Supporting policy decision making

View the following completed projects:

International Patient Decision Aids Standards (IPDAS)

Alex Barratt is a member of the steering committee for the development of international standards for decision aid development. Other contributors include Kirsten McCaffery, Phyllis Butow and Lyndal Trevena. The project is coordinated by the Ottawa Health Research Group Canada, led by Annette O’Connor. Further information about this project is available online at this site.

Model of Outcomes of Screening Mammography: Information to Support Informed Choices

OBJECTIVE: To provide easy to use estimates of the benefits and harms of biennial screening mammography for women aged 40, 50, 60, and 70 years.

DESIGN: Markov process model, with data from BreastScreen Australia, the Australian Institute of Health and Welfare, and the Australian Bureau of Statistics.

MAIN OUTCOME MEASURE: Age specific outcomes expressed per 1000 women over 10 years.

RESULTS: For every 1000 women screened over 10 years, 167-251 (depending on age) receive an abnormal result; 56-64 of these women undergo at least one biopsy, 9-26 have an invasive cancer detected by screening, and 3-6 have ductal carcinoma in situ (DCIS) detected by screening. More breast cancers (both invasive and DCIS) are diagnosed among screened than unscreened women. There are about 0.5, 2, 3, and 2 fewer deaths from breast cancer over 10 years per 1000 women aged 40, 50, 60, and 70, respectively, who choose to be screened compared with women who decline screening at times determined by relevant policy.

CONCLUSION: Benefits and harms of screening mammography are relatively finely balanced. Quantitative estimates such as these can be used to support individual informed choices about screening.

Investigators: Alex Barratt, Kirsten Howard, Les Irwig, Glenn Salkeld, Nehmat Houssami.

National Indicators for Diabetes Education in Australia

This project is being managed by the Australian Health Policy Institute with membership on its advisory committee by Lyndal Trevena. It aims to establish a national framework of outcomes and indicators for diabetes education.

Systematic Review of the Literature on Communicating with Patients about Evidence

This is a summary of the evidence on effective strategies for increasing patient understanding, for communicating probabilistic information and for eliciting patient preferences. It is available online.
For more information or reprints contact Lyndal Trevena

Investigators: Lyndal Trevena, Heather Davey, Alex Barratt, Phyllis Butow, Patrina Caldwell.

Virtual Colonoscopy Project

In Australia, conventional colonoscopy is the diagnostic test of choice for the investigation of patients suspected of having colorectal disease. The number of colonoscopy procedures reimbursed through the nation’s universal health insurance scheme, Medicare, has risen exponentially over recent years. This rise has occurred in spite of a 20% reduction in the Medicare fee schedule in 2002. However, an alternative diagnostic test, a virtual colonoscopy, could potentially offer a cheaper and less invasive means of diagnosing colorectal disease. Virtual colonoscopy (VC) is a non-invasive procedure performed by a helical CT scan of the colon. In 2002, a National Bowel Cancer Screening Pilot Program has been established in Australia. If successful, these pilots will be a forerunner to a national mass colorectal cancer (CRC) screening program. Hence the Australian government is keen to explore whether resources should be allocated to virtual colonoscopy as a possible alternative to conventional colonoscopy in some patients. For this reason, a trial of the diagnostic accuracy of virtual colonoscopy and conventional colonoscopy is being conducted as part of the screening pilot of FOBTs (faecal occult blood tests). The trial will assess the diagnostic accuracy of the two procedures, the costs as well as patient preferences in a group of patients suspected of having colorectal disease. A discrete choice study of patient preferences for VC compared to conventional colonoscopy is being conducted to inform policy makers and clinicians about optimal service delivery for the investigation of patients suspected of having colorectal disease.

Investigators: Kirsten Howard, Glenn Salkeld.