1
|
Crossnohere NL, Fischer R, Vroom E, Furlong P, Bridges JFP. A Comparison of Caregiver and Patient Preferences for Treating Duchenne Muscular Dystrophy. THE PATIENT - PATIENT-CENTERED OUTCOMES RESEARCH 2022; 15:577-588. [PMID: 35243571 PMCID: PMC8894129 DOI: 10.1007/s40271-022-00574-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/23/2022] [Indexed: 12/03/2022]
Abstract
Background and Objectives Caregivers routinely inform medical and regulatory decision making in rare pediatric diseases. While differences in treatment preferences across caregivers and patients have been observed for Duchenne muscular dystrophy, this evidence was limited by small samples of patients and results were confounded by patient age and disease progression. We tested caregiver and patient preference concordance for treating Duchenne. Methods Preferences and demographic/clinical information from 115 caregivers and 107 patients were collected in an international study (response = 80%) using a previously developed discrete-choice experiment consisting of 12 experimentally controlled choice tasks. Each task presented two profiles that varied across four attributes: disease progression, drug failure probability, kidney damage risk, and fracture risk. Caregivers and patients were matched 1:1 based on patient age. We tested for concordance across each task and by comparing caregivers’ and patients’ maximum acceptable risk of drug failure, kidney damage, and fracture for a slowing of disease progression. Results The final analysis included 77 caregivers and 77 patients. No differences were observed in nationality (p = 0.969), disease stage (p = 0.180), or demographic/clinical factors (p = 0.093–0.857); however, patients were more optimistic (p = 0.030). Caregivers and patients chose similarly across tasks (p = 0.101–0.993). To slow disease progression by 1 year, caregivers and patients would tolerate a 9% and 11% increase in drug failure probability, respectively (p = 0.267). Alternatively, they would accept a 3% and 4% increase in the risk of kidney damage (p = 0.719) or a 15% and 20% increase in the risk of fracture (p = 0.534). Conclusions Caregivers and patients had concordant preferences for treating Duchenne. Providers and regulators can trust both caregiver and patient report of preferences to inform medical decision making. Supplementary Information The online version contains supplementary material available at 10.1007/s40271-022-00574-y.
Collapse
|
2
|
Unmet Therapeutic Needs of Non-Ambulatory Patients with Duchenne Muscular Dystrophy: A Mixed-Method Analysis. Ther Innov Regul Sci 2022; 56:572-586. [PMID: 35325439 PMCID: PMC8943787 DOI: 10.1007/s43441-022-00389-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 02/21/2022] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Duchenne muscular dystrophy has been a launching pad for patient-focused drug development (PFDD). Yet, PFDD efforts have largely neglected non-ambulatory patients. To support PFDD efforts in this population, we primarily sought to understand the needs of non-ambulatory Duchenne patients and, secondarily, to examine these needs in the context of the PUL-PROM-a validated patient-reported outcome measure of upper limb functioning. METHODS Non-ambulatory Duchenne patients or their caregivers from eight countries answered open-ended survey questions about patients' needs related to their most significant symptoms and important benefits of new treatments. The PUL-PROM was used to evaluate patients' upper limb functioning and was compared to data collected on non-ambulatory stage and quality of life. We thematically analyzed open-ended data, descriptively analyzed close-ended data, and compared themes by non-ambulatory stage. RESULTS The study included 275 participants. Mean patient age was 24. Most patients were early-stage non-ambulatory (67%). Thematic analysis identified three congruent themes between significant symptoms and important benefits of new treatments: muscle functioning, especially upper limb function; body system functioning; and quality of life. Muscle functioning and body system functioning were endorsed more frequently in responses from early- and late-stage patients, respectively. Mean PUL-PROM total score was 22 with higher scores in early-stage patients (p ≤ 0.001). Upper limb function positively correlated with quality of life (r = 0.42, p ≤ 0.001). DISCUSSION Non-ambulatory Duchenne patients want new treatments that improve upper limb functioning and body system functioning, and not exclusively regaining ambulation. The PUL-PROM can be used as a patient-centric measure that accounts for the needs of later-stage Duchenne patients.
Collapse
|
3
|
Aartsma-Rus A, Vroom E, O'Reilly D. The Role of Patient Involvement When Developing Therapies. Nucleic Acid Ther 2021; 32:118-122. [PMID: 34597188 PMCID: PMC9058870 DOI: 10.1089/nat.2021.0048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The drug development process is a long and arduous one, especially for rare diseases. Patient and patient representatives can and should be involved in this process from an early stage, since they have the perspective of living with a disease on a daily basis and can best identify which symptoms are the largest burden and which benefits would be more important to them. In this perspective, we outline how patients can be involved optimally in drug development. We outline success factors such as finding the right partners, bilateral education, having realistic expectations, and an open and honest dialog with all stakeholders.
Collapse
Affiliation(s)
- Annemieke Aartsma-Rus
- Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Daniel O'Reilly
- RNA Therapeutics Institute, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| |
Collapse
|
4
|
Tsai JH, Crossnohere NL, Strong T, Bridges JFP. Measuring Meaningful Benefit-Risk Tradeoffs to Promote Patient-Focused Drug Development in Prader-Willi Syndrome: A Discrete-Choice Experiment. MDM Policy Pract 2021; 6:23814683211039457. [PMID: 34497876 PMCID: PMC8419554 DOI: 10.1177/23814683211039457] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 06/28/2021] [Indexed: 01/06/2023] Open
Abstract
Background. Prader-Willi syndrome (PWS) is a rare neurodevelopmental disorder causing quality of life impairments such as insatiable hunger (hyperphagia) and obesity. We explored caregivers’ willingness to assume treatment risk in exchange for reduced hyperphagia according to a PWS-validated observer-reported outcome measure. Methods. We partnered with PWS patient organizations to develop a discrete-choice experiment exploring caregivers’ benefit-risk tradeoffs for emerging PWS treatments. The treatment benefit was a reduction in hyperphagia (as measured by a 0-, 5-, or 10-point change on the Hyperphagia Questionnaire for Clinical Trials [HQ-CT]). Treatment risks included weight gain (none, 5%, 10%), added risk of skin rash (none, 10%, 20%), and risk of liver damage (none, 1 in 1000, 10 in 1000). Preference models were estimated using mixed logistic regression and maximum acceptable risk. We explored differences in preferences across familial caregivers of patients with and without hyperphagia. Results. Four hundred sixty-eight caregivers completed the online survey. The majority of caregivers reported that patients experienced hyperphagia (68%) and half of patients experienced obesity (52%). Caregivers of patients without hyperphagia were willing to accept greater weight gain (16.4% v. 8.1%, P = 0.004) and a higher risk of skin rash (11.7% v. 6.2% P = 0.008) as compared to caregivers of patients with hyperphagia. Caregivers of patients with hyperphagia would accept a higher risk of liver damage as compared to caregivers of patients without hyperphagia (11.9 out of 1000 v. 6.4 out of 1000, P = 0.04). Conclusions. This research demonstrates that caregivers are willing to accept risk in exchange for a five-point improvement on the HQ-CT, a smaller marginal improvement than had been previously classified as meaningful. Patient experience with hyperphagia is a modifier in how much risk caregivers will accept.
Collapse
Affiliation(s)
| | - Norah L Crossnohere
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, Ohio
| | - Theresa Strong
- Foundation for Prader-Willi Research, Walnut, California
| | - John F P Bridges
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, Ohio
| |
Collapse
|
5
|
Gonzalez JM, Boeri M. The Impact of the Risk Functional Form Assumptions on Maximum Acceptable Risk Measures. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2021; 14:827-836. [PMID: 33961275 DOI: 10.1007/s40271-021-00518-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/12/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Discrete-choice experiments (DCEs) are increasingly conducted to quantify risk tolerance by computing maximum acceptable risk (MAR) for improvements in efficacy or other benefits gained from new medical treatments. To compute MARs from DCE data, respondents are asked to make choices under uncertainty between treatments. Specific treatment-related harms are included in the choice questions as probabilistic adverse events (AEs), and choice variation with the probability of these outcomes is assumed to indicate their effect on the expected utility of treatments. With a limited number of comparisons between profiles, calculation of MARs requires understanding how outcome probabilities that are not explicitly considered in the DCE can change the value of medical technologies. This study aims to examine how various assumptions on the expected disutility of these excluded probabilities can result in different MAR measures. METHODS We summarize commonly used empirical specifications for the expected disutility of AEs and derive the resulting MAR functions. We then discuss an empirical application on treatments to delay bone metastases in oncology patients with solid tumors. RESULTS A total of 187 respondents completed the DCE. Results show the impact of making various assumptions about the expected disutility of AEs, and the resulting MAR values for specific health benefits. As expected, different assumptions resulted in variations in MAR values for specific health benefits. Even with small differences in MAR measures, our results suggest that the assumptions evaluated here can lead to different conclusions about the acceptability of a medical technology. CONCLUSION Results show possible systematic variations in MARs caused by the assumed form of the effect of changes in the probability of AEs. Furthermore, we find that different assumptions can lead to different conclusions about the acceptability of a medical technology, even when MAR distributions overlap. This result suggests that researchers should evaluate the assumptions they are making for these effects and use sensitivity analysis to evaluate the robustness of risk-tolerance measures from stated-preference data.
Collapse
|
6
|
Crossnohere NL, Fischer R, Lloyd A, Prosser LA, Bridges JFP. Assessing the Appropriateness of the EQ-5D for Duchenne Muscular Dystrophy: A Patient-Centered Study. Med Decis Making 2021; 41:209-221. [DOI: 10.1177/0272989x20978390] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background Duchenne muscular dystrophy is a rare degenerative neuromuscular disorder with pediatric onset. Recent approvals in Duchenne have placed attention on the economic evaluation in pricing and reimbursement decisions across a range of rare conditions. We sought to assess the appropriateness of the EQ-5D, a common measure of generic health state utility, for use among patients and caregivers affected by Duchenne. Methods An international, cross-sectional sample of adults with Duchenne and caregivers reported patient health status using self- or proxy-reported EQ-5D-3L. Appropriateness was assessed across 6 domains of concern raised by stakeholders in Duchenne. These concerns were that the EQ-5D/EQ-VAS would not capture meaningful differences in health status, correlate with disease-specific measures, reflect real health status, exhibit face validity, be accurately interpreted, and be low burden. We evaluated these concerns by comparing EQ-5D index score and EQ-VAS scores to other condition-specific functional measures and open- and closed-ended questions. Results In total, 263 participants (74% response) completed the survey, 24% of whom were adult patients. Most participants lived in the United States or United Kingdom (58%). Patient age ranged from 1 to 48 y. EQ-5D index was higher in ambulatory than nonambulatory patients (0.60 v. 0.30, P < 0.001) and was negatively correlated with upper limb impairment ( r = 0.61, P < 0.001). Three-quarters of respondents agreed that EQ-5D measured real health status (74%). Most respondents interpreted EQ-VAS anchors of best and worst imaginable health as full health (61%) and death/near death (58%). Respondents indicated the EQ-5D was easy to understand (86%) and answer (71%). Conclusions Contrary to anecdotal concerns, we found support for the appropriateness of EQ-5D to assess health status in Duchenne. While other measures may be more sensitive to specific outcomes in Duchenne, there may be some value in results using the EQ-5D measure.
Collapse
Affiliation(s)
- Norah L. Crossnohere
- Department of Biomedical Informatics, Ohio State University Wexner Medical Center, Columbus, OH
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ryan Fischer
- Parent Project Muscular Dystrophy, Hackensack, NJ, USA
| | | | | | - John F. P. Bridges
- Department of Biomedical Informatics, Ohio State University Wexner Medical Center, Columbus, OH
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
7
|
Chetty-Makkan CM, Hoffmann CJ, Charalambous S, Botha C, Ntshuntshe S, Nkosi N, Kim HY. Youth Preferences for HIV Testing in South Africa: Findings from the Youth Action for Health (YA4H) Study Using a Discrete Choice Experiment. AIDS Behav 2021; 25:182-190. [PMID: 32607914 DOI: 10.1007/s10461-020-02960-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We conducted a discrete choice experiment (DCE) and quantified preferences for HIV testing among South African youth (Nov 2018 to Mar 2019). Six attributes and levels were identified through qualitative methods: source of HIV information; incentive amount and type; social support; testing method; and location. Each participant chose one of two options that comprised six attributes across 18 questions. Conditional logistic regression estimated the degree of preference [β]. Of 130 participants, median age was 21 years (interquartile range 19-23 years), majority female (58%), and 85% previously tested for HIV. Testing alone over accompanied by a friend (β = 0.22 vs. - 0.35; p < 0.01); SMS text over paper brochures (β = 0.13 vs. - 0.10; p < 0.01); higher incentive values (R50) over no incentive (β = 0.09 vs. - 0.07; p = 0.01); and food vouchers over cash (β = 0.06 vs. β = - 0.08; p = 0.01) were preferred. Testing at a clinic or home and family encouragement were important. Tailoring HTS to youth preferences may increase HIV testing.
Collapse
Affiliation(s)
- Candice M Chetty-Makkan
- The Aurum Institute, Aurum House, The Ridge, 29 Queens Road, Parktown, Johannesburg, 2193, South Africa.
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Christopher J Hoffmann
- The Aurum Institute, Aurum House, The Ridge, 29 Queens Road, Parktown, Johannesburg, 2193, South Africa
- John Hopkins University, Baltimore, USA
| | - Salome Charalambous
- The Aurum Institute, Aurum House, The Ridge, 29 Queens Road, Parktown, Johannesburg, 2193, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Claire Botha
- The Aurum Institute, Aurum House, The Ridge, 29 Queens Road, Parktown, Johannesburg, 2193, South Africa
| | - Simphiwe Ntshuntshe
- The Aurum Institute, Aurum House, The Ridge, 29 Queens Road, Parktown, Johannesburg, 2193, South Africa
| | - Nolwazi Nkosi
- The Aurum Institute, Aurum House, The Ridge, 29 Queens Road, Parktown, Johannesburg, 2193, South Africa
| | - Hae-Young Kim
- Africa Health Research Institute, Durban, KwaZulu-Natal, South Africa
- Department of Population Health, New York University School of Public Health, New York, USA
| |
Collapse
|
8
|
Barnard AM, Riehl SL, Willcocks RJ, Walter GA, Angell AM, Vandenborne K. Characterizing Enrollment in Observational Studies of Duchenne Muscular Dystrophy by Race and Ethnicity. J Neuromuscul Dis 2020; 7:167-173. [PMID: 31929119 DOI: 10.3233/jnd-190447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Observational research benefits from inclusion of diverse cohorts. To characterize racial and ethnic diversity in observational and natural history research studies of Duchenne muscular dystrophy (DMD), highly cited and influential observational studies were identified. Fourteen United States-based articles were included. All studies cited >70% White participants with the majority having few racial minority participants. Enrollment of Black/African American individuals was particularly limited (<5% in all but one study), and Hispanic/Latino participants ranged from 3.3- 26.5% of cohorts. These results suggest a need for effective strategies to recruit, enroll, and retain racially and ethnically diverse populations into observational research in DMD.
Collapse
Affiliation(s)
- Alison M Barnard
- Department of Physiology and Functional Genomics, University of Florida, Gainesville, FL, USA
| | - Samuel L Riehl
- Department of Physical Therapy, University of Florida, Gainesville, FL, USA
| | | | - Glenn A Walter
- Department of Physiology and Functional Genomics, University of Florida, Gainesville, FL, USA
| | - Amber M Angell
- Department of Occupational Therapy, University of Florida, Gainesville, FL, USA
| | - Krista Vandenborne
- Department of Physical Therapy, University of Florida, Gainesville, FL, USA
| |
Collapse
|
9
|
Choong Wong S, Joseph S, Capaldi N, Marco MD, Dunne J, Guglieri M, Horrocks I, Straub V, Faisal Ahmed S. A survey of the feasibility of developing osteoporosis clinical trials in Duchenne muscular dystrophy: Survey of the opinion of young people with Duchenne muscular dystrophy, families and clinicians. Clin Trials 2020; 18:39-50. [PMID: 33012180 DOI: 10.1177/1740774520958395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND/AIMS Given the extent of osteoporosis in people with Duchenne muscular dystrophy treated with glucocorticoids and the limited evidence of bone-protective therapies, clinical trials are needed. We conducted surveys to obtain the opinion of young people with Duchenne muscular dystrophy, parents/guardians and neuromuscular clinicians on the feasibility of osteoporosis clinical trials in this population. METHODS Online surveys were sent to three groups: (a) people with a confirmed diagnosis of Duchenne muscular dystrophy (≥14 years), (b) parents and guardians and (c) neuromuscular clinicians in the UK NorthStar Clinical Network. Surveys (a) and (b) were distributed via the UK Duchenne muscular dystrophy Registry. RESULTS Survey respondents included 52 people with Duchenne muscular dystrophy with a median age of 17 years (range: 14, 40) and 183 parents/guardians. Fourteen out of 23 (61%) NorthStar centres responded. Of the 52 people with Duchenne muscular dystrophy, 13 (25%) were very concerned about their bone health and 21 (40%) were slightly concerned. Of the 183 parents/guardians, 75 (41%) were very concerned about their son's bone health and 90 (49%) were slightly concerned. Fractures and quality of life were the top two main outcome measures identified by people with Duchenne muscular dystrophy. Fractures and bone density were the top two main outcome measures identified by parents/guardians and neuromuscular clinicians. Thirty percent of people with Duchenne muscular dystrophy and 40% of parents/guardians would not take part if an osteoporosis trial involved a placebo that was administered parenterally. Only 2 of the 14 NorthStar centres (14%) would enrol people with Duchenne muscular dystrophy if a parenteral placebo was used in an osteoporosis trial in Duchenne muscular dystrophy. CONCLUSION There is great awareness of bone health and the need for bone-protective trials among people with Duchenne muscular dystrophy and their carers. However, a proportion of people with Duchenne muscular dystrophy and parents are reluctant to participate in a placebo-controlled osteoporosis trial that included a parenteral therapy. A larger proportion of health care experts are unwilling to enrol their patients in such a trial. Our finding is relevant for the design of bone-protective studies in Duchenne muscular dystrophy.
Collapse
Affiliation(s)
- Sze Choong Wong
- Developmental Endocrinology Research Group, Royal Hospital for Children, University of Glasgow, Glasgow, UK
| | - Shuko Joseph
- Developmental Endocrinology Research Group, Royal Hospital for Children, University of Glasgow, Glasgow, UK.,Paediatric Neurosciences Research Group, Royal Hospital for Children, Glasgow, UK
| | - Nadia Capaldi
- Developmental Endocrinology Research Group, Royal Hospital for Children, University of Glasgow, Glasgow, UK
| | - Marina Di Marco
- Paediatric Neurosciences Research Group, Royal Hospital for Children, Glasgow, UK.,Scottish Muscle Network, Queen Elizabeth University Hospital, Glasgow, UK
| | - Jennifer Dunne
- Paediatric Neurosciences Research Group, Royal Hospital for Children, Glasgow, UK
| | - Michela Guglieri
- John Walton Muscular Dystrophy Research Centre, Institute of Genetic Medicine, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, UK
| | - Iain Horrocks
- Paediatric Neurosciences Research Group, Royal Hospital for Children, Glasgow, UK
| | - Volker Straub
- John Walton Muscular Dystrophy Research Centre, Institute of Genetic Medicine, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, UK
| | - S Faisal Ahmed
- Developmental Endocrinology Research Group, Royal Hospital for Children, University of Glasgow, Glasgow, UK
| | | |
Collapse
|
10
|
Crossnohere NL, Fischer R, Crossley E, Vroom E, Bridges JFP. The evolution of patient-focused drug development and Duchenne muscular dystrophy. Expert Rev Pharmacoecon Outcomes Res 2020; 20:57-68. [DOI: 10.1080/14737167.2020.1734454] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Norah L. Crossnohere
- Department of Health, Behavior and Society, Johns Hopkins School of Public Health, Baltimore, MD, USA
- Department of Biomedical Informatics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Ryan Fischer
- Parent Project Muscular Dystrophy, Hackensack, NJ, USA
| | | | - Elizabeth Vroom
- Duchenne Parent Project Muscular Dystrophys, Amsterdam, NL, Netherlands
| | - John FP Bridges
- Department of Health, Behavior and Society, Johns Hopkins School of Public Health, Baltimore, MD, USA
- Department of Biomedical Informatics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| |
Collapse
|
11
|
Abstract
PURPOSE OF REVIEW The current review highlights the growing number of available methods used to measure patient preferences and discusses how this impacts preference research in rheumatology. Spurred by the growing role of preferences in regulatory decisions and drug development, researchers have begun applying preference methods to study questions beyond the clinical context. We explore these trends, provide case studies highlighting changes in measuring patient preferences, compare strengths and weaknesses of common stated-preference methods, and discuss considerations for the future use of these methods. RECENT FINDINGS Early literature on patient preferences often mimicked clinical practice, asking whether treatment A is better or worse than treatment B for a patient. Early applications of patient preference methods in rheumatology aimed to value different attributes of treatments, but remained focused on informing clinical questions. Spurred by interest in preferences by regulatory agencies and patient-centeredness throughout the product lifecycle, there are now a wide array of methods available to measure preference. SUMMARY Although these different preference methods have strengths and weaknesses, they serve to highlight the broad number of questions that could help rheumatology beyond the clinical context. Researchers in rheumatology now have the opportunity to better serve diverse stakeholders by considering how these methods could aid in clinical trial design, regulatory policy, and other elements of the medical product life cycle.
Collapse
|
12
|
Wilson L, Lin L, Singh K. The Patient Perspective: Putting the Patient at the Center of the Translational Innovation Process. Clin Pharmacol Ther 2019; 107:82-84. [PMID: 31758800 DOI: 10.1002/cpt.1686] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 10/15/2019] [Indexed: 12/20/2022]
Affiliation(s)
- Leslie Wilson
- Department of Clinical Pharmacy, University of California San Francisco, San Francisco, California, USA
| | - Lawrence Lin
- Department of Bioengineering and Therapeutic Sciences, University of California San Francisco, San Francisco, California, USA
| | - Kuldev Singh
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
| |
Collapse
|
13
|
Best-Worst Scaling to Prioritize Outcomes Meaningful to Caregivers of Youth with Mental Health Multimorbidities: A Pilot Study. J Dev Behav Pediatr 2019; 39:101-108. [PMID: 29461997 DOI: 10.1097/dbp.0000000000000525] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Health care decision-making for youth with mental health multimorbidity is guided by outcomes that are considered most meaningful and important. The study objective was to pilot test a best-worst scaling (BWS) instrument designed to assess trade-offs among caregiver-defined, meaningful health care outcomes. METHODS A BWS was designed with continuous stakeholder involvement to elicit caregiver-defined outcomes in 4 domains: school, behavioral, social, and independence. Four attributes were identified for each outcome domain, for a total of 16 attributes. Using a balanced incomplete block design, a BWS instrument was developed with 16 choice task questions displaying 6 attributes at a time. A convenience sample was selected from Maryland caregivers of children who were 21 years old or younger and had a developmental delay and a comorbid mental health condition. Participants completed a survey that included demographics and the BWS instrument. Conditional logit was used to estimate utility scores and 95% confidence intervals (CI) for each attribute, which were ranked in order of importance. Attribute statements were refined after a respondent debriefing session. RESULTS A total of 38 caregivers participated in the pilot study. Child safety to self was the most important outcome (1.01, CI, 0.78-1.24). This was followed by securing support for an Individualized educational plan in school (0.77, CI, 0.54-1.01) and the child being able to stay in school all day (0.53, CI, 0.29-0.77). CONCLUSION BWS scenarios that resemble real-life decision-making can be a useful tool to identify preferences for health care outcomes.
Collapse
|
14
|
Patient and caregiver preferences for the potential benefits and risks of a seizure forecasting device: A best-worst scaling. Epilepsy Behav 2019; 96:183-191. [PMID: 31150998 DOI: 10.1016/j.yebeh.2019.04.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 04/12/2019] [Accepted: 04/13/2019] [Indexed: 01/17/2023]
Abstract
BACKGROUND Epilepsy is the 4th most common neurological disorder and is characterized by recurrent, unpredictable seizures. The ability to forecast seizures is a significant unmet need and would have a transformative effect on the lives of people living with epilepsy. In an effort to address this need, the Epilepsy Foundation has committed effort and resources to promote the development of seizure forecasting devices (SFD). OBJECTIVE To promote user-centered design of future SFD, we sought to quantify patient and caregiver preferences for the potential benefits and risks of SFD. METHODS A community-centered approach was used to develop a survey incorporating a novel best-worst scaling (BWS) to assess preferences for SFD. A main-effect orthogonal array was used to design and generate 18 "prototypes" that systematically varied across six attributes: seizure forecasting probability, seizure forecasting range, inaccuracy of forecasting, amount of time required to use the device, how the device is worn, and cost. The dependent variable was the attributes that respondents selected the best and worst in each profile, and a choice model was estimated using conditional logistic regression, which was also stratified and compared across patients and caregivers. Respondents also indicated that they would accept each of the prototype SFDs if it were real. These acceptance data and net monetary benefits (relative to the least preferred SFD) were explored. RESULTS There were 633 eligible respondents; 493 (78%) completed at least one task. Responses indicated that 346 (68%) had epilepsy, and 147 (29%) were primary caregivers or family members of someone with epilepsy. The data show that short forecasting range is the most favored among experimental attributes, followed by mid forecasting range and notification of high chance of seizure. Having the device implanted is the least favorable attribute. Stated preferences differed between patients and caregivers (p < 0.001) for range of forecasting and inaccuracy of device. Caregivers preferred any range of forecasting, regardless of length, more than patients. Patients cared less about inaccuracy of the device compared to caregivers. The groups also differ in impact of fear of having seizures (versus actually having seizures) (p = 0.034) and on device acceptance. The acceptance of devices ranged from 42.3% to 95%, with caregivers being more likely to use a device (p < 0.05) for the majority of device profiles. Acceptance of devices varied with net monetary benefit of the best device being $717.44 more per month relative to the least preferred device. CONCLUSION Our finding extends previous calls for seizure forecasting devices by demonstrating the value that they might provide to patients and caregivers affected by epilepsy and the feature that might be most and least desirable. In addition to guiding device development, the data can help inform regulatory decisions makers.
Collapse
|
15
|
Paquin RS, Fischer R, Mansfield C, Mange B, Beaverson K, Ganot A, Martin AS, Morris C, Rensch C, Ricotti V, Russo LJ, Sadosky A, Smith EC, Peay HL. Priorities when deciding on participation in early-phase gene therapy trials for Duchenne muscular dystrophy: a best-worst scaling experiment in caregivers and adult patients. Orphanet J Rare Dis 2019; 14:102. [PMID: 31072340 PMCID: PMC6509771 DOI: 10.1186/s13023-019-1069-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 04/17/2019] [Indexed: 01/14/2023] Open
Abstract
PURPOSE Several gene therapy trials for Duchenne muscular dystrophy initiated in 2018. Trial decision making is complicated by non-curative, time-limited benefits; the progressive, fatal course; and high unmet needs. Here, caregivers and patients prioritize factors influencing decision making regarding participation in early-phase gene therapy trials. METHODS We conducted a best-worst scaling experiment among U.S. caregivers and adults with Duchenne (N = 274). Participants completed 11 choice sets, choosing features they cared about most and least when deciding whether to participate in a hypothetical gene therapy trial. We analyzed the data using sequential conditional logistic regression. RESULTS Participants prioritized improved muscle function in trial decision making. Concerns about participation limiting later use of gene transfer and editing were also important, as were improved lung and heart function. Low risk of death fell near the middle. Participants cared least about muscle biopsies and potential for randomization to placebo. Adults with Duchenne and caregivers of non-ambulatory children significantly prioritized improved lung function compared to caregivers of ambulatory children. CONCLUSION Our data demonstrate prioritization of anticipated benefits and opportunity costs relative to potential harms and procedures in gene therapy trial decision making. Such data inform protocol development, education and advocacy efforts, and informed consent.
Collapse
Affiliation(s)
- Ryan S Paquin
- RTI International, Research Triangle Park, North Carolina, USA
| | - Ryan Fischer
- Parent Project Muscular Dystrophy, Hackensack, NJ, USA
| | - Carol Mansfield
- RTI Health Solutions, Research Triangle Park, North Carolina, USA
| | - Brennan Mange
- RTI Health Solutions, Research Triangle Park, North Carolina, USA
| | | | | | | | | | - Colin Rensch
- Parent Project Muscular Dystrophy, Hackensack, NJ, USA
| | | | | | | | | | - Holly L Peay
- RTI International, Research Triangle Park, North Carolina, USA.
| |
Collapse
|
16
|
Landrum Peay H, Fischer R, Tzeng JP, Hesterlee SE, Morris C, Strong Martin A, Rensch C, Smith E, Ricotti V, Beaverson K, Wand H, Mansfield C. Gene therapy as a potential therapeutic option for Duchenne muscular dystrophy: A qualitative preference study of patients and parents. PLoS One 2019; 14:e0213649. [PMID: 31042754 PMCID: PMC6493713 DOI: 10.1371/journal.pone.0213649] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 02/26/2019] [Indexed: 01/14/2023] Open
Abstract
Objectives Duchenne muscular dystrophy (DMD) is a rare neuromuscular disorder that causes progressive weakness and early death. Gene therapy is an area of new therapeutic development. This qualitative study explored factors influencing parents’ and adult patients’ preferences about gene therapy. Methods We report qualitative data from 17 parents of children with DMD and 6 adult patients. Participants responded to a hypothetical gene therapy vignette with features including non-curative stabilizing benefits to muscle, cardiac and pulmonary function; a treatment-related risk of death; and one-time dosing with time-limited benefit of 8–10 years. We used NVivo 11 to code responses and conduct thematic analyses. Results All participants placed high value on benefits to skeletal muscle, cardiac, and pulmonary functioning, with the relative importance of cardiac and pulmonary function increasing with disease progression. More than half tolerated a hypothetical 1% risk of death when balanced against Duchenne progression and limited treatment options. Risk tolerance increased at later stages. Participants perceived a ‘right time’ to initiate gene therapy. Most preferred to wait until a highly-valued function was about to be lost. Conclusion Participants demonstrated a complex weighing of potential benefits against harms and the inevitable decline of untreated Duchenne. Disease progression increased risk tolerance as participants perceived fewer treatment options and placed greater value on maintaining remaining function. In the context of a one-time treatment like gene therapy, our finding that preferences about timing of initiation are influenced by disease state suggest the importance of assessing ‘lifetime’ preferences across the full spectrum of disease progression.
Collapse
Affiliation(s)
- Holly Landrum Peay
- Center for Newborn Screening, Ethics, and Disability Studies, RTI International, Research Triangle Park, North Caroilina, United States of America
- * E-mail:
| | - Ryan Fischer
- Parent Project Muscular Dystrophy, Hackensack, New Jersey, United States of America
| | - Janice P. Tzeng
- Center for Newborn Screening, Ethics, and Disability Studies, RTI International, Research Triangle Park, North Caroilina, United States of America
| | - Sharon E. Hesterlee
- Lion Therapeutics, Asklepios BioPharmaceutical, Inc., Research Triangle Park, North Carolina, United States of America
| | - Carl Morris
- Solid Biosciences, Cambridge, Massachusetts, United States of America
| | - Amy Strong Martin
- Center for Duchenne Muscular Dystrophy at UCLA, University of California Los Angeles, Los Angeles, California, United States of America
| | - Colin Rensch
- Parent Project Muscular Dystrophy, Hackensack, New Jersey, United States of America
| | - Edward Smith
- Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Valeria Ricotti
- Solid Biosciences, Cambridge, Massachusetts, United States of America
| | - Katherine Beaverson
- Rare Disease Research Unit, Pfizer, Inc, Cambridge, Massachusetts, United States of America
| | - Hannah Wand
- Stanford Healthcare and ClinGen, Sanford, California, United States of America
| | - Carol Mansfield
- RTI Health Solutions, RTI International, Research Triangle Park, North Carolina, United States of America
| |
Collapse
|
17
|
Symposium Title: Preference Evidence for Regulatory Decisions. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2019; 11:467-473. [PMID: 29845480 DOI: 10.1007/s40271-018-0311-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
|
18
|
van Putten M, Tanganyika-de Winter C, Bosgra S, Aartsma-Rus A. Nonclinical Exon Skipping Studies with 2'-O-Methyl Phosphorothioate Antisense Oligonucleotides in mdx and mdx-utrn-/- Mice Inspired by Clinical Trial Results. Nucleic Acid Ther 2019; 29:92-103. [PMID: 30672725 PMCID: PMC6461150 DOI: 10.1089/nat.2018.0759] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Duchenne muscular dystrophy is a severe, progressive muscle-wasting disease that is caused by mutations that abolish the production of functional dystrophin protein. The exon skipping approach aims to restore the disrupted dystrophin reading frame, to allow the production of partially functional dystrophins, such as found in the less severe Becker muscular dystrophy. Exon skipping is achieved by antisense oligonucleotides (AONs). Several chemical modifications have been tested in nonclinical and clinical trials. The morpholino phosphorodiamidate oligomer eteplirsen has been approved by the Food and Drug Administration, whereas clinical development with the 2'-O-methyl phosphorothioate (2OMePS) AON drisapersen was recently stopped. In this study, we aimed to study various aspects of 2OMePS AONs in nonclinical animal studies. We show that while efficiency of exon skipping restoration is comparable in young and older C57BL/10ScSn-Dmdmdx/J (mdx/BL10) mice, functional improvement was only observed for younger treated mice. Muscle quality did not affect exon skipping efficiency as exon skip and dystrophin levels were similar between mdx/BL10 and more severely affected, age-matched D2-mdx mice. We further report that treadmill running increases AON uptake and dystrophin levels in mdx/BL10 mice. Finally, we show that even low levels of exon skipping and dystrophin restoration are sufficient to significantly increase the survival of mdx-utrn-/- mice from 70 to 97 days.
Collapse
Affiliation(s)
- Maaike van Putten
- 1 Department of Human Genetics, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Sieto Bosgra
- 2 Biomarin Nederland BV, Leiden, the Netherlands
| | - Annemieke Aartsma-Rus
- 1 Department of Human Genetics, Leiden University Medical Center, Leiden, the Netherlands
| |
Collapse
|
19
|
Grant S, Hazlewood GS, Peay HL, Lucas A, Coulter I, Fink A, Khodyakov D. Practical Considerations for Using Online Methods to Engage Patients in Guideline Development. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2018; 11:155-166. [PMID: 29030831 DOI: 10.1007/s40271-017-0280-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Clinical practice guidelines (CPGs) have been widely used in healthcare policy, practice, and for suggesting future research. As patients increasingly become involved in CPG development to produce patient-centered recommendations, more research is needed on methods to engage patients, particularly methods allowing for scalable engagement of large, diverse, and geographically distributed groups of patients. In this article, we discuss practical considerations for using online methods to engage patients in CPG development. To inform this discussion, we conducted a rapid, systematic review of literature on patient involvement in CPG development and used qualitative evidence synthesis techniques to make inferences about potential advantages and challenges of using online methods to engage patients in this context. We identified 79 articles containing information about involving patients in CPG development. Potential advantages include the ability of online methods to facilitate greater openness and honesty by patients, as well as to reflect the diversity of patient views, which in turn further improve the utility of CPGs. Potential challenges of using online methods may include the extra skill, time, and certain types of resources that may be needed for patient engagement, as well as the difficulty engaging specific patient populations. However, these challenges are mitigated by growing calls for patient engagement as normative for CPG development in addition to patients' increasing familiarity with online technologies. These practical considerations should be examined empirically as guideline development groups further explore the appropriateness of using online methods to engage patients across different stages of CPG development.
Collapse
Affiliation(s)
- Sean Grant
- Behavioral and Policy Sciences Department, RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA, 90407-2138, USA.
| | - Glen S Hazlewood
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Holly L Peay
- RTI International, Research Triangle Park, NC, USA
| | - Ann Lucas
- Parent Project Muscular Dystrophy, Hackensack, NJ, USA
| | - Ian Coulter
- Economics, Sociology, and Statistics Department, RAND Corporation, Santa Monica, CA, USA
| | - Arlene Fink
- David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, USA
| | - Dmitry Khodyakov
- Behavioral and Policy Sciences Department, RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA, 90407-2138, USA
| |
Collapse
|
20
|
Whitty JA, Oliveira Gonçalves AS. A Systematic Review Comparing the Acceptability, Validity and Concordance of Discrete Choice Experiments and Best-Worst Scaling for Eliciting Preferences in Healthcare. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2018; 11:301-317. [PMID: 29177797 DOI: 10.1007/s40271-017-0288-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The aim of this study was to compare the acceptability, validity and concordance of discrete choice experiment (DCE) and best-worst scaling (BWS) stated preference approaches in health. METHODS A systematic search of EMBASE, Medline, AMED, PubMed, CINAHL, Cochrane Library and EconLit databases was undertaken in October to December 2016 without date restriction. Studies were included if they were published in English, presented empirical data related to the administration or findings of traditional format DCE and object-, profile- or multiprofile-case BWS, and were related to health. Study quality was assessed using the PREFS checklist. RESULTS Fourteen articles describing 12 studies were included, comparing DCE with profile-case BWS (9 studies), DCE and multiprofile-case BWS (1 study), and profile- and multiprofile-case BWS (2 studies). Although limited and inconsistent, the balance of evidence suggests that preferences derived from DCE and profile-case BWS may not be concordant, regardless of the decision context. Preferences estimated from DCE and multiprofile-case BWS may be concordant (single study). Profile- and multiprofile-case BWS appear more statistically efficient than DCE, but no evidence is available to suggest they have a greater response efficiency. Little evidence suggests superior validity for one format over another. Participant acceptability may favour DCE, which had a lower self-reported task difficulty and was preferred over profile-case BWS in a priority setting but not necessarily in other decision contexts. CONCLUSION DCE and profile-case BWS may be of equal validity but give different preference estimates regardless of the health context; thus, they may be measuring different constructs. Therefore, choice between methods is likely to be based on normative considerations related to coherence with theoretical frameworks and on pragmatic considerations related to ease of data collection.
Collapse
Affiliation(s)
- Jennifer A Whitty
- Health Economics Group, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, Norfolk, NR4 7JT, UK.
| | - Ana Sofia Oliveira Gonçalves
- Health Economics Group, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, Norfolk, NR4 7JT, UK
| |
Collapse
|
21
|
Ladin K, Emerson J, Butt Z, Gordon EJ, Hanto DW, Perloff J, Daniels N, Lavelle TA. How important is social support in determining patients' suitability for transplantation? Results from a National Survey of Transplant Clinicians. JOURNAL OF MEDICAL ETHICS 2018; 44:666-674. [PMID: 29954874 PMCID: PMC6425471 DOI: 10.1136/medethics-2017-104695] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 04/16/2018] [Accepted: 05/10/2018] [Indexed: 05/17/2023]
Abstract
BACKGROUND National guidelines require programmes use subjective assessments of social support when determining transplant suitability, despite limited evidence linking it to outcomes. We examined how transplant providers weigh the importance of social support for kidney transplantation compared with other factors, and variation by clinical role and personal beliefs. METHODS The National survey of the American Society of Transplant Surgeons and the Society of Transplant Social Work in 2016. Using a discrete choice approach, respondents compared two hypothetical patient profiles and selected one for transplantation. Conditional logistic regression estimated the relative importance of each factor; results were stratified by clinical role (psychosocial vs medical/surgical providers) and beliefs (outcomes vs equity). RESULTS Five hundred and eighy-four transplant providers completed the survey. Social support was the second most influential factor among transplant providers. Providers were most likely to choose a candidate who had social support (OR=1.68, 95% CI 1.50 to 1.86), always adhered to a medical regimen (OR=1.64, 95% CI 1.46 to 1.88), and had a 15 years life expectancy with transplant (OR=1.61, 95% CI 1.42 to 1.85). Psychosocial providers were more influenced by adherence and quality of life compared with medical/surgical providers, who were more influenced by candidates' life expectancy with transplant (p<0.05). For providers concerned with avoiding organ waste, social support was the most influential factor, while it was the least influential for clinicians concerned with fairness (p<0.05). CONCLUSIONS Social support is highly influential in listing decisions and may exacerbate transplant disparities. Providers' beliefs and reliance on social support in determining suitability vary considerably, raising concerns about transparency and justice.
Collapse
Affiliation(s)
- Keren Ladin
- Departments of Occupational Therapy and Community, Tufts University, Medford, Massachusetts, USA
- Research on Ethics, Aging, and Community Health (REACH Lab), Tufts University, Medford, Massachusetts, USA
| | - Joanna Emerson
- Research on Ethics, Aging, and Community Health (REACH Lab), Tufts University, Medford, Massachusetts, USA
| | - Zeeshan Butt
- Department of Surgery, Division of Transplantation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Elisa J Gordon
- Department of Surgery, Division of Transplantation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Douglas W Hanto
- Department of Surgery, Vanderbilt Transplant Center, Vanderbilt University Medical Center, Boston, Massachusetts, USA
| | - Jennifer Perloff
- Heller School of Social Policy and Management, Brandeis University, Waltham, Massachusetts, USA
| | - Norman Daniels
- Department of Global Health and Population, Harvard Chan School of Public Health, Boston, Massachusetts, USA
| | - Tara A Lavelle
- Center for the Evaluation of Value and Risk, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts, USA
| |
Collapse
|
22
|
How Do Members of the Duchenne and Becker Muscular Dystrophy Community Perceive a Discrete-Choice Experiment Incorporating Uncertain Treatment Benefit? An Application of Research as an Event. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2018; 12:247-257. [DOI: 10.1007/s40271-018-0330-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
23
|
Aartsma-Rus A, Mercuri E, Vroom E, Balabanov P. Meeting report of the “Regulatory Exchange Matters” session at the 5th International TREAT-NMD Conference:. Neuromuscul Disord 2018; 28:619-623. [DOI: 10.1016/j.nmd.2018.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 04/11/2018] [Indexed: 10/17/2022]
|
24
|
Moving from Patient Advocacy to Partnership: A Long and Bumpy Road. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2018; 10:271-276. [PMID: 28097637 DOI: 10.1007/s40271-017-0216-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Real-life experiences of grassroots patient organizations across a variety of diseases, countries and contexts have been used to develop a four-mode framework of the transition from patient advocacy to partnership, defined by one axis as individual versus collective action and the other axis as activities 'outside' or 'inside' the system. The four quadrants are labeled as advocacy, activism, reform and broker, and engagement is further refined by whether the participation is 'pushed' by the group or 'pulled' by the system. There are many examples of patient advocacy groups transitioning through the four quadrants; however, depending on other factors of culture, opportunity and their own preferences, groups may work primarily through one or two quadrants.
Collapse
|
25
|
Salloum RG, Shenkman EA, Louviere JJ, Chambers DA. Application of discrete choice experiments to enhance stakeholder engagement as a strategy for advancing implementation: a systematic review. Implement Sci 2017; 12:140. [PMID: 29169397 PMCID: PMC5701380 DOI: 10.1186/s13012-017-0675-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 11/15/2017] [Indexed: 01/11/2023] Open
Abstract
Background One of the key strategies to successful implementation of effective health-related interventions is targeting improvements in stakeholder engagement. The discrete choice experiment (DCE) is a stated preference technique for eliciting individual preferences over hypothetical alternative scenarios that is increasingly being used in health-related applications. DCEs are a dynamic approach to systematically measure health preferences which can be applied in enhancing stakeholder engagement. However, a knowledge gap exists in characterizing the extent to which DCEs are used in implementation science. Methods We conducted a systematic literature search (up to December 2016) of the English literature to identify and describe the use of DCEs in engaging stakeholders as an implementation strategy. We searched the following electronic databases: MEDLINE, Econlit, PsychINFO, and the CINAHL using mesh terms. Studies were categorized according to application type, stakeholder(s), healthcare setting, and implementation outcome. Results Seventy-five publications were selected for analysis in this systematic review. Studies were categorized by application type: (1) characterizing demand for therapies and treatment technologies (n = 32), (2) comparing implementation strategies (n = 22), (3) incentivizing workforce participation (n = 11), and (4) prioritizing interventions (n = 10). Stakeholders included providers (n = 27), patients (n = 25), caregivers (n = 5), and administrators (n = 2). The remaining studies (n = 16) engaged multiple stakeholders (i.e., combination of patients, caregivers, providers, and/or administrators). The following implementation outcomes were discussed: acceptability (n = 75), appropriateness (n = 34), adoption (n = 19), feasibility (n = 16), and fidelity (n = 3). Conclusions The number of DCE studies engaging stakeholders as an implementation strategy has been increasing over the past decade. As DCEs are more widely used as a healthcare assessment tool, there is a wide range of applications for them in stakeholder engagement. The DCE approach could serve as a tool for engaging stakeholders in implementation science. Electronic supplementary material The online version of this article (10.1186/s13012-017-0675-8) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Ramzi G Salloum
- Department of Health Outcomes and Policy, College of Medicine, University of Florida, 2004 Mowry Road, Gainesville, FL, 32610, USA.
| | - Elizabeth A Shenkman
- Department of Health Outcomes and Policy, College of Medicine, University of Florida, 2004 Mowry Road, Gainesville, FL, 32610, USA
| | - Jordan J Louviere
- Institute for Choice, School of Marketing, University of South Australia, Adelaide, SA, Australia
| | - David A Chambers
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| |
Collapse
|
26
|
Janssen EM, Marshall DA, Hauber AB, Bridges JFP. Improving the quality of discrete-choice experiments in health: how can we assess validity and reliability? Expert Rev Pharmacoecon Outcomes Res 2017; 17:531-542. [DOI: 10.1080/14737167.2017.1389648] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Ellen M. Janssen
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Deborah A. Marshall
- Department of Community Health Sciences, University of Calgary, Health Research Innovation Centre (HRIC), Calgary, AB, Canada
| | | | - John F. P. Bridges
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
27
|
Danner M, Vennedey V, Hiligsmann M, Fauser S, Gross C, Stock S. Comparing Analytic Hierarchy Process and Discrete-Choice Experiment to Elicit Patient Preferences for Treatment Characteristics in Age-Related Macular Degeneration. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2017; 20:1166-1173. [PMID: 28964450 DOI: 10.1016/j.jval.2017.04.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 03/22/2017] [Accepted: 04/26/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND In this study, we conducted an analytic hierarchy process (AHP) and a discrete choice experiment (DCE) to elicit the preferences of patients with age-related macular degeneration using identical attributes and levels. OBJECTIVES To compare preference-based weights for age-related macular degeneration treatment attributes and levels generated by two elicitation methods. The properties of both methods were assessed, including ease of instrument use. METHODS A DCE and an AHP experiment were designed on the basis of five attributes. Preference-based weights were generated using the matrix multiplication method for attributes and levels in AHP and a mixed multinomial logit model for levels in the DCE. Attribute importance was further compared using coefficient (DCE) and weight (AHP) level ranges. The questionnaire difficulty was rated on a qualitative scale. Patients were asked to think aloud while providing their judgments. RESULTS AHP and DCE generated similar results regarding levels, stressing a preference for visual improvement, frequent monitoring, on-demand and less frequent injection schemes, approved drugs, and mild side effects. Attribute weights derived on the basis of level ranges led to a ranking that was opposite to the AHP directly calculated attribute weights. For example, visual function ranked first in the AHP and last on the basis of level ranges. CONCLUSIONS The results across the methods were similar, with one exception: the directly measured AHP attribute weights were different from the level-based interpretation of attribute importance in both DCE and AHP. The dependence/independence of attribute importance on level ranges in DCE and AHP, respectively, should be taken into account when choosing a method to support decision making.
Collapse
Affiliation(s)
- Marion Danner
- Institute for Health Economics and Clinical Epidemiology, University Hospital of Cologne (AöR), Cologne, Germany.
| | - Vera Vennedey
- Institute for Health Economics and Clinical Epidemiology, University Hospital of Cologne (AöR), Cologne, Germany
| | - Mickaël Hiligsmann
- Department of Health Services Research, CAPHRI School for Primary Care and Public Health, Maastricht University, Maastricht, The Netherlands
| | - Sascha Fauser
- Center for Ophthalmology, University Hospital of Cologne (AöR), Cologne, Germany
| | - Christian Gross
- Institute for Health Economics and Clinical Epidemiology, University Hospital of Cologne (AöR), Cologne, Germany
| | - Stephanie Stock
- Institute for Health Economics and Clinical Epidemiology, University Hospital of Cologne (AöR), Cologne, Germany
| |
Collapse
|
28
|
The Ball is in Your Court: Agenda for Research to Advance the Science of Patient Preferences in the Regulatory Review of Medical Devices in the United States. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2017; 10:531-536. [DOI: 10.1007/s40271-017-0272-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
29
|
Ng X, Bridges JFP, Ross MM, Frosch E, Reeves G, Cunningham CE, dosReis S. A Latent Class Analysis to Identify Variation in Caregivers' Preferences for their Child's Attention-Deficit/Hyperactivity Disorder Treatment: Do Stated Preferences Match Current Treatment? THE PATIENT 2017; 10:251-262. [PMID: 27798814 PMCID: PMC6029258 DOI: 10.1007/s40271-016-0202-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To investigate variation in caregiver preferences for their child's attention-deficit/hyperactivity disorder (ADHD) care and to determine if their stated preferences align with current care management. METHODS Caregivers of a child aged 4-14 years and in care for ADHD were recruited from pediatric outpatient clinics and advocacy groups across the state of Maryland. Participants completed a survey collecting demographics, the child's treatment, and caregiver preferences-elicited using a best-worst scaling experiment (case 2). Latent class analysis was used to identify distinct preference segments and bivariate analyses were used to compare the association between segment membership with what the child was currently receiving for their ADHD. RESULTS Participants (n = 184) were predominantly White (68%) and the child's mother (84%). Most children had ADHD for 2 or more years (79%). Caregiver preferences were distinguished by two segments: continuous medication (36%) and minimal medication (64%). The two groups had very different preferences for when medication was administered (p < 0.001), but they had similar preferences for provider-oriented and non-medication interventions (p > 0.05 for the caregiver behavior training, provider communication, provider specialty, and out-of-pocket costs). One third of the sample did not receive the preferred individualized education program and 42% of the minimal medication group reported using medication 7 days a week all year round. CONCLUSIONS Although behavior management training and school accommodations aspects of an ADHD care plan are more important to caregivers than evidence-based medication, fewer families had access to educational accommodations. Further research is needed to clarify how stated preferences for care align with treatments used in actual practice settings.
Collapse
Affiliation(s)
- Xinyi Ng
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, 220 Arch Street, 12th Floor, Baltimore, MD, 21201, USA
| | - John F P Bridges
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Melissa M Ross
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, 220 Arch Street, 12th Floor, Baltimore, MD, 21201, USA
| | - Emily Frosch
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Gloria Reeves
- University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - Susan dosReis
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, 220 Arch Street, 12th Floor, Baltimore, MD, 21201, USA.
| |
Collapse
|
30
|
Hollin IL, Peay HL, Apkon SD, Bridges JFP. Patient-centered benefit-risk assessment in duchenne muscular dystrophy. Muscle Nerve 2017; 55:626-634. [PMID: 27649378 DOI: 10.1002/mus.25411] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2016] [Indexed: 01/10/2023]
Abstract
INTRODUCTION This study quantified caregiver and patient preferences for a therapeutic agent with demonstrated pulmonary benefits for Duchenne muscular dystrophy (DMD). Caregiver and patient differences were also explored. METHODS A best-worst scaling survey (BWS) was administered to caregivers and patients. Across 9 profiles, respondents selected the best and worst attributes. Utility scores were estimated using mixed logistic regression. RESULTS Respondents indicated greatest preference for therapies that maintain their current level of cough strength for 10 years or for 2 years. Preference scores for risks were low: 50% chance of diarrhea and 4 additional blood draws per year. CONCLUSION There is a strong preference for pulmonary benefit and willingness to trade off risks and burden to achieve these benefits. In exchange for maintaining cough strength for 10 years, respondents were willing to tolerate high probabilities of diarrhea and additional blood draws. Muscle Nerve 55: 626-634, 2017.
Collapse
Affiliation(s)
- Ilene L Hollin
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Holly L Peay
- RTI International, Research Triangle Park, North Carolina, USA.,Parent Project Muscular Dystrophy, Hackensack, New Jersey, USA
| | - Susan D Apkon
- Department of Rehabilitation Medicine, Seattle Children's Hospital and University of Washington, Seattle, Washington, USA
| | - John F P Bridges
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| |
Collapse
|
31
|
Hampson LA, Allen IE, Gaither TW, Lin T, Ting J, Osterberg EC, Wilson L, Breyer BN. Patient-centered Treatment Decisions for Urethral Stricture: Conjoint Analysis Improves Surgical Decision-making. Urology 2017; 99:246-253. [PMID: 27645527 PMCID: PMC6425929 DOI: 10.1016/j.urology.2016.07.053] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 07/18/2016] [Accepted: 07/22/2016] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To determine whether the use of a choice-based conjoint analysis (CA) exercise decreased patients' decisional conflict about treatment preferences for surgical management of urethral stricture disease. Understanding patient preferences for treatment decisions assists in shared decision-making and emphasizes patient-centered outcomes. CA offers a method to understand what risks patients are willing to take for what gains. METHODS The CA methodology was used by providing participants with case-based choices to elucidate the relative importance that individuals place on various treatment aspects. Patients' decisional conflict regarding surgery for urethral stricture was assessed before and after the CA exercise to assess the impact the exercise had on their decisional conflict. RESULTS Completion of the CA exercise resulted in a significant decrease in decisional conflict (P < .001). The majority (59.5%) of participants with decisional conflict before the CA exercise experienced a decrease in decisional conflict afterwards, with only a minority (16.5%) experiencing new decisional conflict after the exercise. Participants felt the choice-based CA exercise was helpful in deciding what was important in making treatment decisions (70%) and in expressing their priorities and treatment preferences (82%). The number needed to counsel to achieve a decrease in decisional conflict was 1.69 and to achieve no decisional conflict was 3.65. CONCLUSION Choice-based CA improves patients' ability to express their treatment preferences and decreases decisional conflict. CA may be a new tool that physicians and patients can use to aid in shared decision-making with a focus on patient-centered outcomes.
Collapse
Affiliation(s)
- Lindsay A Hampson
- Philip R. Lee Institute for Health Policy Studies, Department of Urology, UCSF School of Medicine, San Francisco, CA.
| | - Isabel E Allen
- Department of Epidemiology & Biostatistics, UCSF School of Medicine, San Francisco, CA
| | | | - Tracy Lin
- Department of Clinical Pharmacy, UCSF School of Pharmacy, San Francisco, CA
| | - Jie Ting
- Department of Clinical Pharmacy, UCSF School of Pharmacy, San Francisco, CA
| | | | - Leslie Wilson
- Department of Clinical Pharmacy, UCSF School of Pharmacy, San Francisco, CA
| | | |
Collapse
|
32
|
Mühlbacher AC, Kaczynski A, Zweifel P, Johnson FR. Experimental measurement of preferences in health and healthcare using best-worst scaling: an overview. HEALTH ECONOMICS REVIEW 2016; 6:2. [PMID: 26743636 PMCID: PMC4705077 DOI: 10.1186/s13561-015-0079-x] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 12/18/2015] [Indexed: 05/20/2023]
Abstract
Best-worst scaling (BWS), also known as maximum-difference scaling, is a multiattribute approach to measuring preferences. BWS aims at the analysis of preferences regarding a set of attributes, their levels or alternatives. It is a stated-preference method based on the assumption that respondents are capable of making judgments regarding the best and the worst (or the most and least important, respectively) out of three or more elements of a choice-set. As is true of discrete choice experiments (DCE) generally, BWS avoids the known weaknesses of rating and ranking scales while holding the promise of generating additional information by making respondents choose twice, namely the best as well as the worst criteria. A systematic literature review found 53 BWS applications in health and healthcare. This article expounds possibilities of application, the underlying theoretical concepts and the implementation of BWS in its three variants: 'object case', 'profile case', 'multiprofile case'. This paper contains a survey of BWS methods and revolves around study design, experimental design, and data analysis. Moreover the article discusses the strengths and weaknesses of the three types of BWS distinguished and offered an outlook. A companion paper focuses on special issues of theory and statistical inference confronting BWS in preference measurement.
Collapse
Affiliation(s)
- Axel C Mühlbacher
- IGM Institute for Health Economics and Health Care Management, Hochschule Neubrandenburg, Neubrandenburg, Germany.
| | - Anika Kaczynski
- IGM Institute for Health Economics and Health Care Management, Hochschule Neubrandenburg, Neubrandenburg, Germany.
| | - Peter Zweifel
- Department of Economics, University of Zürich, Zürich, Switzerland.
| | - F Reed Johnson
- Center for Clinical and Genetic Economics, Duke Clinical Research Institute, Duke University, Durham, USA.
| |
Collapse
|
33
|
Cheung KL, Wijnen BFM, Hollin IL, Janssen EM, Bridges JF, Evers SMAA, Hiligsmann M. Using Best-Worst Scaling to Investigate Preferences in Health Care. PHARMACOECONOMICS 2016; 34:1195-1209. [PMID: 27402349 PMCID: PMC5110583 DOI: 10.1007/s40273-016-0429-5] [Citation(s) in RCA: 144] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
INTRODUCTION Best-worst scaling (BWS) is becoming increasingly popular to elicit preferences in health care. However, little is known about current practice and trends in the use of BWS in health care. This study aimed to identify, review and critically appraise BWS in health care, and to identify trends over time in key aspects of BWS. METHODS A systematic review was conducted, using Medline (via Pubmed) and EMBASE to identify all English-language BWS studies published up until April 2016. Using a predefined extraction form, two reviewers independently selected articles and critically appraised the study quality, using the Purpose, Respondents, Explanation, Findings, Significance (PREFS) checklist. Trends over time periods (≤2010, 2011, 2012, 2013, 2014 and 2015) were assessed further. RESULTS A total of 62 BWS studies were identified, of which 26 were BWS object case studies, 29 were BWS profile case studies and seven were BWS multi-profile case studies. About two thirds of the studies were performed in the last 2 years. Decreasing sample sizes and decreasing numbers of factors in BWS object case studies, as well as use of less complicated analytical methods, were observed in recent studies. The quality of the BWS studies was generally acceptable according to the PREFS checklist, except that most studies did not indicate whether the responders were similar to the non-responders. CONCLUSION Use of BWS object case and BWS profile case has drastically increased in health care, especially in the last 2 years. In contrast with previous discrete-choice experiment reviews, there is increasing use of less sophisticated analytical methods.
Collapse
Affiliation(s)
- Kei Long Cheung
- Department of Health Services Research, CAPHRI Research School for Public Health and Primary Care, Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands.
| | - Ben F M Wijnen
- Department of Health Services Research, CAPHRI Research School for Public Health and Primary Care, Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands
- Department of Research and Development, Epilepsy Centre Kempenhaeghe, Heeze, The Netherlands
| | - Ilene L Hollin
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ellen M Janssen
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - John F Bridges
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Silvia M A A Evers
- Department of Health Services Research, CAPHRI Research School for Public Health and Primary Care, Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands
| | - Mickael Hiligsmann
- Department of Health Services Research, CAPHRI Research School for Public Health and Primary Care, Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands
| |
Collapse
|
34
|
Hollin IL, Hanson C, Bridges JFP, Peay H. Developing a Patient-Centered Benefit-Risk Survey: A Community-Engaged Process. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2016; 19:751-757. [PMID: 27712702 DOI: 10.1016/j.jval.2016.02.014] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 02/17/2016] [Accepted: 02/19/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To provide a community-engaged process to inform the design of a stated-preferences experiment. The process involved integrating patients and caregivers of people with Duchenne/Becker muscular dystrophy, advocates, clinicians, and the sponsor in conceptualizing and developing a benefit-risk survey on the basis of phase III trial results. METHODS Our community-engagement process for the development of a stated-preference survey included a set of five guiding principles with a foundation in the principles of community-engaged research. Engagement efforts were carried out through an informal network of three committees. Members of the leadership, stakeholder, and review committees comprised patients, caregivers, clinicians, advocacy leadership, and industry representatives. RESULTS Committee members participated in 15 hours of formal engagement including interviews and conference calls that ranged from 45 to 90 minutes, plus additional less-formal ad hoc communication. Committees comprised 20 individuals across three committees including adults with DMD (n = 6), parents of children with DMD (n = 6), clinicians (n = 3), members of research and advocacy organizations (n = 4), and an industry representative (n = 1). Community engagement informed attribute selection, survey length, word choice, and eligibility criteria. Challenges in the process included managing diverse stakeholder perspectives, time requirements, and the inherent tension between outcomes used in clinical trials versus attributes that correspond to patient- and family-relevant outcomes. CONCLUSIONS We demonstrated how community engagement can successfully influence study design to support the design of a relevant survey instrument that is ethical, acceptable, meaningful to the community, and enhances patient-centered benefit-risk assessment for regulatory decision making.
Collapse
Affiliation(s)
- Ilene L Hollin
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Caroline Hanson
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - John F P Bridges
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Holly Peay
- Parent Project Muscular Dystrophy, Hackensack, NJ, USA; RTI International, Research Triangle Park, NC, USA
| |
Collapse
|
35
|
Facey K, Hansen HP. The imperative for patient-centred research to develop better quality services in rare diseases. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2016; 8:1-3. [PMID: 25616560 DOI: 10.1007/s40271-015-0113-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Karen Facey
- Evidence Based Health Policy Consultant, Woodlands Lodge, Buchanan Castle Estate, Drymen, G63 0HX, UK,
| | | |
Collapse
|
36
|
dosReis S, Ng X, Frosch E, Reeves G, Cunningham C, Bridges JFP. Using Best-Worst Scaling to Measure Caregiver Preferences for Managing their Child's ADHD: A Pilot Study. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2016; 8:423-31. [PMID: 25392024 DOI: 10.1007/s40271-014-0098-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Management of attention-deficit/hyperactivity disorder (ADHD) is a trade-off between caregivers' concerns about the benefits versus the risks of evidence-based treatment. Few studies have used choice-based methods to assess what treatment attributes matter most to caregivers. OBJECTIVE The aim was to develop and to pilot an instrument to elicit caregivers' preferences for evidence-based management of their child's ADHD. METHODS Mixed methods were used to develop a Best-Worst Scaling (BWS) instrument, and quantitative methods were used to pilot the instrument. Primary caregivers of children with ADHD from two community organizations were recruited for the development (n = 21) and pilot (n = 37) phase. The instrument was a BWS case 2, where 18 management profiles are presented one at a time, with respondents indicating the one best and one worst feature of each profile. Profiles were developed using a main effects orthogonal array. The mean of best-minus-worse scores was estimated, and attribute importance was based on the sum of maximum minus minimum scores for each attribute. Feasibility of eliciting stated preferences was evaluated with t tests and 95 % confidence intervals. RESULTS Seven attributes (medication, therapy, school, caregiver training, provider specialty, provider communication, and out-of-pocket costs) with three levels each were identified. All mean scores were significant except for pediatrician management of the child's ADHD (p = 0.089). Caregiver training had the highest relative importance, followed by medication and provider communication. CONCLUSIONS The BWS instrument was a relatively simple measure, caregivers completed it independently, and it distinguished the relative importance of different attributes in managing a child's ADHD.
Collapse
Affiliation(s)
- Susan dosReis
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, 220 Arch Street, 12th Floor, Baltimore, MD, 21201, USA.
| | - Xinyi Ng
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, 220 Arch Street, 12th Floor, Baltimore, MD, 21201, USA
| | - Emily Frosch
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Gloria Reeves
- University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - John F P Bridges
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
37
|
Janssen EM, Segal JB, Bridges JFP. A Framework for Instrument Development of a Choice Experiment: An Application to Type 2 Diabetes. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2016; 9:465-79. [DOI: 10.1007/s40271-016-0170-3] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
|
38
|
Similuk MN, Wang A, Lenardo MJ, Erby LH. Life with a Primary Immune Deficiency: a Systematic Synthesis of the Literature and Proposed Research Agenda. J Clin Immunol 2016; 36:123-33. [PMID: 26873708 PMCID: PMC11090044 DOI: 10.1007/s10875-016-0241-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 01/31/2016] [Indexed: 12/28/2022]
Abstract
PURPOSE The clinical immunology literature is punctuated with research on psychosocial dimensions of illness. Studies investigating the lived experiences and stated needs of patients with primary immune deficiencies and their families are essential to improving clinical management and determining the research questions that matter to patients and other stakeholders. Yet, to move the field forward, a systematic review of literature and proposed agenda is needed. METHODS A systematic review was conducted via PubMed and Scopus to include original research on psychological, social, or behavioral aspects of primary immune deficiencies published between 1999 and 2015. A Title/Abstract keyword search was conducted, 317 candidate article abstracts were manually reviewed, and forward/backward reference searches were completed. RESULTS Twenty-nine studies met inclusion criteria. These illuminate the complex psychological, social, and emotional experiences of primary immune deficiency. Themes included the potential for negative psychosocial impact from disease; adaptation over time; the multi-dimensional assessments of quality of life; familial impact; the important roles of hope, developing a sense of control, social support; and addressing anxiety/depression in our patients and their families. Methodological considerations and areas for improvement are discussed. CONCLUSION We propose the research agenda focus on study creativity and rigor, with improved engagement with existing literature and critical study design (e.g., methodology with adequate statistical power, careful variable selection, etc.). This review highlights opportunities to advance psychosocial research and bring a brighter future to clinicians, researchers, and families affected by primary immune deficiency.
Collapse
Affiliation(s)
- Morgan N Similuk
- National Institute of Allergy and Infectious Disease, NIH, 10 Center Drive, Building 10, Room 12C103, Bethesda, MD, USA.
| | - Angela Wang
- Clinical Research Directorate/Clinical Monitoring Research Program, Leidos Biomedical Research, Inc., Frederick National Laboratory for Cancer Research, Frederick, MD, 21702, USA
| | - Michael J Lenardo
- National Institute of Allergy and Infectious Disease, NIH, 10 Center Drive, Building 10, Room 12C103, Bethesda, MD, USA
| | - Lori H Erby
- National Human Genome Research Institute, NIH, Bethesda, MD, USA
| |
Collapse
|
39
|
Smith SK, Selig W, Harker M, Roberts JN, Hesterlee S, Leventhal D, Klein R, Patrick-Lake B, Abernethy AP. Patient Engagement Practices in Clinical Research among Patient Groups, Industry, and Academia in the United States: A Survey. PLoS One 2015; 10:e0140232. [PMID: 26465328 PMCID: PMC4605726 DOI: 10.1371/journal.pone.0140232] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Accepted: 09/23/2015] [Indexed: 12/22/2022] Open
Abstract
Objective Patient-centered clinical trial design and execution is becoming increasingly important. No best practice guidelines exist despite a key stakeholder declaration to create more effective engagement models. This study aims to gain a better understanding of attitudes and practices for engaging patient groups so that actionable recommendations may be developed. Methods Individuals from industry, academic institutions, and patient groups were identified through Clinical Trials Transformation Initiative and Drug Information Association rosters and mailing lists. Objectives, practices, and perceived barriers related to engaging patient groups in the planning, conduct, and interpretation of clinical trials were reported in an online survey. Descriptive and inferential statistical analysis of survey data followed a literature review to inform survey questions. Results Survey respondents (n = 179) valued the importance of involving patient groups in research; however, patient group respondents valued their contributions to research protocol development, funding acquisition, and interpretation of study results more highly than those contributions were valued by industry and academic respondents (all p < .001). Patient group respondents placed higher value in open communications, clear expectations, and detailed contract execution than did non–patient group respondents (all p < .05). Industry and academic respondents more often cited internal bureaucratic processes and reluctance to share information as engagement barriers than did patient group respondents (all p < .01). Patient groups reported that a lack of transparency and understanding of the benefits of collaboration on the part of industry and academia were greater barriers than did non–patient group respondents (all p< .01). Conclusions Despite reported similarities among approaches to engagement by the three stakeholder groups, key differences exist in perceived barriers and benefits to partnering with patient groups among the sectors studied. This recognition could inform the development of best practices for patient-centered clinical trial design and execution. Additional research is needed to define and optimize key success factors.
Collapse
Affiliation(s)
- Sophia K. Smith
- School of Nursing, Duke University, Durham, NC, United States of America
- * E-mail:
| | - Wendy Selig
- WS Collaborative, McLean, VA, United States of America
| | - Matthew Harker
- Clinical Trials Transformation Initiative, Duke Clinical Research Institute, Durham, NC, United States of America
| | - Jamie N. Roberts
- Clinical Trials Transformation Initiative, Duke Clinical Research Institute, Durham, NC, United States of America
| | - Sharon Hesterlee
- Parent Project Muscular Dystrophy, Hackensack, NJ, United States of America
| | - David Leventhal
- Pfizer Worldwide Research and Development, Groton, CT, United States of America
| | - Richard Klein
- U.S. Food and Drug Administration, Silver Spring, MD, United States of America
| | - Bray Patrick-Lake
- Clinical Trials Transformation Initiative, Duke Clinical Research Institute, Durham, NC, United States of America
| | | |
Collapse
|
40
|
Beusterien K, Kennelly MJ, Bridges JFP, Amos K, Williams MJ, Vasavada S. Use of best-worst scaling to assess patient perceptions of treatments for refractory overactive bladder. Neurourol Urodyn 2015; 35:1028-1033. [PMID: 26370222 DOI: 10.1002/nau.22876] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 08/19/2015] [Indexed: 11/07/2022]
Abstract
AIMS Refractory overactive bladder (OAB) treatments, including sacral neuromodulation (SNM), onabotulinumtoxin A (OnabotA), and percutaneous tibial nerve stimulation (PTNS), differ considerably. Best-Worst Scaling (BWS) was used to assess patient preferences for these treatments. METHODS A cross-sectional Web survey, based on findings from qualitative interviews with 23 OAB patients and 7 clinical experts, was conducted with idiopathic OAB patients in the US and UK. The BWS exercise involved prioritizing subsets of 13 attributes across 13 choice tasks, where patients identified the attribute they considered as best and as worst in each task. Attribute BWS scores, ranging from -1.0 (worst) to 1.0 (best) were calculated based on the rates that each attribute was chosen. Attitudes toward the attributes also were assessed via like/dislike Likert scales, and questions regarding the percentage likelihood (0-100%) of trying each treatment, based on standardized treatment descriptions. RESULTS The sample included 245 patients (118 US, 127 UK); 79% female, mean age 50 ± 7.8 years. All 13 attribute BWS scores were significantly positive or negative. "Lasting improvement" (0.82), "minimal side effects" (0.67), and "sends signals between bladder and brain" (0.35)' were rated most favorably, and "complications with implant" (-0.65), and "be willing to self-catheterize" (-0.53) were rated worst. All but one of the attribute BWS scores were significantly correlated with the respective like/dislike scores and the percentage likelihood estimates for trying one of the three treatments. CONCLUSION BWS was successful in assessing the magnitude of patient preferences for key attributes associated with substantially different refractory OAB therapies. Neurourol. Urodynam. 35:1028-1033, 2016. © 2015 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
| | - Michael J Kennelly
- Women's Center for Pelvic Health, Carolinas Heathcare System, Charlotte, North Carolina
| | - John F P Bridges
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | | | - Sandip Vasavada
- Center for Female Pelvic Medicine and Reconstructive Surgery, Glickman Urological Institute, Cleveland Clinic, Cleveland, Ohio
| |
Collapse
|