteria. 59% participants considered “Mandate and scope of the healthcare system” (“How do you rate the impact of healthcare system on thyroid diagnostics”) had a positive impact. Consideration of “System capacity and appropriate use of intervention”, 63% participants thought it had a negative impact, and for “Population priorities and access”, with the question “How do you rate the influence of stakeholders on the procedure in thyroid diagnostics”, also 47% participants considered it had a negative impact. Nearly 58% participants thought “Political/historical/cultural context” had no impact on the intervention of thyroid nodules. The overall negative impact, no impact and positive impact was 38%, 35%, and 27%, respectively.