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Jonsson, H., Andersson, A., Mao, Z. & Nyström, L. (2024). Age-specific differences in tumour characteristics between screen-detected and non-screen-detected breast cancers in women aged 40–74 at diagnosis in Sweden from 2008 to 2017. Journal of Medical Screening
Open this publication in new window or tab >>Age-specific differences in tumour characteristics between screen-detected and non-screen-detected breast cancers in women aged 40–74 at diagnosis in Sweden from 2008 to 2017
2024 (English)In: Journal of Medical Screening, ISSN 0969-1413, E-ISSN 1475-5793Article in journal (Refereed) Epub ahead of print
Abstract [en]

Objective:  To analyze differences between screen-detected and non-screen-detected invasive breast cancers by tumour characteristics and age at diagnosis in the nationwide population-based mammography screening program in Sweden.

Methods:  Data were retrieved from the National Quality Register for Breast Cancer for 2008-2017. Logistic regression analysis was used to estimate the likelihood for a tumour to be screen-detected by tumour characteristics and age group at diagnosis.

Results:  In total there were 51,429 invasive breast cancers in the target age group for mammography screening of 40-74 years. Likelihood of screen detection decreased with larger tumour size, lymph node metastases, higher histological grade and distant metastasis. Odds ratios (ORs) for negative oestrogen (ER) and progesterone (PgR) were 0.41 and 0.57; for positive HER2, 0.62; for Ki-67 high versus low, 0.49. Molecular sub-types had OR of 0.56, 0.40 and 0.28, respectively, for luminal B-like, HER2-positive and triple negative versus luminal A-like. Adjusting for tumour size (T), lymph node status (N), age, year and county at diagnosis slightly elevated the ORs. Statistically significant interactions between tumour characteristics and age were found (p < 0.05) except for ER and PgR. The age group 40-49 deviated most from the other age groups.

Conclusions:  Our study demonstrates that screen-detected invasive breast cancers had more favourable tumour characteristics than non-screen-detected after adjusting for age, year and county of diagnosis, and even after adjusting for T and N. The trend towards favourable tumour characteristics was less pronounced in the 40-49 age group compared to the other age groups, except for ER and PgR.

Place, publisher, year, edition, pages
Sage Publications, 2024
Keywords
Breast cancer, detection mode, mammography, screening program, tumour characteristics
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:umu:diva-222415 (URN)10.1177/09691413241237616 (DOI)38454634 (PubMedID)2-s2.0-85187110390 (Scopus ID)
Funder
Cancerforskningsfonden i Norrland
Available from: 2024-03-22 Created: 2024-03-22 Last updated: 2024-03-22
Brunström, M., Ng, N., Dahlström, J., Lindholm, L. H., Norberg, M., Nyström, L., . . . Carlberg, B. (2022). Association of education and feedback on hypertension management with risk for stroke and cardiovascular disease. Blood Pressure, 31(1), 31-39
Open this publication in new window or tab >>Association of education and feedback on hypertension management with risk for stroke and cardiovascular disease
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2022 (English)In: Blood Pressure, ISSN 0803-7051, E-ISSN 1651-1999, Vol. 31, no 1, p. 31-39Article in journal (Refereed) Published
Abstract [en]

PURPOSE: Education and feedback on hypertension management has been associated with improved hypertension control. This study aimed to assess the effectiveness of such interventions to reduce the risk of stroke and cardiovascular events. MATERIALS AND METHODS: Individuals ≥18 years with a blood pressure (BP) recording in Västerbotten or Södermanland County during the study period 2001 to 2009 were included in 108 serial cohort studies, each with 24 months follow-up. The primary outcome was risk of first-ever stroke in Västerbotten County (intervention) compared with Södermanland County (control). Secondary outcomes were first-ever major adverse cardiovascular event (MACE), myocardial infarction, and heart failure, as well as all-cause and cardiovascular mortality. All outcomes were analysed using time-to-event data included in a Cox proportional hazards model adjusted for age, sex, hypertension, diabetes, coronary artery disease, atrial fibrillation, systolic BP at inclusion, marital status, and disposable income. RESULTS: A total of 121 365 individuals (mean [SD] age at inclusion 61.7 [16.3] years; 59.9% female; mean inclusion BP 142.3/82.6 mmHg) in the intervention county were compared to 131 924 individuals (63.6 [16.2] years; 61.2% female; 144.1/81.1 mmHg) in the control county. A first-ever stroke occurred in 2 823 (2.3%) individuals in the intervention county, and 3 584 (2.7%) individuals in the control county (adjusted hazard ratio 0.96, 95% CI 0.90 to 1.03). No differences were observed for MACE, myocardial infarction or heart failure, whereas all-cause mortality (HR 0.91, 95% CI 0.87 to 0.95) and cardiovascular mortality (HR 0.91, 95% CI 0.85 to 0.98) were lower in the intervention county. CONCLUSIONS: This study does not support an association between education and feedback on hypertension management to primary care physicians and the risk for stroke or cardiovascular outcomes. The observed differences for mortality outcomes should be interpreted with caution.

Place, publisher, year, edition, pages
Taylor & Francis Group, 2022
Keywords
antihypertensive treatment, continuous medical education, Hypertension, implementation science, primary care
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-192773 (URN)10.1080/08037051.2022.2041393 (DOI)000757622100001 ()35179089 (PubMedID)2-s2.0-85124775764 (Scopus ID)
Funder
Swedish Research Council, K2007-70X-20515-01-2Swedish Research Council, K2009-69X-20515-04-2Swedish Research Council, 2017-02246Västerbotten County CouncilSwedish Society for Medical Research (SSMF)
Available from: 2022-03-09 Created: 2022-03-09 Last updated: 2023-05-22Bibliographically approved
Musarandega, R., Ngwenya, S., Murewanhema, G., Machekano, R., Magwali, T., Nyström, L., . . . Munjanja, S. (2022). Changes in causes of pregnancy-related and maternal mortality in Zimbabwe 2007-08 to 2018-19: findings from two reproductive age mortality surveys. BMC Public Health, 22(1), Article ID 923.
Open this publication in new window or tab >>Changes in causes of pregnancy-related and maternal mortality in Zimbabwe 2007-08 to 2018-19: findings from two reproductive age mortality surveys
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2022 (English)In: BMC Public Health, E-ISSN 1471-2458, Vol. 22, no 1, article id 923Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Reducing maternal mortality is a priority of Sustainable Development Goal 3.1 which requires frequent epidemiological analysis of trends and patterns of the causes of maternal deaths. We conducted two reproductive age mortality surveys to analyse the epidemiology of maternal mortality in Zimbabwe and analysed the changes in the causes of deaths between 2007-08 and 2018-19.

METHODS: We performed a before and after analysis of the causes of death among women of reproductive ages (WRAs) (12-49 years), and pregnant women from the two surveys implemented in 11 districts, selected using multi-stage cluster sampling from each province of Zimbabwe (n=10); an additional district selected from Harare. We calculated mortality incidence rates and incidence rate ratios per 10000 WRAs and pregnant women (with 95% confidence intervals), in international classification of disease groups, using negative binomial models, and compared them between the two surveys. We also calculated maternal mortality ratios, per 100 000 live births, for selected causes of pregnancy-related deaths.

RESULTS: We identified 6188 deaths among WRAs and 325 PRDs in 2007-08, and 1856 and 137 respectively in 2018-19. Mortality in the WRAs decreased by 82% in diseases of the respiratory system and 81% in certain infectious or parasitic diseases' groups, which include HIV/AIDS and malaria. Pregnancy-related deaths decreased by 84% in the indirect causes group and by 61% in the direct causes group, and HIV/AIDS-related deaths decreased by 91% in pregnant women. Direct causes of death still had a three-fold MMR than indirect causes (151 vs. 51 deaths per 100 000) in 2018-19.

CONCLUSION: Zimbabwe experienced a decline in both direct and indirect causes of pregnancy-related deaths. Deaths from indirect causes declined mainly due to a reduction in HIV/AIDS-related and malaria mortality, while deaths from direct causes declined because of a reduction in obstetric haemorrhage and pregnancy-related infections. Ongoing interventions ought to improve the coverage and quality of maternal care in Zimbabwe, to further reduce deaths from direct causes.

Place, publisher, year, edition, pages
BioMed Central, 2022
Keywords
Causes of death, Civil registration and vital statistics, CRVS, ICD-10, ICD-MM, International classification of diseases, Maternal death, Maternal mortality, Pregnancy-related deaths, Sustainable development goals, Women of reproductive ages, Zimbabwe
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-194904 (URN)10.1186/s12889-022-13321-7 (DOI)000792635900002 ()35534811 (PubMedID)2-s2.0-85129459289 (Scopus ID)
Funder
Bill and Melinda Gates FoundationStiftelsen Gamla Tjänarinnor
Available from: 2022-06-01 Created: 2022-06-01 Last updated: 2023-08-28Bibliographically approved
Musarandega, R., Cresswell, J., Magwali, T., Makosa, D., MacHekano, R., Ngwenya, S., . . . Munjanja, S. (2022). Maternal mortality decline in Zimbabwe, 2007/2008 to 2018/2019: findings from mortality surveys using civil registration, vital statistics and health system data. BMJ Global Health, 7(8), Article ID e009465.
Open this publication in new window or tab >>Maternal mortality decline in Zimbabwe, 2007/2008 to 2018/2019: findings from mortality surveys using civil registration, vital statistics and health system data
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2022 (English)In: BMJ Global Health, E-ISSN 2059-7908, Vol. 7, no 8, article id e009465Article in journal (Refereed) Published
Abstract [en]

Background: Sustainable Development Goal (SDG) 3.1 target is to reduce the global maternal mortality ratio (MMR) to less than 70 maternal deaths per 100 000 live births by 2030. In the Ending Preventable Maternal Mortality strategy, a supplementary target was added, that no country has an MMR above 140 by 2030. We conducted two cross-sectional reproductive age mortality surveys to analyse changes in Zimbabwe's MMR between 2007-2008 and 2018-2019 towards the SDG target.

Methods: We collected data from civil registration, vital statistics and medical records on deaths of women of reproductive ages (WRAs), including maternal deaths from 11 districts, randomly selected from each province (n=10) using cluster sampling. We calculated weighted mortality rates and MMRs using negative binomial models, with 95% CIs, performed a one-way analysis of variance of the MMRs and calculated the annual average reduction rate (ARR) for the MMR.

Results: In 2007-2008 we identified 6188 deaths of WRAs, 325 pregnancy-related deaths and 296 maternal deaths, and in 2018-2019, 1856, 137 and 130, respectively. The reproductive age mortality rate, weighted by district, declined from 11 to 3 deaths per 1000 women. The MMR (95% CI) declined from 657 (485 to 829) to 217 (164 to 269) deaths per 100 000 live births at an annual ARR of 10.1%.

Conclusions: Zimbabwe's MMR declined by an annual ARR of 10.1%, against a target of 10.2%, alongside declining reproductive age mortality. Zimbabwe should continue scaling up interventions against direct maternal mortality causes to achieve the SDG 3.1 target by 2030.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2022
Keywords
epidemiology, health services research, maternal health, public Health
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-198904 (URN)10.1136/bmjgh-2022-009465 (DOI)000837259900002 ()35926916 (PubMedID)2-s2.0-85136077795 (Scopus ID)
Funder
Bill and Melinda Gates Foundation, OPP1169546
Available from: 2022-09-05 Created: 2022-09-05 Last updated: 2022-09-05Bibliographically approved
Gani, M. S., Ullah, A. K., Subramaniam, T., Nyström, L. & Chowdhury, A. M. (2022). Reduction in Lifetime Fertility Through MNCS in Rural Bangladesh. Asia-Pacific Journal of Rural Development, 31(2), 149-171
Open this publication in new window or tab >>Reduction in Lifetime Fertility Through MNCS in Rural Bangladesh
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2022 (English)In: Asia-Pacific Journal of Rural Development, ISSN 1018-5291, E-ISSN 2074-0131, Vol. 31, no 2, p. 149-171Article in journal (Refereed) Published
Abstract [en]

This study assesses the effect of a customised Maternal Neonatal and Child Survival (MNCS) intervention in the rural areas of Bangladesh. This study attempts to estimate the lifetime fertility rate and the proportion of live births ≥3, and the age-specific lifetime fertility patterns among the women of reproductive age. This quasi-experimental study used impact evaluation data from the MNCS intervention in 2013 and compared these with the baseline data collected in 2008. We used a multi-stage, cluster random sampling technique to include 6,000 and 4,800 women in 2008 and 2013, respectively. The respondents were either mothers who had alive/deceased infants or the mothers whose pregnancy was terminated or who had living children of 12–59 months without pregnancy outcomes in the preceding year of the surveys. Based on the mean difference of live births from baseline to endline year for each intervention union, and then we compared these two areas (intervention and control unions). Overall lifetime fertility rate declined significantly in high-performing intervention unions (from 2.6 to 2.2/woman, p < .001) or in control unions (from 2.4 to 2.2/woman; p < .001). The degree of reduction of fertility increased significantly with age, and such a change was most prominent in the case of women ≥35 years old. Multivariate analyses suggest that the likelihood of having live births ≥3 reduced significantly in high-performed intervention compared to control unions. In conclusion, the probability of reducing lifetime fertility over time increases with a higher level of access, degree and duration of the customised intervention.

Keywords
Lifetime fertility, IMNCS intervention, BRAC, rural Bangladesh
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-193030 (URN)10.1177/10185291211065788 (DOI)
Available from: 2022-03-10 Created: 2022-03-10 Last updated: 2022-03-11Bibliographically approved
Mao, Z., Nyström, L. & Jonsson, H. (2021). Breast cancer screening with mammography in women aged 40-49 years: impact of length of screening interval on effectiveness of the program. Journal of Medical Screening, 28(2), 200-206, Article ID 0969141320918283.
Open this publication in new window or tab >>Breast cancer screening with mammography in women aged 40-49 years: impact of length of screening interval on effectiveness of the program
2021 (English)In: Journal of Medical Screening, ISSN 0969-1413, E-ISSN 1475-5793, Vol. 28, no 2, p. 200-206, article id 0969141320918283Article in journal (Refereed) Published
Abstract [en]

Objectives: To estimate the impact on the effectiveness of Swedish breast cancer screening program in women aged 40-49 years of shortening the screening interval from 21 months to 18 or 12 months.

Methods: The reduction in breast cancer mortality among participants in screening with mammography was previously estimated in the Swedish SCReening of Young women (SCRY) study to be 29%. The expected increased effectiveness with a hypothetical shorter screening interval than the average of 21 months in SCRY was calculated using data about the women who died from breast cancer even though they participated in the SCRY program.

Results: During the study period, 547 women who participated in the index screening round died from breast cancer. Shortening the screening interval to 18 months led to an improved effectiveness of 0.7-3.9% considering interval cancers only and of 1.3-7.6% considering screening-detected cancers only, and for both interval and screening-detected cancers the improvement was 1.9-11.5% when the assumed mortality reduction for the deceased cases varied from 5% to 30%. Shortening the screening interval to 12 months increased the effectiveness by 1.6-9.8% for interval cancers and by 2.9-17.4% for both interval and screening-detected cancers.

Conclusion: Shortening the screening interval for women aged 40-49 years to 18 or 12 months might further reduce the breast cancer mortality rate.

Place, publisher, year, edition, pages
Sage Publications, 2021
Keywords
Breast cancer, mammography, mortality, evaluation, screening interval
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-174263 (URN)10.1177/0969141320918283 (DOI)000532947200001 ()32404033 (PubMedID)2-s2.0-85084573812 (Scopus ID)
Note

Article first published online: May 13, 2020

Available from: 2020-08-19 Created: 2020-08-19 Last updated: 2021-12-10Bibliographically approved
Giorgi Rossi, P., Lebeau, A., Canelo-Aybar, C., Saz-Parkinson, Z., Quinn, C., Langendam, M., . . . Young, K. (2021). Recommendations from the European Commission Initiative on Breast Cancer for multigene testing to guide the use of adjuvant chemotherapy in patients with early breast cancer, hormone receptor positive, HER-2 negative. British Journal of Cancer, 124(9), 1503-1512
Open this publication in new window or tab >>Recommendations from the European Commission Initiative on Breast Cancer for multigene testing to guide the use of adjuvant chemotherapy in patients with early breast cancer, hormone receptor positive, HER-2 negative
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2021 (English)In: British Journal of Cancer, ISSN 0007-0920, E-ISSN 1532-1827, Vol. 124, no 9, p. 1503-1512Article, review/survey (Refereed) Published
Abstract [en]

Background: Predicting the risk of recurrence and response to chemotherapy in women with early breast cancer is crucial to optimise adjuvant treatment. Despite the common practice of using multigene tests to predict recurrence, existing recommendations are inconsistent. Our aim was to formulate healthcare recommendations for the question “Should multigene tests be used in women who have early invasive breast cancer, hormone receptor-positive, HER2-negative, to guide the use of adjuvant chemotherapy?”

Methods: The European Commission Initiative on Breast Cancer (ECIBC) Guidelines Development Group (GDG), a multidisciplinary guideline panel including experts and three patients, developed recommendations informed by systematic reviews of the evidence. Grading of Recommendations Assessment, Development and Evaluation (GRADE) Evidence to Decision frameworks were used. Four multigene tests were evaluated: the 21-gene recurrence score (21-RS), the 70-gene signature (70-GS), the PAM50 risk of recurrence score (PAM50-RORS), and the 12-gene molecular score (12-MS).

Results: Five studies (2 marker-based design RCTs, two treatment interaction design RCTs and 1 pooled individual data analysis from observational studies) were included; no eligible studies on PAM50-RORS or 12-MS were identified and the GDG did not formulate recommendations for these tests.

Conclusions: The ECIBC GDG suggests the use of the 21-RS for lymph node-negative women (conditional recommendation, very low certainty of evidence), recognising that benefits are probably larger in women at high risk of recurrence based on clinical characteristics. The ECIBC GDG suggests the use of the 70-GS for women at high clinical risk (conditional recommendation, low certainty of evidence), and recommends not using 70-GS in women at low clinical risk (strong recommendation, low certainty of evidence).

Place, publisher, year, edition, pages
Springer, 2021
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:umu:diva-186339 (URN)10.1038/s41416-020-01247-z (DOI)2-s2.0-85101181473 (Scopus ID)
Available from: 2021-07-22 Created: 2021-07-22 Last updated: 2021-07-22Bibliographically approved
Brunström, M., Ng, N., Dahlström, J., Lindholm, L. H., Lönnberg, G., Norberg, M., . . . Carlberg, B. (2020). Association of Physician Education and Feedback on Hypertension Management With Patient Blood Pressure and Hypertension Control. JAMA Network Open, 3(1), Article ID e1918625.
Open this publication in new window or tab >>Association of Physician Education and Feedback on Hypertension Management With Patient Blood Pressure and Hypertension Control
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2020 (English)In: JAMA Network Open, E-ISSN 2574-3805, Vol. 3, no 1, article id e1918625Article in journal (Refereed) Published
Abstract [en]

Importance: Elevated systolic blood pressure (SBP) is the most important risk factor for premature death worldwide. However, hypertension detection and control rates continue to be suboptimal.

Objective: To assess the association of education and feedback to primary care physicians with population-level SBP and hypertension control rates.

Design, Setting, and Participants: This pooled series of 108 population-based cohort studies involving 283 079 patients used data from primary care centers in 2 counties (Västerbotten and Södermanland) in Sweden from 2001 to 2009. Participants were individuals aged 18 years or older who had their blood pressure (BP) measured and recorded in either county during the intervention period. All analyses were performed in February 2019.

Exposures: An intervention comprising education and feedback for primary care physicians in Västerbotten County (intervention group) compared with usual care in Södermanland County (control group).

Main Outcomes and Measures: Difference in mean SBP levels between counties and likelihood of hypertension control in the intervention county compared with the control county during 24 months of follow-up.

Results: A total of 136 541 unique individuals (mean [SD] age at inclusion, 64.6 [16.1] years; 57.0% female; mean inclusion BP, 142/82 mm Hg) in the intervention county were compared with 146 538 individuals (mean [SD] age at inclusion, 65.7 [15.9] years; 58.3% female; mean inclusion BP, 144/80 mm Hg) in the control county. Mean SBP difference between counties during follow-up, adjusted for inclusion BP and other covariates, was 1.1 mm Hg (95% CI, 1.0-1.1 mm Hg). Hypertension control improved by 8.4 percentage points, and control was achieved in 37.8% of participants in the intervention county compared with 29.4% in the control county (adjusted odds ratio, 1.30; 95% CI, 1.29-1.31). Differences between counties increased during the intervention period and were more pronounced in participants with higher SBP at inclusion. Results were consistent across all subgroups.

Conclusions and Relevance: This study suggests that SBP levels and hypertension control rates in a county population may be improved by educational approaches directed at physicians and other health care workers. Similar strategies may be adopted to reinforce the implementation of clinical practice guidelines for hypertension management.

Place, publisher, year, edition, pages
American Medical Association, 2020
National Category
General Practice Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-167169 (URN)10.1001/jamanetworkopen.2019.18625 (DOI)000606753400005 ()31913490 (PubMedID)2-s2.0-85077675217 (Scopus ID)
Available from: 2020-01-10 Created: 2020-01-10 Last updated: 2023-09-05Bibliographically approved
Schunemann, H. J., Lerda, D., Quinn, C., Follmann, M., Alonso-Coello, P., Rossi, P. G., . . . Saz-Parkinson, Z. (2020). Breast Cancer Screening and Diagnosis: A Synopsis of the European Breast Guidelines. Annals of Internal Medicine, 172(1), 46-56
Open this publication in new window or tab >>Breast Cancer Screening and Diagnosis: A Synopsis of the European Breast Guidelines
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2020 (English)In: Annals of Internal Medicine, ISSN 0003-4819, E-ISSN 1539-3704, Vol. 172, no 1, p. 46-56Article in journal (Refereed) Published
Abstract [en]

Description: The European Commission Initiative for Breast Cancer Screening and Diagnosis guidelines (European Breast Guidelines) are coordinated by the European Commission's Joint Research Centre. The target audience for the guidelines includes women, health professionals, and policymakers.

Methods: An international guideline panel of 28 multidisciplinary members, including patients, developed questions and corresponding recommendations that were informed by systematic reviews of the evidence conducted between March 2016 and December 2018. GRADE (Grading of Recommendations Assessment, Development and Evaluation) Evidence to Decision frameworks were used to structure the process and minimize the influence of competing interests by enhancing transparency. Questions and recommendations, expressed as strong or conditional, focused on outcomes that matter to women and provided a rating of the certainty of evidence.

Recommendations: This synopsis of the European Breast Guidelines provides recommendations regarding organized screening programs for women aged 40 to 75 years who are at average risk. The recommendations address digital mammography screening and the addition of hand-held ultrasonography, automated breast ultrasonography, or magnetic resonance imaging compared with mammography alone. The recommendations also discuss the frequency of screening and inform decision making for women at average risk who are recalled for suspicious lesions or who have high breast density.

Place, publisher, year, edition, pages
Amer Coll Physicians, 2020
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:umu:diva-167646 (URN)10.7326/M19-2125 (DOI)000506650200008 ()31766052 (PubMedID)2-s2.0-85077931254 (Scopus ID)
Available from: 2020-02-03 Created: 2020-02-03 Last updated: 2023-03-24Bibliographically approved
Baldeh, T., Saz-Parkinson, Z., Muti, P., Santesso, N., Morgano, G. P., Wiercioch, W., . . . Schunemann, H. J. (2020). Development and use of health outcome descriptors: a guideline development case study. Health and Quality of Life Outcomes, 18(1), Article ID 167.
Open this publication in new window or tab >>Development and use of health outcome descriptors: a guideline development case study
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2020 (English)In: Health and Quality of Life Outcomes, ISSN 1477-7525, E-ISSN 1477-7525, Vol. 18, no 1, article id 167Article in journal (Refereed) Published
Abstract [en]

Background: During healthcare guideline development, panel members often have implicit, different definitions of health outcomes that can lead to misunderstandings about how important these outcomes are and how to balance benefits and harms. McMaster GRADE Centre researchers developed ‘health outcome descriptors’ for standardizing descriptions of health outcomes and overcoming these problems to support the European Commission Initiative on Breast Cancer (ECIBC) Guideline Development Group (GDG). We aimed to determine which aspects of the development, content, and use of health outcome descriptors were valuable to guideline developers.

Methods: We developed 24 health outcome descriptors related to breast cancer screening and diagnosis for the European Commission Breast Guideline Development Group (GDG). Eighteen GDG members provided feedback in written format or in interviews. We then evaluated the process and conducted two health utility rating surveys.

Results: Feedback from GDG members revealed that health outcome descriptors are probably useful for developing recommendations and improving transparency of guideline methods. Time commitment, methodology training, and need for multidisciplinary expertise throughout development were considered important determinants of the process. Comparison of the two health utility surveys showed a decrease in standard deviation in the second survey across 21 (88%) of the outcomes.

Conclusions: Health outcome descriptors are feasible and should be developed prior to the outcome prioritization step in the guideline development process. Guideline developers should involve a subgroup of multidisciplinary experts in all stages of development and ensure all guideline panel members are trained in guideline methodology that includes understanding the importance of defining and understanding the outcomes of interest.

Place, publisher, year, edition, pages
BioMed Central, 2020
Keywords
Health outcomes, Health states, Health utility, Guideline methodology
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:umu:diva-173334 (URN)10.1186/s12955-020-01338-8 (DOI)000540320900001 ()32503619 (PubMedID)2-s2.0-85086008051 (Scopus ID)
Available from: 2020-07-02 Created: 2020-07-02 Last updated: 2023-03-23Bibliographically approved
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