title: Development of an evidence-based decision pathway for vestibular schwannoma treatment options.
abstract: OBJECTIVE
  To integrate multiple sources of clinical information with patient feedback to build evidence-based decision support model to facilitate treatment selection for patients suffering from vestibular schwannomas (VS).
  
  
  METHODS
  This was a mixed methods study utilizing focus group and survey methodology to solicit feedback on factors important for making treatment decisions among patients. Two 90-minute focus groups were conducted by an experienced facilitator. Previously diagnosed VS patients were recruited by clinical investigators at the University of Pittsburgh Medical Center (UPMC). Classical content analysis was used for focus group data analysis. Providers were recruited from practices within the UPMC system and were surveyed using Delphi methods. This information can provide a basis for multi-criteria decision analysis (MCDA) framework to develop a treatment decision support system for patients with VS.
  
  
  RESULTS
  Eight themes were derived from these data (focus group + surveys): doctor/health care system, side effects, effectiveness of treatment, anxiety, mortality, family/other people, quality of life, and post-operative symptoms. These data, as well as feedback from physicians were utilized in building a multi-criteria decision model.
  
  
  CONCLUSIONS
  The study illustrated steps involved in the development of a decision support model that integrates evidence-based data and patient values to select treatment alternatives.
  
  
  CONCLUSIONS
  Studies focusing on the actual development of the decision support technology for this group of patients are needed, as decisions are highly multifactorial. Such tools have the potential to improve decision making for complex medical problems with alternate treatment pathways.
authors: Magee-Womens Research Institute, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA; Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA. Electronic address: linkfy@mail.upmc.edu.
authors: Faina
authors: F
authors: Linkov
authors: Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA.
authors: Benita
authors: B
authors: Valappil
authors: Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA.
authors: Jacob
authors: J
authors: McAfee
authors: Magee-Womens Research Institute, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA.
authors: Sharon L
authors: SL
authors: Goughnour
authors: Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA.
authors: Douglas M
authors: DM
authors: Hildrew
authors: Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA.
authors: Andrew A
authors: AA
authors: McCall
authors: Engineering and Public Policy, Carnegie Mellon University.
authors: Igor
authors: I
authors: Linkov
authors: Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA.
authors: Barry
authors: B
authors: Hirsch
authors: Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA.
authors: Carl
authors: C
authors: Snyderman
mesh_terms: D000066491:Clinical Decision-Making; D003661:Decision Support Techniques; D003697:Delphi Technique; D019317:Evidence-Based Medicine; D005260:Female; D017144:Focus Groups; D006801:Humans; D008297:Male; D009464:Neuroma, Acoustic / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D011379:Prognosis; D011788:Quality of Life; D016634:Radiosurgery / Q000009:adverse effects / Q000379:methods; D016019:Survival Analysis; D016896:Treatment Outcome; D057832:Watchful Waiting / Q000379:methods*