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Title: Medical judgement and decision making in stratified medicine
Author: McMichael, Alan James
ISNI:       0000 0004 6494 3825
Awarding Body: Queen's University Belfast
Current Institution: Queen's University Belfast
Date of Award: 2017
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Background: Stratified medicine aims to use a patient's genotype and other individual characteristics to predict their treatment outcomes. Several treatments have been developed which may potentially offer patients an increased response to treatment. For instance 5% of patients with cystic fibrosis can be prescribed Ivacaftor based on a specific genetic mutation. However, it is unclear about how a patient's genotype may influence particular aspects of medical decision-making, despite the relevance that this may have in routine clinical practice. Methods: Medical decision-making was investigated using a series of discrete-choice experiments (DCEs) in which participants were asked to consider and choose one of the presented scenarios. Regarding profession decision-making, in particular, the PhD research investigated extent to which a patient's genotype influenced the treatment judgements and recommendations of psychiatrists (n=68). Patient decision-making was investigated by using DCEs to assess how people with cystic fibrosis (n=80) 'traded-off the risks and benefits that were associated with each treatment option. In the final study of the thesis, I investigated whether or not members of the public (n=2804) would be willing to incur an increase in tax to help fund stratified medicine treatments. Results: The main findings of these studies suggest that clinicians may be unduly influenced by a patient's genotype when judging a patient's response to treatment and in their treatment recommendations. Cystic fibrosis patients may not be willing to tolerate some of the increased risks associated with their treatment options. Thus clinicians should discuss the risks and benefits associated with treatments with their patients. The PhD research highlighted that members of the public may not be willing to pay an increase in taxation unless the majority of people were eligible for the stratified medicine treatment, a result that poses a challenge for stratified medicine because only few people are eligible for potentially more effective treatments. Conclusions: Clinicians need to be cautious about being unduly influenced by a patient's genotype and should discuss the risks and benefits associated with different treatment options. Further research is needed to understand how a patient's genotype may influence the decisions that are made at the clinician, patient and policy level.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available