Evidence map›Paper›PMID 32716354›Full record

ReviewJournal of Alzheimer's disease : JAD2020

Health Outcome Prioritization in Alzheimer's Disease: Understanding the Ethical Landscape.

Alex McKeown, Andrew Turner, Zuzanna Angehrn, Dianne Gove, Amanda Ly, Clementine Nordon, Mia Nelson, Claire Tochel, Brent Mittelstadt, Alex Keenan and 2 more

Open access · bronzeAbstract readReview
PubMed Full text at PMC Publisher
In one paragraph

Review in Journal of Alzheimer's disease : JAD, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
0.6field-weighted citation impact, top 17% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed, 9 citations in OpenAlex.

  1. Review
  2. Review
  3. Article
  4. Review
  5. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors at 8 institutions in 4 countries.

Alex McKeownDepartment of Psychiatry and Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, UK.
Andrew TurnerThe National Institute for Health Research Applied Research Collaboration West [NIHR ARC West] at University Hospitals Bristol NHS Foundation Trust, University of Bristol, Bristol, UK.
Zuzanna AngehrnCertara, Loerrach, Germany.
Dianne GoveAlzheimer Europe, Luxembourg.
Amanda LyMRC Integrative Epidemiology Unit & Centre for Academic Mental Health, University of Bristol, Bristol, UK.
Clementine NordonCESP, INSERM U1178, Paris, France.
Mia NelsonUsher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK.
Claire TochelUsher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK.
Brent MittelstadtOxford Internet Institute, University of Oxford, Oxford, UK.
Alex KeenanJanssen Pharmaceutica NV, Titusville, NJ, USA.
Michael SmithAlzheimer Scotland Centre for Policy and Practice, University of the West of Scotland, Paisley, Scotland, UK.
Ilina SinghDepartment of Psychiatry and Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, UK.
University of Oxford · GBUniversity of Edinburgh · GBAlzheimer Europe · LUAlzheimer Scotland · GBInserm · FRJanssen (United States) · USUniversity Hospitals Bristol NHS Foundation Trust · GBUniversity of Bristol · GB

Funding

Department of Health IS-BRC-1215-20005Medical Research Council MC_PC_17215Wellcome TrustWellcome Trust 104825/Z/14/ZWellcome Trust 203132/Z/16/Z
6 · The paper itself

Abstract

backgroundDementia has been described as the greatest global health challenge in the 21st Century on account of longevity gains increasing its incidence, escalating health and social care pressures. These pressures highlight ethical, social, and political challenges about healthcare resource allocation, what health improvements matter to patients, and how they are measured. This study highlights the complexity of the ethical landscape, relating particularly to the balances that need to be struck when allocating resources; when measuring and prioritizing outcomes; and when individual preferences are sought.

objectiveHealth outcome prioritization is the ranking in order of desirability or importance of a set of disease-related objectives and their associated cost or risk. We analyze the complex ethical landscape in which this takes place in the most common dementia, Alzheimer's disease.

methodsNarrative review of literature published since 2007, incorporating snowball sampling where necessary. We identified, thematized, and discussed key issues of ethical salience.

resultsEight areas of ethical salience for outcome prioritization emerged: 1) Public health and distributive justice, 2) Scarcity of resources, 3) Heterogeneity and changing circumstances, 4) Knowledge of treatment, 5) Values and circumstances, 6) Conflicting priorities, 7) Communication, autonomy and caregiver issues, and 8) Disclosure of risk.

conclusionThese areas highlight the difficult balance to be struck when allocating resources, when measuring and prioritizing outcomes, and when individual preferences are sought. We conclude by reflecting on how tools in social sciences and ethics can help address challenges posed by resource allocation, measuring and prioritizing outcomes, and eliciting stakeholder preferences.

Indexed as

Alzheimer DiseaseDelivery of Health CareHumansOutcome Assessment, Health CareAlzheimer’s diseasedementiaethicshealth priorities

Identifiers

PMID32716354
PMCPMC7592677
OpenAlexW3043851174

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.