, Volume 36, Issue 12, pp 1453–1462 | Cite as

Understanding and Identifying Key Issues with the Involvement of Clinicians in the Development of Decision-Analytic Model Structures: A Qualitative Study

  • Samantha HusbandsEmail author
  • Susan Jowett
  • Pelham Barton
  • Joanna Coast
Original Research Article



Decision-analytic models play an essential role in informing healthcare resource allocation decisions; however, their value to decision makers will depend on model structures being clinically valid to determine cost-effectiveness recommendations. Clinician involvement can help modellers to develop clinically valid but straightforward structures; however, there is little guidance available on methods for clinician input to model structure. This study aims to provide an in-depth exploration of clinician involvement in structural development, highlighting key issues and generating recommendations to optimise practices.


A qualitative study was undertaken with a range of modellers and clinicians working in different modelling contexts. In-depth interviews and case studies using observations were carried out to understand how clinicians are involved in model structural development and to identify problems and optimal approaches from informants’ perspectives.


Twenty-four interviews and two case studies were undertaken with modellers and modelling teams. Key issues included the number and diversity of clinicians contributing to structural development, potentially impacting the generalisability of structures, and problems with clinician understanding of important information to contribute to model pathways. Modellers and clinicians suggested that clinician training in modelling could enhance structural processes.


Recommendations to optimise current practices include recruiting clinicians from a variety of backgrounds and using discussions between experts to develop valid and generalisable structures. Future research should focus on developing training materials for clinicians and finding ways to help modellers recruit clinicians from different settings.



Samantha Husbands was primarily responsible for conducting and analysing the qualitative research and for the conception and drafting of the manuscript. Susan Jowett, Pelham Barton and Joanna Coast assisted with the conception of the manuscript and critically reviewed early drafts. Joanna Coast analysed a proportion of the qualitative interviews with modellers. All authors read, edited and approved the final manuscript.

Compliance with Ethical Standards


Financial support for this study was provided in part by a scholarship from the University of Birmingham, and in part by a PhD Scholarship from Universitas 21 for the Canadian element of the work.

Conflict of Interest

Samantha Husbands, Susan Jowett, Pelham Barton, and Joanna Coast declare they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Ethical approval was granted from the Science, Technology, Engineering and Mathematics Ethical Review Committee at the University of Birmingham and the University of British Columbia Behavioural Research Ethics Board (references: ERN_12-1553 and H13-01796).

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Data Availability

The data generated during the current study are not publicly available due to the highly identifiable nature of the data collected from the interviewees and about the case studies.

Supplementary material

40273_2018_705_MOESM1_ESM.docx (13 kb)
Supplementary material 1 (DOCX 13 kb)


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Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  1. 1.Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolEngland, UK
  2. 2.Health Economics Unit, Institute of Applied Health ResearchUniversity of BirminghamBirminghamEngland, UK

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