Course Level: Intermediate
Course Limit: 40
Format Requirements: The course will be based on: Llewellyn-Thomas HA. Threshold Technique. In: The Encyclopedia of Medical Decision Making. Thousand Oaks, CA: Sage Publications, 2009. pp. 1134-1137. This reading will be provided in the course teaching materials and reviewed with the course participants. A detailed annotated bibliography of other TT publications will be provided. The course format will involve: presentations by the course faculty; “hands-on” exercises with basic versions of the TT; small-group problem-solving; and full-group discussion sessions.
Background: The Threshold Technique (TT) measures attitudes towards a particular “target” therapy. It proceeds by repeatedly varying the level of a key attribute, and, with each variation, asking the respondent to choose between the “target” therapy and an alternate “reference” therapy. The TT is very flexible. [Consider a current analgesic (the reference) versus a new medication (the target) offering greater pain relief but with a higher risk of gastric bleed. TTs can reveal the minimal pain relief that patients would require—or the maximal risk of gastric bleed they would accept—before preferring the new drug over their current medication.] However, the TT focuses on a single attribute, so it can address only narrowly-defined, context-specific research problems. This course provides the skills needed to: appreciate the TT’s flexibility; identify the research problems that can/can’t be addressed using the TT; design different versions of the TT; and critique publications about the TT.
Description and Objectives: Course Objectives
- To understand the original motivations driving the development of the TT, its conceptual basis, and the rationale underlying the design and use of different versions of the TT.
- To gain skills in judging whether a particular TT is or isn’t scientifically appropriate for a particular research purpose, and in designing different versions of the TT that would be suitable for different research purposes.
- To gain awareness of the contributions that the TT—as a research tool—could make in clinical epidemiology, in the design of clinical trials, in the formulation of practice policies, and in resource allocation in public health policy.
Course Description
The course will involve four main teaching activities.
- The course faculty will present the TT’s background and outline its conceptual basis in multi-attribute utility assessment and in decisional conflict.
- The course faculty will explain the TT’s basic design principles, and illustrate some previous applications in a wide range of clinical research problems. These include eliciting patients’: maximal acceptable wait times for total joint replacement of the hip or knee, for radiation therapy, and for coronary artery bypass grafting; minimal required chances of symptom alleviation in the treatment of benign prostatic hyperplasia, osteoarthritis, and Crohn’s disease; and minimal required chances for survival in the treatment of lung cancer.
- Small groups will be formed. Each small group will be assigned a “case study” requiring them to design a version of the TT that could appropriately be used to address a particular research question/test a particular research hypothesis. Each small group will bring its work back to the full class for discussion and debate.
- Finally, the course faculty will highlight some future research challenges that the TT could help to resolve.