The Rationale and Design of Public Involvement in Health Technology Assessment: A Systems Thinking Approach
Notice bibliographique
Résumé
Governments worldwide utilise an evaluation methodology named Health Technology Assessment (HTA) to decide which medical treatments they will fund. HTA evaluates the safety and (cost-) effectiveness, and broader implications of introducing new interventions into a given healthcare system. Involving the public in HTA is considered an appropriate way to collect information on the social and ethical implications of new medical interventions. This thesis examines why and how the public should be involved in HTA processes and healthcare funding policymaking. Its objective is to propose directions on how to improve public involvement in HTA based on an understanding of stakeholders’ perspectives. The thesis uses a theoretical framework based on two Systems Thinking approaches: Complex Adaptive Systems and Soft Systems Methodology. The thesis is composed of four studies. First, there is a survey of members of the public to examine public involvement in policy decisions. Then, there is a theoretical piece on how to define which types of public might take part in HTA. Finally, there is a Canadian case study comprising two studies. The first study features interviews with HTA stakeholders to understand their views about public involvement processes, and the second study features focus groups with members of the public to ascertain their views on being involved in HTA. The reasons for involving the public in policy are clarified; engagement processes are used to increase trust and transparency in decision making as part of governance strategies. A taxonomy for defining and differentiating the public from other types of stakeholders in HTA is proposed, along with the reasons and goals for engaging with each group. Examining HTA as a system shows that the HTA process and its outcomes are influenced by stakeholders’ worldviews and values both at a personal and group level. Members of the public report being suspicious of the interests driving HTA stakeholders and see public input as a counterbalance to those interests. Members of the public also suggest the use of a mixed-methods approach to public involvement to provide information to HTA processes and meet the public’s democratic aspirations to take part in government decisions. This research shows that the challenges related to increasing and improving public involvement in HTA do not pertain exclusively to methodological problems such as a lack of standards for the design and evaluation of such processes. The main challenge is the differences in worldviews of those involved in HTA and those not directly involved. However, if all stakeholders’ worldviews are explicitly considered, conflicts can be managed with provisional agreements that enable policy decisions to move forward. The inclusion of members of the public adds a set of values that may be different from the values of actors already involved in HTA and thus may warrant significant changes to current HTA processes. This body of work indicates that establishing formal procedures to foster discussion between stakeholders was seen a useful by those directly or indirectly involved in HTA as it allows them to understand a range of viewpoints and access potential solutions to challenges in this field.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,117 | 0,066 |
| Méta-épidémiologie (sens strict) | 0,002 | 0,002 |
| Méta-épidémiologie (sens large) | 0,002 | 0,003 |
| Bibliométrie | 0,008 | 0,006 |
| Études des sciences et des technologies | 0,009 | 0,062 |
| Communication savante | 0,019 | 0,018 |
| Science ouverte | 0,006 | 0,013 |
| Intégrité de la recherche | 0,015 | 0,013 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,007 | 0,002 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».