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Haupt MR, Cuomo R, Cui M, Mackey TK. Is This Safe? Examining Safety Assessments of Illicit Drug Purchasing on Social Media Using Conjoint Analysis. Subst Use Misuse 2024; 59:999-1011. [PMID: 38319039 PMCID: PMC11019931 DOI: 10.1080/10826084.2024.2310507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
Background: Illicit substance sales facilitated by social media platforms are a growing public health issue given recent increases in overdose deaths, including an alarming rise in cases of fentanyl poisoning. However, little is known about how online users evaluate what features of social media posts convey safety, which can influence their intent to source illicit substances. Objectives: This study adapts conjoint analysis which assessed how attributes of social media posts (i.e., features) influence safety evaluations of mock posts selling illicit substances. 440 participants were recruited online for self-reporting use or purchase of controlled substances or prescription medicines recreationally. The following attributes were tested: drug packaging, drug offerings, profile photo of seller, payment info provided, and use of emojis. Results: Packaging was ranked the most important attribute (Average Importance =43.68, Offering=14.94, Profile=13.86, Payment=14.11, Emoji=13.41), with posts that displayed drugs in pill bottles assessed as the most safe. Attribute levels for advertising multiple drugs, having a blank profile photo, including payment information, and including emojis also ranked higher in perceived safety. Rankings were consistent across tested demographic factors (i.e., gender, age, and income). Survey results show that online pharmacies were most likely to be perceived as safe for purchasing drugs and medications. Additionally, those who were younger in age, had higher income, and identified as female were more likely to purchase from a greater number of platforms. Conclusions: These findings can assist in developing more precise content moderation for platforms seeking to address this ongoing threat to public safety.
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Affiliation(s)
- Michael Robert Haupt
- Department of Cognitive Science, University of California San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, USA
- Global Health Policy & Data Institute, San Diego, CA USA
| | - Raphael Cuomo
- Global Health Policy & Data Institute, San Diego, CA USA
- Department of Anesthesiology, University of California, San Diego School of Medicine, San Diego, CA USA
| | - Manying Cui
- Global Health Policy & Data Institute, San Diego, CA USA
| | - Tim K. Mackey
- Global Health Policy & Data Institute, San Diego, CA USA
- Global Health Program, Department of Anthropology, University of California, San Diego, CA USA
- S-3 Research LLC, San Diego, CA USA
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Ben-Zacharia AB, Lee JM, Kahle JS, Lord B. Shared decision-making in multiple sclerosis physical symptomatic care: a systematic review. Ther Adv Chronic Dis 2023; 14:20406223231172920. [PMID: 37324408 PMCID: PMC10265321 DOI: 10.1177/20406223231172920] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 04/14/2023] [Indexed: 06/17/2023] Open
Abstract
Background Multiple sclerosis (MS) is a chronic autoimmune inflammatory, demyelinating, and neurodegenerative disease affecting young adults. People with MS are highly interested in engaging in physical symptom management and decision-making but are often not actively engaged in symptom management discussions. Research examining the benefit of shared decision-making in the management of physical MS symptoms is sparse. Objectives This study aimed to identify and synthesize the evidence on the use of shared decision-making in physical MS symptom management. Design This study is a systematic review of published evidence on the use of shared decision-making in physical MS symptom management. Data sources and methods MEDLINE, CINAHL, EMBASE, and CENTRAL databases were searched in April 2021, June 2022, and April 2, 2023, for primary, peer-reviewed studies of shared decision-making in the management of MS physical symptoms. Citations were screened, data extracted, and study quality assessed according to Cochrane guidelines for systematic reviews, including risk of bias assessment. Statistical synthesis of the included study results was not appropriate; results were summarized in a nonstatistical manner using the vote-counting method to estimate beneficial versus harmful effects. Results Of 679 citations, 15 studies met the inclusion criteria. Six studies addressed shared decision-making in the management of pain, spasms, neurogenic bladder, fatigue, gait disorder, and/or balance issues, and nine studies addressed physical symptoms in general. One study was a randomized controlled trial; most studies were observational studies. All study results and study author conclusions indicated that shared decision-making is important to the effective management of physical MS symptoms. No study results suggested that shared decision-making was harmful or delayed the management of physical MS symptoms. Conclusion Reported results consistently indicate that shared decision-making is important in effective MS symptomatic care. Further rigorous randomized controlled trials are warranted to investigate the effectiveness of shared decision-making associated with MS physical symptomatic care. Registration PROSPERO: CRD42023396270.
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Affiliation(s)
- Aliza Bitton Ben-Zacharia
- Assistant Professor, Hunter Bellevue School of Nursing, 425 East 25 Street, New York, NY 10010, USA
- Mount Sinai Hospital, New York, NY, USA
| | - Jong-Mi Lee
- Neuroscience Clinic, Stanford Health Care, CA, USA
| | - Jennifer S. Kahle
- Department of Psychological Sciences, University of San Diego, San Diego, CA, USA
- IHS International, San Diego, CA, USA
| | - Bonnie Lord
- A patient living with multiple sclerosis since 2003
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LoCastro M, Wang Y, Sanapala C, Jensen-Battaglia M, Wittink M, Norton S, Klepin HD, Richardson DR, Mendler JH, Liesveld J, Huselton E, Loh KP. Patient preferences, regret, and health-related quality of life among older adults with acute myeloid leukemia: A pilot longitudinal study. J Geriatr Oncol 2023; 14:101529. [PMID: 37244139 PMCID: PMC10288066 DOI: 10.1016/j.jgo.2023.101529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/13/2023] [Accepted: 05/11/2023] [Indexed: 05/29/2023]
Abstract
INTRODUCTION Acute myeloid leukemia (AML) is associated with poor outcomes and is generally incurable. Therefore, understanding preferences of older adults with AML is critical. We sought to assess whether best-worst scaling (BWS) can be used to capture attributes considered by older adults with AML when making initial treatment decisions and longitudinally, as well as assess changes in health-related quality of life (HRQoL) and decisional regret over time. MATERIALS AND METHODS In a longitudinal study for adults ≥60 years with newly diagnosed AML, we collected: (1) attributes of treatment most important to patients using BWS, (2) HRQoL using EQ-5D-5L, (3) decisional regret using the Decisional Regret Scale, and (4) treatment worthiness using the "Was it worth it?" questionnaire. Data was collected at baseline and over six months. A hierarchical Bayes model was used to allocate percentages out of 100%. Due to small sample size, hypothesis testing was performed at α = 0.10 (2-tailed). We analyzed how these measures differed by treatment choice (intensive vs. lower intensity treatment). RESULTS Mean age of patients was 76 years (n = 15). At baseline, the most important attributes of treatment to patients were response to treatment (i.e., chance that the cancer will respond to treatment; 20.9%). Compared to those who received lower intensity treatment (n = 7) or best supportive care (n = 2), those who received intensive treatment (n = 6) generally ranked "alive one year or more after treatment" (p = 0.03) with higher importance and ranked "daily activities" (p = 0.01) and "location of treatment" (p = 0.01) with less importance. Overall, HRQoL scores were high. Decisional regret was mild overall and lower for patients who chose intensive treatment (p = 0.06). DISCUSSION We demonstrated that BWS can be used to assess the importance of various treatment attributes considered by older adults with AML when making initial treatment decisions and longitudinally throughout treatment. Attributes of treatment important to older patients with AML differed between treatment groups and changed over time. Interventions are needed to re-assess patient priorities throughout treatment to ensure care aligns with patient preferences.
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Affiliation(s)
- Marissa LoCastro
- School of Medicine and Dentistry, University of Rochester, Rochester, New York, USA.
| | - Ying Wang
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, New York, USA.
| | | | - Marielle Jensen-Battaglia
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, New York, USA.
| | - Marsha Wittink
- Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
| | - Sally Norton
- School of Nursing, University of Rochester Medical Center, Rochester, New York, USA.
| | - Heidi D Klepin
- Section on Hematology and Oncology, Wake Forest Baptist Comprehensive Cancer Center, Medical Center Blvd, Winston-Salem, NC, USA.
| | - Daniel R Richardson
- Division of Hematology, Department of Medicine, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA.
| | - Jason H Mendler
- Division of Hematology/Oncology, Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA.
| | - Jane Liesveld
- Division of Hematology/Oncology, Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA.
| | - Eric Huselton
- Division of Hematology/Oncology, Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA.
| | - Kah Poh Loh
- Division of Hematology/Oncology, Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA.
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Tatlock S, Sully K, Batish A, Finbow C, Neill W, Lines C, Brennan R, Adlard N, Backhouse T. Individual Differences in the Patient Experience of Relapsing Multiple Sclerosis (RMS): A Multi-Country Qualitative Exploration of Drivers of Treatment Preferences Among People Living with RMS. THE PATIENT 2023:10.1007/s40271-023-00617-y. [PMID: 37017920 PMCID: PMC10074350 DOI: 10.1007/s40271-023-00617-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Accepted: 01/30/2023] [Indexed: 04/06/2023]
Abstract
AIMS The aim of this study was to explore the experiences, values and preferences of people living with relapsing multiple sclerosis (PLwRMS) focusing on their treatments and what drives their treatment preferences. METHODS In-depth, semi-structured, qualitative telephone interviews were conducted using a purposive sampling approach with 72 PLwRMS and 12 health care professionals (HCPs, MS specialist neurologists and nurses) from the United Kingdom, United States, Australia and Canada. Concept elicitation questioning was used to elicit PLwRMS' attitudes, beliefs and preferences towards features of disease-modifying treatments. Interviews with HCPs were conducted to inform on HCPs' experiences of treating PLwRMS. Responses were audio recorded and transcribed verbatim and then subjected to thematic analysis. RESULTS Participants discussed numerous concepts that were important to them when making treatment decisions. Levels of importance participants placed on each concept, as well as reasons underpinning importance, varied substantially. The concepts with the greatest variability in terms of how much PLwRMS found them to be important in their decision-making process were mode of administration, speed of treatment effect, impact on reproduction and parenthood, impact on work and social life, patient engagement in decision making, and cost of treatment to the participant. Findings also demonstrated high variability in what participants described as their ideal treatment and the most important features a treatment should have. HCP findings provided clinical context for the treatment decision-making process and supported patient findings. CONCLUSIONS Building upon previous stated preference research, this study highlighted the importance of qualitative research in understanding what drives patient preferences. Characterized by the heterogeneity of the RMS patient experience, findings indicate the nature of treatment decisions in RMS to be highly individualized, and the subjective relative importance placed on different treatment factors by PLwRMS to vary. Such qualitative patient preference evidence could offer valuable and supplementary insights, alongside quantitative data, to inform decision making related to RMS treatment.
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Affiliation(s)
- Sophi Tatlock
- Adelphi Values, Adelphi Mill, Grimshaw Lane, Bollington, SK10 5JB, Cheshire, UK.
| | - Kate Sully
- Adelphi Values, Adelphi Mill, Grimshaw Lane, Bollington, SK10 5JB, Cheshire, UK
| | - Anjali Batish
- Adelphi Values, Adelphi Mill, Grimshaw Lane, Bollington, SK10 5JB, Cheshire, UK
| | - Chelsea Finbow
- Adelphi Values, Adelphi Mill, Grimshaw Lane, Bollington, SK10 5JB, Cheshire, UK
| | - William Neill
- Adelphi Values, Adelphi Mill, Grimshaw Lane, Bollington, SK10 5JB, Cheshire, UK
| | - Carol Lines
- Novartis Pharma AG, 4002, Basel, Switzerland
| | | | | | - Tamara Backhouse
- University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, Norfolk, UK
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LoCastro M, Sanapala C, Wang Y, Jensen‐Battaglia M, Wittink M, Norton S, Klepin HD, Richardson DR, Mendler JH, Liesveld J, Huselton E, O'Dwyer K, Cortes A, Rodriguez C, Dale W, Loh KP. Patient-centered communication tool for older patients with acute myeloid leukemia, their caregivers, and oncologists: A single-arm pilot study. Cancer Med 2023; 12:8581-8593. [PMID: 36533397 PMCID: PMC10134384 DOI: 10.1002/cam4.5547] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/18/2022] [Accepted: 11/29/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND In a single-arm pilot study, we assessed the feasibility and usefulness of an innovative patient-centered communication tool (UR-GOAL tool) that addresses aging-related vulnerabilities, patient values, and prognostic awareness for use in treatment decision making between older adults with newly diagnosed acute myeloid leukemia (AML), their caregivers, and oncologists. METHODS Primary feasibility metric was retention rate; >50% was considered feasible. We collected recruitment rate, usefulness, and outcomes including AML knowledge (range 0-14) and perceived efficacy in communicating with oncologists (range 5-25). Due to the pilot nature and small sample size, hypothesis testing was performed at α = 0.10. RESULTS We included 15 patients (mean age 76 years, range 64-88), 12 caregivers, and 5 oncologists; enrollment and retention rates for patients were 84% and 73%, respectively. Patients agreed that the UR-GOAL tool helped them understand their AML diagnosis and treatment options, communicate with their oncologist, and make more informed decisions. From baseline to post-intervention, patients and caregivers scored numerically higher on AML knowledge (patients: +0.6, p = 0.22; caregivers: +1.1, p = 0.05) and perceived greater efficacy in communicating with their oncologists (patients: +1.5, p = 0.22; caregivers: +1.2, p = 0.06). CONCLUSION We demonstrated that it is feasible to incorporate the UR-GOAL tool into treatment decision making for older patients with AML, their caregivers, and oncologists.
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Affiliation(s)
- Marissa LoCastro
- School of Medicine and DentistryUniversity of RochesterRochesterNew YorkUSA
| | - Chandrika Sanapala
- Burrell College of Osteopathic MedicineLas CrucesNew MexicoUnited States
| | - Ying Wang
- Department of Public Health SciencesUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | | | - Marsha Wittink
- Department of PsychiatryUniversity of Rochester School of Medicine and DentistryRochesterNew YorkUSA
| | - Sally Norton
- School of NursingUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Heidi D. Klepin
- Section on Hematology and OncologyWake Forest Baptist Comprehensive Cancer Center, Medical Center BlvdWinston‐SalemNorth CarolinaUSA
| | - Daniel R. Richardson
- Division of Hematology, Department of Medicine, Lineberger Comprehensive Cancer CenterUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Jason H. Mendler
- Division of Hematology/Oncology, Department of MedicineJames P. Wilmot Cancer Institute, University of Rochester Medical CenterRochesterNew YorkUSA
| | - Jane Liesveld
- Division of Hematology/Oncology, Department of MedicineJames P. Wilmot Cancer Institute, University of Rochester Medical CenterRochesterNew YorkUSA
| | - Eric Huselton
- Division of Hematology/Oncology, Department of MedicineJames P. Wilmot Cancer Institute, University of Rochester Medical CenterRochesterNew YorkUSA
| | - Kristen O'Dwyer
- Division of Hematology/Oncology, Department of MedicineJames P. Wilmot Cancer Institute, University of Rochester Medical CenterRochesterNew YorkUSA
| | | | - Chrystina Rodriguez
- Division of Hematology/Oncology, Department of MedicineJames P. Wilmot Cancer Institute, University of Rochester Medical CenterRochesterNew YorkUSA
| | - William Dale
- Department of Supportive CareCity of Hope National Medical CenterDuarteCaliforniaUSA
| | - Kah Poh Loh
- Division of Hematology/Oncology, Department of MedicineJames P. Wilmot Cancer Institute, University of Rochester Medical CenterRochesterNew YorkUSA
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Parikh ND, Girvan A, Coulter J, Gable J, Poon JL, Kim S, Chatterjee A, Boeri M. Risk thresholds for patients to switch between daily tablets and biweekly infusions in second-line treatment for advanced hepatocellular carcinoma: a patient preference study. BMC Cancer 2023; 23:66. [PMID: 36658529 PMCID: PMC9851100 DOI: 10.1186/s12885-022-10388-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 11/30/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Historically, high hepatocellular carcinoma (HCC)-related mortality has been, in part, due to lack of effective therapies; however, several systemic therapies have been recently approved for HCC treatment, including regorafenib and ramucirumab. These two treatments utilize different routes of administration (four daily tablets and biweekly intravenous infusions, respectively) and have different risks of adverse events (AEs). However, we lack data on patient preferences in balancing the route of administration and risk of AEs in patients with HCC. We aimed to determine patient preferences and trade-offs for second-line treatment in patients with HCC. METHODS: Patients with advanced or metastatic HCC were recruited through their physicians for this study. Patient preferences were assessed by using a modified threshold technique (TT) design in which respondents were asked two direct-elicitation questions before (assuming same safety and efficacy and only varying mode of administration) and after (incorporating the safety profiles of ramucirumab and regorafenib) the TT series on seven risks of clinically relevant AEs. RESULTS In total, of the 157 patients recruited by their physicians, 150 were eligible and consented to participate. In the first elicitation question (assuming risk and efficacy were equivalent), 61.3% of patients preferred daily tablets. However, 76.7% of patients preferred the biweekly infusion when the safety profiles of the two available second-line therapies were included. The TT analysis confirmed that preferences for oral administration were not strong enough to balance out the risk of AEs that differentiate the two therapies. DISCUSSION We found that when patients were asked to choose between a daily, oral medication and a biweekly IV medication for HCC, they were more likely to choose a daily, oral medication if efficacy and safety profiles were the same. However, when risks of AEs representing the safety profiles of two currently available second-line treatments were introduced in a second direct-elicitation question, respondents often selected an IV administration with a safety profile similar to ramucirumab, rather than oral tablets with a safety profile similar to regorafenib. Our findings indicate that the risk profile of a second-line treatment for HCC may be more important than the mode of administration to patients.
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Affiliation(s)
- Neehar D. Parikh
- grid.412590.b0000 0000 9081 2336Division of Gastroenterology and Hepatology, University of Michigan Health System, Ann Arbor, MI USA
| | - Allicia Girvan
- grid.417540.30000 0000 2220 2544Eli Lilly and Company, Indianapolis, IN USA
| | - Joshua Coulter
- grid.62562.350000000100301493RTI Health Solutions, Research Triangle Park, NC USA
| | - Jonathon Gable
- grid.417540.30000 0000 2220 2544Eli Lilly and Company, Indianapolis, IN USA
| | - Jiat Ling Poon
- grid.417540.30000 0000 2220 2544Eli Lilly and Company, Indianapolis, IN USA
| | - Sangmi Kim
- grid.417540.30000 0000 2220 2544Eli Lilly and Company, Indianapolis, IN USA
| | - Anindya Chatterjee
- grid.417540.30000 0000 2220 2544Eli Lilly and Company, Indianapolis, IN USA
| | - Marco Boeri
- RTI Health Solutions, 123B Forsyth House, Cromac Square, Belfast, BT2 8LA UK
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A Targeted Literature Search and Phenomenological Review of Perspectives of People with Multiple Sclerosis and Healthcare Professionals of the Immunology of Disease-Modifying Therapies. Neurol Ther 2022; 11:955-979. [PMID: 35608740 PMCID: PMC9127487 DOI: 10.1007/s40120-022-00349-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 03/25/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction The mechanisms of action of disease-modifying therapies (DMTs) for multiple sclerosis (MS) are complex and involve an interplay of immune system components. People with MS (PwMS) may lack a clear understanding of the immunological pathways involved in MS and its treatment; effective communication between healthcare professionals (HCPs) and PwMS is needed to facilitate shared decision-making when discussing the disease and selecting DMTs and is particularly important in the coronavirus disease 2019 (COVID-19) era. Methods In this patient-authored two-part review, we performed a targeted literature search to assess the need for better communication between HCPs and PwMS regarding treatment selection, and also conducted a qualitative survey of four patient and care-partner authors to obtain insights regarding their understanding of and preferences for the treatment and management of MS. Results Following a search of the Embase and MEDLINE databases using Ovid in June 2020, an analysis of 40 journal articles and conference abstracts relating to patient empowerment and decision-making in DMT selection for MS showed a preference for safety and efficacy of treatments, followed by autonomy and convenience of administration. A need for better communication between HCPs and PwMS during treatment selection to improve patient satisfaction was also identified. The open survey responses from the patient authors revealed a need for greater involvement in decision-making processes and desire for improved communication and information tools. Conclusions This targeted literature search and phenomenological review confirms PwMS preferences for empowered decision-making in disease management and treatment selection, to optimize independence, safety, and efficacy. It also identifies an unmet need for improved communication and information tools that convey MS information in a relatable manner. Furthermore, this review seeks to address this unmet need by providing plain language figures and descriptions of MS immune mechanisms that can be used to facilitate discussions between HCPs and PwMS. Supplementary Information The online version contains supplementary material available at 10.1007/s40120-022-00349-5. In multiple sclerosis (MS), there are different cells in the immune system that contribute to the disease. The main cells in the immune system are T and B cells. People with MS (PwMS) might not be familiar with details about the immune system, and healthcare professionals might not always communicate details about how treatments work clearly to PwMS when choosing treatments with them. It is important for PwMS to have all the information they need to help make decisions about treatments. This information needs to be given in a way they can understand. This is especially important during the coronavirus disease 2019 (COVID-19) pandemic. In this paper, we first looked at what research has already been published about what is most important to PwMS when making treatment decisions. The existing research says that safety and effectiveness are the most important things and that PwMS prefer treatments that they can take themselves. PwMS also need better communication and information from doctors to make decisions and to help explain how MS treatments work in the body. Next, we gave a survey to the patients who are authors of this paper to ask about what is important to them when making treatment decisions. Their answers were very similar to the existing research. Overall, PwMS need better communication from healthcare professionals about the immune system. This paper also includes plain language descriptions and figures to help healthcare professionals explain and discuss the importance of the immune system in MS with PwMS.
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Quigley EMM. Editorial: risky business. What do sufferers' perceptions of risk from interventions for irritable bowel syndrome really mean? Aliment Pharmacol Ther 2022; 55:1218-1219. [PMID: 35429038 DOI: 10.1111/apt.16909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
LINKED CONTENTThis article is linked to Goodoory et al papers. To view these articles, visit https://doi.org/10.1111/apt.16816 and https://doi.org/10.1111/apt.16917
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Affiliation(s)
- Eamonn M M Quigley
- Lynda K and David M Underwood Center for Digestive Disorders, Houston Methodist Hospital and Weill Cornell Medical College, Houston, Texas, USA
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9
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Masri HE, McGuire TM, Dalais C, van Driel M, Benham H, Hollingworth SA. Patient-based benefit-risk assessment of medicines: development, refinement, and validation of a content search strategy to retrieve relevant studies. J Med Libr Assoc 2022; 110:185-204. [PMID: 35440905 PMCID: PMC9014953 DOI: 10.5195/jmla.2022.1306] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Introduction: Poor indexing and inconsistent use of terms and keywords may prevent efficient retrieval of studies on the patient-based benefit-risk assessment (BRA) of medicines. We aimed to develop and validate an objectively derived content search strategy containing generic search terms that can be adapted for any search for evidence on patient-based BRA of medicines for any therapeutic area. Methods: We used a robust multistep process to develop and validate the content search strategy: (1) we developed a bank of search terms derived from screening studies on patient-based BRA of medicines in various therapeutic areas, (2) we refined the proposed content search strategy through an iterative process of testing sensitivity and precision of search terms, and (3) we validated the final search strategy in PubMed by firstly using multiple sclerosis as a case condition and secondly computing its relative performance versus a published systematic review on patient-based BRA of medicines in rheumatoid arthritis. Results: We conceptualized a final search strategy to retrieve studies on patient-based BRA containing generic search terms grouped into two domains, namely the patient and the BRA of medicines (sensitivity 84%, specificity 99.4%, precision 20.7%). The relative performance of the content search strategy was 85.7% compared with a search from a published systematic review of patient preferences in the treatment of rheumatoid arthritis. We also developed a more extended filter, with a relative performance of 93.3% when compared with a search from a published systematic review of patient preferences in lung cancer.
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Affiliation(s)
- Hiba El Masri
- , PhD Candidate, School of Pharmacy, The University of Queensland, Woolloongabba, QLD, Australia
| | - Treasure M McGuire
- , Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, Australia, Mater Pharmacy, Mater Health, Raymond Tce, South Brisbane, QLD, Australia
| | - Christine Dalais
- , University Library, The University of Queensland, Brisbane, QLD, Australia
| | - Mieke van Driel
- , Primary Care Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Helen Benham
- , Department of Rheumatology, Princess Alexandra Hospital, Brisbane, QLD, Australia
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Johnson CA, Tran DN, Mwangi A, Sosa-Rubí SG, Chivardi C, Romero-Martínez M, Pastakia S, Robinson E, Jennings Mayo-Wilson L, Galárraga O. Incorporating respondent-driven sampling into web-based discrete choice experiments: preferences for COVID-19 mitigation measures. HEALTH SERVICES AND OUTCOMES RESEARCH METHODOLOGY 2022; 22:297-316. [PMID: 35035272 PMCID: PMC8747856 DOI: 10.1007/s10742-021-00266-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 09/22/2021] [Accepted: 11/25/2021] [Indexed: 11/28/2022]
Abstract
To slow the spread of COVID-19, most countries implemented stay-at-home orders, social distancing, and other nonpharmaceutical mitigation strategies. To understand individual preferences for mitigation strategies, we piloted a web-based Respondent Driven Sampling (RDS) approach to recruit participants from four universities in three countries to complete a computer-based Discrete Choice Experiment (DCE). Use of these methods, in combination, can serve to increase the external validity of a study by enabling recruitment of populations underrepresented in sampling frames, thus allowing preference results to be more generalizable to targeted subpopulations. A total of 99 students or staff members were invited to complete the survey, of which 72% started the survey (n = 71). Sixty-three participants (89% of starters) completed all tasks in the DCE. A rank-ordered mixed logit model was used to estimate preferences for COVID-19 nonpharmaceutical mitigation strategies. The model estimates indicated that participants preferred mitigation strategies that resulted in lower COVID-19 risk (i.e. sheltering-in-place more days a week), financial compensation from the government, fewer health (mental and physical) problems, and fewer financial problems. The high response rate and survey engagement provide proof of concept that RDS and DCE can be implemented as web-based applications, with the potential for scale up to produce nationally-representative preference estimates.
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Affiliation(s)
- Courtney A Johnson
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, 121 South Main Street, Box G-S121-2, Providence, RI 02912 USA
| | - Dan N Tran
- Department of Pharmacy Practice, Temple University School of Pharmacy, Philadelphia, PA USA
| | - Ann Mwangi
- Department of Behavioural Science, School of Medicine, Moi University, Eldoret, Kenya
| | | | - Carlos Chivardi
- National Institute of Public Health (INSP), Cuernavaca, Morelos Mexico
| | | | - Sonak Pastakia
- Center for Health Equity and Innovation, Purdue University College of Pharmacy, Indianapolis, IN USA
| | | | | | - Omar Galárraga
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, 121 South Main Street, Box G-S121-2, Providence, RI 02912 USA
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The Impact of Reproductive Issues on Preferences of Women with Relapsing Multiple Sclerosis for Disease-Modifying Treatments. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2021; 13:583-597. [PMID: 32588337 DOI: 10.1007/s40271-020-00429-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Relapsing-remitting multiple sclerosis (RRMS) is an incurable disease characterised by relapses (periods of function loss) followed by full or partial recovery, and potential permanent disability over time. Many disease-modifying treatments (DMTs) exist that help reduce relapses and slow disease progression. Most are contraindicated during conception/pregnancy and some require a discontinuation period before trying to conceive. Although around three-quarters of people with RRMS are women, there is limited knowledge about how reproductive issues impact DMT preference. OBJECTIVE The aim of this study was to measure the preferences for DMTs of women with RRMS who are considering pregnancy. DESIGN An online discrete choice experiment (DCE). METHODS Participants chose between two hypothetical DMTs characterised by a set of attributes, then indicated if they preferred their choice to no treatment. Attributes were identified from interviews and focus groups with people with RRMS and MS professionals, as well as literature reviews, and included the probability of problems with pregnancy, discontinuation of DMTs, and breastfeeding safety. In each DCE task, participants were asked to imagine making decisions in three scenarios: now; when trying to conceive; and when pregnant. ANALYSIS Two mixed logit models were estimated, one to assess the statistical significance between scenarios and one in maximum acceptable risk space to allow comparison of the magnitudes of parameters between scenarios. SAMPLE Women with RRMS who were considering having a child in the future, recruited from a UK MS patient register. RESULTS Sixty respondents completed the survey. Participants preferred no treatment in 12.6% of choices in the 'now' scenario, rising significantly to 37.6% in the 'trying to conceive' scenario and 60.3% in the 'pregnant' scenario (Kruskal-Wallis p < 0.001). This pattern corresponds with results from models that included a no-treatment alternative-specific constant (ASC) capturing differences between taking and not taking a DMT not specified by the attributes. The ASC was lower in the trying to conceive scenario than in the now scenario, and lower still in the pregnant scenario, indicating an intrinsic preference for no treatment. Participants also placed relatively less preference on reducing relapses and avoiding disease progression in the trying to conceive and pregnant scenarios compared with a lower risk of problems with pregnancy. In the trying to conceive scenario, participants' preference for treatments with shorter washout periods increased. CONCLUSION Women with RRMS considering having a child prefer DMTs with more favourable reproduction-related attributes, even when not trying to conceive. Reproductive issues also influenced preferences for DMT attributes not directly related to pregnancy, with preferences dependent on the life circumstances in which choices were made. The design of the DCE highlights the benefits of considering the scenario in which participants make choices, as they may change over time.
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12
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Kremer IEH, Hiligsmann M, Carlson J, Zimmermann M, Jongen PJ, Evers SMAA, Petersohn S, Pouwels XGLV, Bansback N. Exploring the Cost Effectiveness of Shared Decision Making for Choosing between Disease-Modifying Drugs for Relapsing-Remitting Multiple Sclerosis in the Netherlands: A State Transition Model. Med Decis Making 2021; 40:1003-1019. [PMID: 33174513 PMCID: PMC7672783 DOI: 10.1177/0272989x20961091] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background Up to 31% of patients with relapsing-remitting multiple sclerosis (RRMS) discontinue treatment with disease-modifying drug (DMD) within the first year, and of the patients who do continue, about 40% are nonadherent. Shared decision making may decrease nonadherence and discontinuation rates, but evidence in the context of RRMS is limited. Shared decision making may, however, come at additional costs. This study aimed to explore the potential cost-effectiveness of shared decision making for RRMS in comparison with usual care, from a (limited) societal perspective over a lifetime. Methods An exploratory economic evaluation was conducted by adapting a previously developed state transition model that evaluates the cost-effectiveness of a range of DMDs for RRMS in comparison with the best supportive care. Three potential effects of shared decision making were explored: 1) a change in the initial DMD chosen, 2) a decrease in the patient’s discontinuation in using the DMD, and 3) an increase in adherence to the DMD. One-way and probabilistic sensitivity analyses of a scenario that combined the 3 effects were conducted. Results Each effect separately and the 3 effects combined resulted in higher quality-adjusted life years (QALYs) and costs due to the increased utilization of DMD. A decrease in discontinuation of DMDs influenced the incremental cost-effectiveness ratio (ICER) most. The combined scenario resulted in an ICER of €17,875 per QALY gained. The ICER was sensitive to changes in several parameters. Conclusion This study suggests that shared decision making for DMDs could potentially be cost-effective, especially if shared decision making would help to decrease treatment discontinuation. Our results, however, may depend on the assumed effects on treatment choice, persistence, and adherence, which are actually largely unknown.
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Affiliation(s)
- Ingrid E H Kremer
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, Limburg, The Netherlands.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Mickael Hiligsmann
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, Limburg, The Netherlands
| | - Josh Carlson
- Department of Pharmacy, University of Washington, Seattle, WA, USA
| | | | - Peter J Jongen
- MS4 Research Institute, Nijmegen, The Netherlands.,Department of Community and Occupational Medicine, University Medical Center Groningen, Groningen, The Netherlands
| | - Silvia M A A Evers
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, Limburg, The Netherlands.,Centre for Economic Evaluations, Trimbos Institute, Utrecht, The Netherlands
| | - Svenja Petersohn
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, Limburg, The Netherlands.,Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Xavier G L V Pouwels
- Department of Health Technology & Services Research, Faculty of Behavioral, Management & Social Sciences, University of Twente, Enschede, The Netherlands
| | - Nick Bansback
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
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13
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Loh KP, Abdallah M, Kadambi S, Wells M, Kumar AJ, Mendler J, Liesveld J, Wittink M, O’Dwyer K, Becker MW, McHugh C, Stock W, Majhail NS, Wildes TM, Duberstein P, Mohile SG, Klepin HD. Treatment decision-making in acute myeloid leukemia: a qualitative study of older adults and community oncologists. Leuk Lymphoma 2021; 62:387-398. [PMID: 33040623 PMCID: PMC7878016 DOI: 10.1080/10428194.2020.1832662] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 09/13/2020] [Accepted: 09/29/2020] [Indexed: 01/19/2023]
Abstract
Little is known about the characteristics of patients, physicians, and organizations that influence treatment decisions in older patients with AML. We conducted qualitative interviews with community oncologists and older patients with AML to elicit factors that influence their treatment decision-making. Recruitment was done via purposive sampling and continued until theoretical saturation was reached, resulting in the inclusion of 15 patients and 15 oncologists. Participants' responses were analyzed using directed content analysis. Oncologists and patients considered comorbidities, functional status, emotional health, cognition, and social factors when deciding treatment; most oncologists evaluated these using clinical gestalt. Sixty-seven percent of patients perceived that treatment was their only option and that they had not been offered a choice. In conclusion, treatment decision-making is complex and influenced by patient-related factors. These factors can be assessed as part of a geriatric assessment which can help oncologists better determine fitness and guide treatment decision-making.
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Affiliation(s)
- Kah Poh Loh
- James P. Wilmot Cancer Institute, Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center
| | - Maya Abdallah
- Department of Medicine, Sections of Geriatrics and Hematology/Oncology, Boston University School of Medicine, Boston, , Massachusetts
| | - Sindhuja Kadambi
- James P. Wilmot Cancer Institute, Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center
| | - Megan Wells
- James P. Wilmot Cancer Institute, Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center
| | | | - Jason Mendler
- James P. Wilmot Cancer Institute, Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center
| | - Jane Liesveld
- James P. Wilmot Cancer Institute, Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center
| | - Marsha Wittink
- Department of Psychiatry, University of Rochester Medical Center
| | - Kristen O’Dwyer
- James P. Wilmot Cancer Institute, Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center
| | - Michael W. Becker
- James P. Wilmot Cancer Institute, Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center
| | - Colin McHugh
- James P. Wilmot Cancer Institute, Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center
| | - Wendy Stock
- The University of Chicago Medicine Comprehensive Cancer Center, Chicago, Illinois
| | - Navneet S. Majhail
- Blood and Marrow Transplant Program, Taussig Cancer Center, Cleveland Clinic, Cleveland, Ohio
| | - Tanya M. Wildes
- Division of Medical Oncology, Department of Medicine, Washington University School of Medicine, St Louis, Missouri
| | | | - Supriya Gupta Mohile
- James P. Wilmot Cancer Institute, Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center
| | - Heidi D. Klepin
- Wake Forest Baptist Comprehensive Cancer Center, Medical Center Blvd, Winston-Salem, NC
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14
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Ngorsuraches S, Poudel N. Incorporating patients' preferences in the value assessment of disease-modifying therapies for multiple sclerosis: a narrative review. Expert Rev Pharmacoecon Outcomes Res 2021; 21:183-195. [PMID: 33472451 DOI: 10.1080/14737167.2021.1880321] [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: 10/22/2022]
Abstract
Introduction: Despite the increasing role of patients in the US healthcare system, patients have yet been engaged in the value assessment of their treatments, including disease-modifying therapies (DMTs) for multiple sclerosis (MS). The objectives of this review were therefore to summarize existing studies on cost-effectiveness analysis (CEA) with quality-adjusted life years (QALYs) and patients' preferences of DMTs for MS, and to discuss how to incorporate patients' preferences into the value assessment of DMTs.Area covered: We reviewed previous systematic reviews and conducted further search until November 2020 for studies on CEA with QALYs and patients' preferences of DMTs for MS. We identified the outcomes that were assessed or valued in the CEA studies and the DMT attributes that were important to patients with MS.Expert opinion: Our literature review showed that the studies using CEA with QALYs failed to capture some important DMT attributes, e.g., route and frequency of administration, identified in the studies on the patients' preferences. Various approaches were available for incorporating the patients' preferences in the value assessment of DMTs for MS. We supported this incorporation, which subsequently would increase patient access to preferred DMTs.
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Affiliation(s)
- Surachat Ngorsuraches
- Department of Health Outcomes Research and Policy, Auburn University, Harrison School of Pharmacy, Auburn, AL, USA
| | - Nabin Poudel
- Department of Health Outcomes Research and Policy, Auburn University, Harrison School of Pharmacy, Auburn, AL, USA
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15
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Rahn AC, Solari A, Beckerman H, Nicholas R, Wilkie D, Heesen C, Giordano A. "I Will Respect the Autonomy of My Patient": A Scoping Review of Shared Decision Making in Multiple Sclerosis. Int J MS Care 2021; 22:285-293. [PMID: 33424485 DOI: 10.7224/1537-2073.2020-027] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Patient autonomy is a bioethical principle that was strengthened in the revised Declaration of Geneva. Shared decision making (SDM) is particularly relevant in the management of multiple sclerosis (MS) because many preference-sensitive decisions have to be made during the disease course. We aimed to summarize the available evidence on SDM in the MS field and to inform future research and practice. Methods We performed a scoping review by searching MEDLINE (past 5 years). Studies were included if they reported primary/secondary research and focused on SDM related to people with MS. Data were grouped into topics, with results presented in narrative form. Results From 865 references, we included 55 studies conducted mostly in Europe. Half of the studies were observational, followed by qualitative (20%), mixed-methods (17%), randomized controlled trials (RCTs, 5%), quasi-experimental (5%), and reviews (4%). Most studies addressed people with relapsing-remitting MS (85%); the remaining addressed health care professionals, patients' significant others, or a combination. We identified five main topics: decisions on disease-modifying drugs, decisions on chronic cerebrospinal venous insufficiency treatment, information provision and patient education, health literacy, and risk knowledge. Conclusions The high proportion of included studies on SDM in MS in Europe suggests an earlier adoption of these concepts in this area. Decisions on disease-modifying drugs was the prevalent topic. Only 5% of studies were RCTs, indicating that more research is needed to study the effectiveness of SDM interventions. Studies addressing people with primary and secondary progressive MS are also needed.
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16
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Kumar J, Cambron-Mellott MJ, Tencer T, Will O, Mackie DS, Beusterien K. Patient and Neurologist Preferences in the United States for Relapsing-Remitting Multiple Sclerosis Treatments: Findings from a Discrete Choice Experiment. Patient Prefer Adherence 2021; 15:1515-1527. [PMID: 34267507 PMCID: PMC8275192 DOI: 10.2147/ppa.s306498] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 05/28/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Relapsing-remitting multiple sclerosis (RRMS) is a chronic inflammatory disease associated with central nervous system dysfunction and accelerated brain volume loss (BVL). There exists a paucity of research examining the importance of BVL to patients and neurologists and exploring whether such preferences may differ between these two groups. This study sought to evaluate the preferences of patients and neurologists for RRMS treatments by considering benefits and risks associated with novel and common disease-modifying therapies (DMTs). PATIENTS AND METHODS US patients diagnosed with non-highly active RRMS and US-based neurologists completed an online cross-sectional survey. A discrete choice experiment was used to assess patient and neurologist treatment preferences, with neurologists considering preferences for patients with non-highly active RRMS. Respondents chose between two treatment profiles with seven attributes identified in qualitative research: 2-year disability progression; 1-year relapse rate; rate of BVL; and risks of gastrointestinal symptoms, flu-like symptoms, infection, and life-threatening events. Attribute-level weighted preferences were estimated using a hierarchical Bayesian model. RESULTS Analyses included 150 patients with non-highly active RRMS (mean age: 54 years) and 150 neurologists (65% in private practice). Among patients, the most important treatment attribute was reducing the rate of BVL, followed by reducing the risk of infection and risk of flu-like symptoms. In contrast, the most important treatment attribute among neurologists was reducing the risk of a life-threatening event, followed by slowing the rate of 2-year disability progression and risk of infection. CONCLUSION The findings highlight differences in treatment preferences between US patients and neurologists for non-highly active RRMS. The importance placed by patients on slowing the rate of BVL makes this a key topic that should be covered in the shared decision-making process.
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Affiliation(s)
- Jinender Kumar
- Worldwide Health Economics and Outcomes Research, Bristol Myers Squibb, Princeton, NJ, USA
| | - M Janelle Cambron-Mellott
- RWE Data and Analytics, Kantar Health, New York, NY, USA
- Correspondence: M Janelle Cambron-Mellott Kantar Health, 3 World Trade Center, 175 Greenwich Street, 35th Floor, New York, NY, 10007, USATel +1 212 706 3961 Email
| | - Tom Tencer
- Worldwide Health Economics and Outcomes Research, Bristol Myers Squibb, Princeton, NJ, USA
| | - Oliver Will
- RWE Data and Analytics, Kantar Health, New York, NY, USA
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17
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Oberst U, De Quintana M, Del Cerro S, Chamarro A. Recruiters prefer expert recommendations over digital hiring algorithm: a choice-based conjoint study in a pre-employment screening scenario. MANAGEMENT RESEARCH REVIEW 2020. [DOI: 10.1108/mrr-06-2020-0356] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
This study aims to analyze aspects of decision-making in recruitment. Using a choice-based conjoint (CBC) experiment with typified screening scenarios, it was analyzed what aspects will be more important for recruiters: the recommendation provided by a hiring algorithm or the recommendation of a human co-worker; gender of the candidate and of the recruiter was taken into account.
Design/methodology/approach
A total of 135 recruitment professionals (67 female) completed a measure of sex roles and a set of 20 CBC trials on the hiring of a pharmacologist.
Findings
Participants were willing to accept a lower algorithm score if the level of the human recommendation was maximum, indicating a preference for the co-worker’s recommendation over that of the hiring algorithm. The biological sex of neither the candidate nor the participant influenced in the decision.
Research limitations/implications
Participants were presented with a fictitious scenario that did not involve real choices with real consequences. In a real-life setting, considerably more variables influence hiring decisions.
Practical implications
Results show that there are limits on the acceptance of technology based on artificial intelligence in the field of recruitment, which has relevance more broadly for the psychological correlates of the acceptance of the technology.
Originality/value
An additional value is the use of a methodological approach (CBC) with high ecological validity that may be useful in other psychological studies of decision-making in management.
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18
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Minacapelli E, Giordano A, Falautano M, Sangalli F, Pietrolongo E, Lorefice L, Cocco E, Lugaresi A, Comi G, Filippi M, Martinelli V. Risk attitude and personality in people with multiple sclerosis facing the choice of different disease-modifying therapy scenarios. J Neurol Sci 2020; 417:117064. [DOI: 10.1016/j.jns.2020.117064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 07/23/2020] [Accepted: 07/24/2020] [Indexed: 11/24/2022]
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19
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Cutter G, Veneziano A, Grinspan A, Al-Banna M, Boyko A, Zakharova M, Maida E, Pasic MB, Gandhi SK, Everts R, Cordioli C, Rossi S. Satisfaction and adherence with glatiramer acetate 40mg/mL TIW in RRMS after 12 months, and the effect of switching from 20mg/mL QD. Mult Scler Relat Disord 2020; 40:101957. [PMID: 32028117 DOI: 10.1016/j.msard.2020.101957] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 01/16/2020] [Accepted: 01/17/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patient satisfaction with treatment in relapsing-remitting multiple sclerosis (RRMS) has a direct impact on adherence to treatment and, consequently, upon treatment outcomes and costs. Patient-reported outcomes (PROs) are a common method for determining patient satisfaction in MS and other diseases. METHODS The 12-month, open-label, Phase IV CONFIDENCE study assessed patient satisfaction and treatment adherence, using PROs, as well as safety outcomes in patients with RRMS treated with glatiramer acetate (GA). In the previously reported (Cutter et al., 2019) initial 6-month core phase of the study, patients were randomized to receive three-times-weekly (TIW) GA 40 mg/mL (GA40; n = 431) or once-daily GA 20 mg/mL (GA20; n = 430). In the 6-month, single-arm extension phase, 789 patients completing the core phase were treated with GA40 to determine whether benefits observed in the core phase were sustained during the extension phase, to ascertain if switching from GA20 to GA40 resulted in PRO changes, and to assess safety outcomes. RESULTS Superior PRO scores for patient satisfaction with treatment, patient perception of treatment convenience, and symptomatic changes (fatigue impact and mental health) observed in the GA40 group versus the GA20 group in the core phase were all maintained in the extension phase. Treatment adherence, significantly greater in the GA40 versus the GA20 group in the core phase, was sustained in patients continuing to receive GA40 in the extension phase, while those who switched from GA20 to GA40 increased their adherence during the extension phase. Safety variables remained consistent throughout the study, with no notable changes observed in patients switching from GA20 to GA40. CONCLUSIONS Data from the extension phase of the CONFIDENCE study show that the benefits associated with GA40 treatment in terms of medication satisfaction, treatment convenience perception, symptomatic changes in fatigue impact and mental health status, and treatment adherence were maintained over a 12-month observation period. These results confirm the preferential utility of GA40 versus GA20 in clinical practice, with no additional safety concerns associated with switching from GA20 to GA40.
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Affiliation(s)
- Gary Cutter
- University of Alabama at Birmingham, Ryals Public Health Building 410B, 1665 University Boulevard, Birmingham, AL 35294-0022, USA; Pythagoras, Inc., Birmingham, AL 35205, USA.
| | | | - Augusto Grinspan
- Teva Pharmaceutical Industries Ltd, 41 Moores Rd, Malvern, PA 19355, USA
| | - Mahir Al-Banna
- Teva Pharmaceutical Industries Ltd, 41 Moores Rd, Malvern, PA 19355, USA.
| | - Alexey Boyko
- Neuroimmunological Department at Federal Center of Cerebrovascular Pathology and Stroke, Multiple Sclerosis Center at Yusupov Hospital, Ulitsa Ostrovityanova, 1, Pirogov Russian National Research Medical University, Moscow 117997, Russia
| | - Maria Zakharova
- Research Center of Neurology, m. Sokol, Tushinskaya, Schukinskaya Volokolamskoe shosse, 80, Moscow 125367, Russia.
| | - Eva Maida
- Multiple Sclerosis Center, Vienna, Koellnerhofgasse 4/12, 1010 Vienna, Austria.
| | - Marija Bosnjak Pasic
- Department of Neurology, University Hospital Centre Zagreb, School of Medicine, Josip Juraj Strossmayer University of Osijek, Trg Svetog Trojstva 3, 31000 Osijek, Croatia; Referral Centre of the Ministry of Health of the Republic of Croatia for Demyelinating Diseases of the Central Nervous System, 10000 Zagreb, Croatia
| | - Sanjay K Gandhi
- Teva Pharmaceutical Industries Ltd, 41 Moores Rd, Malvern, PA 19355, USA.
| | - Robin Everts
- Teva Pharmaceutical Industries Ltd, 41 Moores Rd, Malvern, PA 19355, USA.
| | - Cinzia Cordioli
- Multiple Sclerosis Center, Montichiari Hospital, Via G. Ciotti, 154, 25018 Montichiari, Brescia, Italy
| | - Silvia Rossi
- Neuroimmunology and Neuromuscular Diseases Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Giovanni Celoria, 11, 20133 Milan, Italy.
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Visser LA, Louapre C, Uyl-de Groot CA, Redekop WK. Patient needs and preferences in relapsing-remitting multiple sclerosis: A systematic review. Mult Scler Relat Disord 2020; 39:101929. [PMID: 31924590 DOI: 10.1016/j.msard.2020.101929] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 10/29/2019] [Accepted: 01/01/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND Considering the multiple treatments approved for multiple sclerosis (MS) by the Food and Drug Administration (FDA) and European Medicines Agency (EMA), determining a treatment strategy for patients with clinically isolated syndrome (CIS) and relapsing-remitting MS (RRMS) can be challenging. To date, an overview of the needs and preferences of patients at each treatment decision-making moment is lacking. Therefore, the aim of this systematic review is to examine the existing literature about the needs and preferences of patients with CIS and RRMS when making treatment decisions. METHODS A systematic search was done using Embase, Medline, PsychINFO, Web of Science and Google Scholar. Eligibility criteria included whether the article described a study of adults with CIS/RRMS and reported patient needs or preferences regarding first-line disease modifying treatment (DMT) decisions. Publications were categorized by treatment decision: initiation of first DMT (D1), DMT adherence/discontinuation (D2a/D2b), and switch to a second DMT (D3). A separate category was created for stated preference studies such as discrete choice experiment methods to examine the relative importance of different treatment attributes. Publications were compared to identify key factors. RESULTS The search yielded 2789 articles after removal of duplicates and 434 full-text publications were reviewed for eligibility. Twenty-four articles fulfilled all criteria: n = 5 (D1), n = 12 (D2a), n = 13 (D2b), and n = 3 (D3); six articles studied more than one treatment decision. The need for social support is important during D1. The most commonly reported reasons for adherence/discontinuation/switch included forgetfulness, side-effects, and injection-related reasons. Eight articles described preference studies; the most important DMT attributes were efficacy, mode and frequency of administration, and side-effect profile. CONCLUSIONS Understanding the needs and preferences of CIS/RRMS patients regarding DMT attributes and non-treatment related attributes are important to improve treatment decision-making and reduce non-adherence. Studies are needed to understand patient preferences upon treatment initiation. Furthermore, preference studies should include attributes based on the patient perspective.
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Affiliation(s)
- L A Visser
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam. Bayle Building, Burgermeester Oudlaan 50. 3062 PA, Rotterdam, the Netherlands.
| | - C Louapre
- Institut du Cerveau et de la Moelle épinière - ICM, Groupe hospitalier Pitié-Salpêtrière, 47-83, bd de l'Hôpital. 75651 Paris CEDEX 13, France.
| | - C A Uyl-de Groot
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam. Bayle Building, Burgermeester Oudlaan 50. 3062 PA, Rotterdam, the Netherlands.
| | - W K Redekop
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam. Bayle Building, Burgermeester Oudlaan 50. 3062 PA, Rotterdam, the Netherlands.
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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
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Nayyar A, Jadi J, Garimella R, Elkins-Williams ST, Gallagher KK, Kalliainen LK, Hultman CS, Wu C. Are You on the Right Platform? A Conjoint Analysis of Social Media Preferences in Aesthetic Surgery Patients. Aesthet Surg J 2019; 39:1019-1032. [PMID: 30239573 DOI: 10.1093/asj/sjy238] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Social media has become an indispensable tool for patients to learn about aesthetic surgery. Currently, procedure-specific patient preferences for social media platforms and content are unknown. OBJECTIVES The authors sought to evaluate social media preferences of patients seeking aesthetic surgery. METHODS We utilized a choice-based conjoint analysis survey to analyze the preferences of patients seeking 3 common aesthetic procedures: breast augmentation (BA), facial rejuvenation (FR), and combined breast/abdominal surgery (BAB). Participants were asked to choose among social media platforms (Facebook, Twitter, Instagram, Snapchat, Pinterest, Tumblr, YouTube), information extent (basic, moderate, comprehensive), delivery mechanism (prerecorded video, live video, photographs, text description), messenger (surgeon, nurse/clinic staff, patient), and option for interactivity (yes/no). The survey was administered using an Internet crowdsourcing service (Amazon Mechanical Turk). RESULTS A total of 647 participants were recruited: 201 in BA, 255 in FR, and 191 in BAB. Among attributes surveyed, participants in all 3 groups (BA, FR, BAB) valued social media platform as the most important (30.9%, 33.1%, 31.4%), followed by information extent (23.1%, 22.9%, 21.6%), delivery mechanism (18.9%, 17.4%, 18%), messenger (16%, 17%, 17.2%), and interactivity (11.1%, 9.8%, 11.8%). Within these attributes, Facebook ranked as the preferred platform, with comprehensive information extent, live video as the delivery mechanism, and surgeon as the messenger as most preferred. CONCLUSIONS The choice of social media platform is the most important factor for patients, and they indicated a preference for comprehensive information delivered by the surgeon via live video on Facebook. Our study elucidates social media usage in common aesthetic populations, which can help improve aesthetic patient outreach.
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Affiliation(s)
- Apoorve Nayyar
- Postdoctoral Research Associate, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jihane Jadi
- Medical Student, University of North Carolina School of Medicine, Chapel Hill, NC
| | | | | | - Kristalyn K Gallagher
- Chief of Breast Surgery Section, Director of the UNC Surgical Breast Care Program, University of North Carolina, Chapel Hill, NC
| | - Loree K Kalliainen
- Division of Plastic and Reconstructive Surgery, University of North Carolina, Chapel Hill, NC
| | - Charles Scott Hultman
- Director of the Johns Hopkins Burn Center and Professor of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Cindy Wu
- Plastic surgeon in private practice in Cary, NC
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Frost N, Freeman J, Brixner D, Mort J, Clem J, Ngorsuraches S. Patients' preferences and willingness-to-pay for disease-modifying therapies. Mult Scler Relat Disord 2019; 35:55-60. [PMID: 31323483 DOI: 10.1016/j.msard.2019.07.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 07/05/2019] [Accepted: 07/08/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND While disease-modifying therapies (DMTs) for multiple sclerosis (MS) treatments are costly, patient valuation of DMTs has not been examined. The objective of this study was to examine patients' preferences and willingness-to-pay (WTP) for DMTs. METHODS Six attributes (i.e., number of relapses, percentage of disability progression, percentage of severe adverse events, route of administration, frequency of administration, and out-of-pocket cost) and their levels were used to develop a discrete choice experiment questionnaire. Each questionnaire comprised seven choice sets and each choice set contained two hypothetical DMTs and an opt-out alternative. A total of 1,200 U.S. patients with MS were asked to choose a DMT option or opt-out in each choice set. Multinomial logit model was used to determine relative preferences of each attribute. WTPs for all attributes and DMTs were calculated. RESULTS A total of 508 patients were analyzed. Patients preferred DMTs with lower relapse rate, lower disability progression, lower severe adverse event, lower frequency of administration, and lower cost. In addition, they preferred oral DMTs. They were willing to pay $2,768, $289, $292, and $76 a month in exchange for every 1-time decrease in the number of relapses in two years, every 1% decrease in disability progression in two years, every 1% decrease in severe adverse events, and every 1-time decrease in the frequency of administration per month, respectively. The patients were willing to pay, in relation to market prices, between $7,020 and $134,934 per year for all DMTs, but interferon beta-1a SC. CONCLUSIONS Patients with MS considered relapse rate, disability progression, severe adverse events, route of administration, frequency of administration, and out-of-pocket cost, when they chose DMTs. Their WTPs for DMTs varied widely.
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Affiliation(s)
- Natasha Frost
- Department of Neurology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI 53792, USA
| | - Jerome Freeman
- Department of Neurosciences, Sanford School of Medicine, University of South Dakota, Vermillion, SD 57069, USA
| | - Diana Brixner
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT 84112, USA
| | - Jane Mort
- Department of Pharmacy Practice, College of Pharmacy and Allied Health Professions, South Dakota State University, Brookings, SD 57007, USA
| | - James Clem
- Department of Pharmacy Practice, College of Pharmacy and Allied Health Professions, South Dakota State University, Brookings, SD 57007, USA
| | - Surachat Ngorsuraches
- Department of Health Outcomes Research and Policy, Harrison School of Pharmacy, Auburn University, Auburn, AL 36849, USA.
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Ozakbas S, Cinar BP, Kahraman T. The 20-year history: Change of multiple sclerosis patient profile over 20 years. Mult Scler Relat Disord 2019; 33:1-4. [PMID: 31128520 DOI: 10.1016/j.msard.2019.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 04/15/2019] [Accepted: 05/12/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Patients attending multiple sclerosis (MS) clinics experience less disability compared to previous years. OBJECTIVE This study was conducted retrospectively examining the patient records of our MS Clinic. The patient records in 1996 were compared to those in 2016. METHODS Demographic data, duration of disease, time to diagnosis, course of the disease, Expanded Disability Status Scale (EDSS) scores, and whether or not patients used disease modifying therapies were recorded in both 1996 and 2016. RESULTS The mean frequency of visits were significantly higher in 1996 compared to 2016 (p = 0.003). There were significantly more number of patients with clinically isolated syndrome (p = 0.004) and secondary progressive MS (p = 0.001) in 1996; however, significantly less number of patients with relapsing-remitting MS (p < 0.001). EDSS scores of ≤3 were significantly higher in 2016 (p < 0.001). On the other hand, the number of patients with the EDSS scores of 6-6.5 and ≥7 were significantly less in 2016 (p < 0.001). Significantly more patients with secondary progressive MS, EDSS scores of 6-6.5 and ≥7 (wheel-chair dependent patients) came to the clinic in 1996 compared to 2016. CONCLUSION The emergence of treatment options in MS and the increasing availability of new treatment options for patients with no/inadequate treatment response have changed the MS patient profile over the 20 years. The number of wheelchair-dependent patients dramatically reduced.
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Affiliation(s)
- Serkan Ozakbas
- Department of Neurology, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - Bilge Piri Cinar
- Department of Neurology, Faculty of Medicine, Bulent Ecevit University, Zonguldak, Turkey.
| | - Turhan Kahraman
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Katip Celebi University, Izmir, Turkey
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Aikin KJ, Betts KR, Ziemer KS, Keisler A. Consumer tradeoff of advertising claim versus efficacy information in direct-to-consumer prescription drug ads. Res Social Adm Pharm 2019; 15:1484-1488. [PMID: 30846370 DOI: 10.1016/j.sapharm.2019.01.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 01/17/2019] [Accepted: 01/17/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Consumers' decision making about prescription drugs may be influenced by more than thoughts about drug efficacy and the potential for side effects. Choices may be based on tradeoffs among multiple factors, for example, medical condition, risk severity, risk likelihood, product efficacy, and resources. Some information used in tradeoff choices might be derived from marketing efforts by drug manufacturers. How market claims, such as "#1 Prescribed" may affect this tradeoff is an area that has yet to be explored fully. OBJECTIVE Using conjoint analysis techniques, this research examined the tradeoff of market claim and efficacy information in direct-to-consumer (DTC) print advertising for prescription drugs. METHODS Two hundred fifteen adult participants with a self-reported diagnosis of diabetes were recruited through an online consumer panel. Participants were presented a series of choices. Each choice pair represented a prescription diabetic nerve pain drug with a different efficacy level and one of the two had a market claim of "#1 Prescribed". Participants indicated which drug they would prefer if they had to choose one. Results showed an advantage of #1 Prescribed. A drug without this claim needed at least 1.23% greater efficacy to be chosen over a drug with this claim. CONCLUSIONS Study findings align with previous research which found that extrinsic cues can influence consumer product choice, which has implications for optimal medication use.
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Affiliation(s)
- Kathryn J Aikin
- Office of Prescription Drug Promotion, U.S. Food and Drug Administration, 10903 New Hampshire Ave., Silver Spring, MD, 20993, United States.
| | - Kevin R Betts
- Office of Prescription Drug Promotion, U.S. Food and Drug Administration, 10903 New Hampshire Ave., Silver Spring, MD, 20993, United States.
| | | | - Aysha Keisler
- Ipsos Public Affairs, 2020 K St NW, Suite 410, Washington, DC, 20850, United States.
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Webb EJD, Meads D, Eskyte I, King N, Dracup N, Chataway J, Ford HL, Marti J, Pavitt SH, Schmierer K, Manzano A. A Systematic Review of Discrete-Choice Experiments and Conjoint Analysis Studies in People with Multiple Sclerosis. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2019; 11:391-402. [PMID: 29313265 DOI: 10.1007/s40271-017-0296-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) is a chronic disabling, inflammatory, and degenerative disease of the central nervous system that, in most cases, requires long-term disease-modifying treatment (DMT). The drugs used vary in efficacy and adverse effect profiles. Several studies have used attribute-based stated-preference methods, primarily to investigate patient preferences for initiating or escalating DMT. OBJECTIVES To conduct a systematic review of attribute-based stated-preference studies in people with MS to identify common methods employed and to assess study quality, with reference to the specific challenges of this disease area. METHODS We conducted a systematic search for studies related to attribute-based stated-preference and MS in multiple databases, including Cochrane and MEDLINE. Studies were included if they were published in a peer-reviewed journal, were on the topic of MS, and used a survey methodology that measured stated preferences for attributes of a whole. Analysis was conducted using narrative synthesis and summary statistics. Study quality was judged against the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) conjoint analysis checklist. RESULTS We identified 16 relevant articles reporting 17 separate studies, all but one focusing on DMTs. Most studies were discrete-choice experiments. Study quality was generally high, but we recommend the following: (1) that consideration of sample sizes be improved, (2) that survey design choices be justified and documented, (3) that qualitative approaches for attribute and level selection be incorporated to better involve patients, and (4) that reporting of experimental practice be improved. The effects of DMTs on reproduction and the impact of how risk and uncertainty are presented were identified as neglected research topics. The ISPOR conjoint analysis checklist was found to be unsuitable for the assessment of study quality. CONCLUSION Attribute-based stated preference is a useful method with which to examine the preferences of people with MS in their choice of DMT. However, further research embracing the methodological recommendations identified, particularly greater use of qualitative methods in attribute development, is needed.
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Affiliation(s)
- Edward J D Webb
- Leeds Institute for Health Sciences, University of Leeds, Leeds, UK.
| | - David Meads
- Leeds Institute for Health Sciences, University of Leeds, Leeds, UK
| | - Ieva Eskyte
- School of Dentistry, University of Leeds, Leeds, UK
| | - Natalie King
- Leeds Institute for Health Sciences, University of Leeds, Leeds, UK
| | - Naila Dracup
- Leeds Institute for Health Sciences, University of Leeds, Leeds, UK
| | - Jeremy Chataway
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, University College London, London, UK
| | | | - Joachim Marti
- Institute of Social and Preventive Medicine (IUMSP), Centre Hospitalier Universitaire Vaudois, Université de Lausanne, Lausanne, Switzerland
| | - Sue H Pavitt
- Dental Translational and Clinical Research Unit, School of Dentistry, University of Leeds, Leeds, UK
| | - Klaus Schmierer
- Blizard Institute (Neuroscience) Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.,Clinical Board Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Ana Manzano
- School of Sociology and Social Policy, University of Leeds, Leeds, UK
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Enduring Clinical Value of Copaxone® (Glatiramer Acetate) in Multiple Sclerosis after 20 Years of Use. Mult Scler Int 2019; 2019:7151685. [PMID: 30775037 PMCID: PMC6350531 DOI: 10.1155/2019/7151685] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 06/29/2018] [Accepted: 11/29/2018] [Indexed: 11/18/2022] Open
Abstract
Multiple sclerosis (MS) is a chronic progressive neurodegenerative demyelinating disease affecting the central nervous system. Glatiramer acetate (GA; Copaxone®) was the first disease-modifying treatment (DMT) for MS successfully tested in humans (1977) and was approved by the US Food and Drug Administration in December 1996. Since then, there have been numerous developments in the MS field: advances in neuroimaging allowing more rapid and accurate diagnosis; the availability of a range of DMTs including immunosuppressant monoclonal antibodies and oral agents; a more holistic approach to treatment by multidisciplinary teams; and an improved awareness of the need to consider a patient's preferences and patient-reported outcomes such as quality of life. The use of GA has endured throughout these advances. The purpose of this article is to provide an overview of the important developments in the MS field during the 20 years since GA was approved and to review clinical data for GA in MS, with the aim of understanding the continued and widespread use of GA. Both drug-related (efficacy versus side-effect profile and monitoring requirements) and patient factors (preferences regarding mode of administration and possible pregnancy) will be explored.
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PREFERENCES OF PATIENTS WITH MULTIPLE SCLEROSIS FOR ATTRIBUTES OF INJECTABLE MULTIPLE SCLEROSIS TREATMENTS IN THE UNITED KINGDOM AND FRANCE. Int J Technol Assess Health Care 2019; 34:425-433. [PMID: 30251947 PMCID: PMC6190072 DOI: 10.1017/s0266462318000491] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Objectives: Adherence to injectable disease-modifying treatments in patients with multiple sclerosis (MS) impacts outcomes and can be influenced by perceptions of treatment efficacy, side effects, injection frequency, and the duration of injection. This study aimed to quantify preferences for selected attributes of injectable treatments among individuals with MS in the United Kingdom and France. Methods: Respondents with a self-reported diagnosis of MS completed an online discrete-choice-experiment survey, consisting of a series of treatment-choice questions. Each choice question presented two hypothetical treatments, each with six attributes (years until disability progression, relapses in the next 4 years, injection time, injection frequency, flu-like symptoms (FLS), and injection-site reactions), each with various levels. Mixed-logit regression analysis was used to estimate preference weights for attribute levels and to calculate the relative importance of changes in treatment attributes (vertical distance between preference weights). Minimum acceptable efficacy estimates indicate improvement in efficacy that respondents would require in exchange for worsening injection frequency and FLS. Results: In both countries, 100 respondents completed the survey. In the United Kingdom and France, respectively, improving the time until disability progression from 2 to 4 years, reducing injection frequency from “daily” to “every 2 weeks”, and reducing FLS from 3 days after every injection to none had a relative importance of 2.9 and 2.6, 3.0 and 3.5, and 2.5 and 3.1. Given the ranges included in the study, changes in these attributes were more important than most changes in other attributes assessed. Conclusions: Reductions in the injection frequency of MS treatments and FLS can be as important to patients as improvements in treatment efficacy.
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Ben-Zacharia A, Adamson M, Boyd A, Hardeman P, Smrtka J, Walker B, Walker T. Impact of Shared Decision Making on Disease-Modifying Drug Adherence in Multiple Sclerosis. Int J MS Care 2018; 20:287-297. [PMID: 30568566 PMCID: PMC6295876 DOI: 10.7224/1537-2073.2017-070] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Shared decision making (SDM) and adherence to treatment are an integral part of multiple sclerosis (MS) care. A collaborative process, SDM actively involves the patient, the health care provider, and an extended network in making treatment decisions. Adherence to disease-modifying drug therapies in patients with MS presents an ongoing challenge for patients and health care providers due to the chronic nature of this disease. This narrative review aims to explore the impact of SDM on adherence based on existing literature and to identify new approaches to optimizing adherence. METHODS A search was conducted using medical subject heading terms, including decision-making, adherence, shared decision-making, compliance, and patient-centered care. RESULTS Shared decision making between patients and clinicians promotes adherence to the treatment plan in MS. A proactive SDM approach is based on patient preferences, education, and engagement. Providing credible and accurate sources of information is essential for improving patient engagement. Home monitoring, computerized models, and active patient engagement are a few new approaches to improve adherence in patients with MS. CONCLUSIONS Shared decision-making interventions can have a positive effect on patient adherence to disease-modifying drug therapy in MS care. A range of new strategies is emerging that may help promote optimal disease management.
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Rahimi F, Rasekh HR, Abbasian E, Peiravian F. A new approach to pharmaceutical pricing based on patients' willingness to pay. Trop Med Int Health 2018; 23:1326-1331. [PMID: 30286256 DOI: 10.1111/tmi.13157] [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: 11/29/2022]
Abstract
OBJECTIVES Pharmaceutical pricing is an important and contentious issue in middle- and low-income countries. The present study evaluated a value-based pricing system for estimating the price of interferon-beta (IFN-β). METHODS Prices were estimated through the Willingness to Pay (WTP) system using the Discrete Choice Experiment (DCE) from the viewpoint of MS patients, levels of attributes and patients' willingness to pay for these attributes. RESULTS The results indicate that the new approach to pricing medicines leads to more integrated prices than the current system. The current prices of four brands were higher than their pharmaceutical market price; the prices of other brands were consistent with it. CONCLUSION Application of the proposed pricing system will help pharmaceutical companies make realistic price estimates of their products while accounting for patient preferences, which may enhance patients' adherence to treatment.
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Affiliation(s)
- Farimah Rahimi
- Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamid Reza Rasekh
- Department of Pharmacoeconomics and Pharmaceutical Management, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ezatollah Abbasian
- Department of Public Administration, Faculty of Management, Tehran University, Tehran, Iran
| | - Farzad Peiravian
- Department of Pharmacoeconomics and Pharmaceutical Management, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Zamarian L, Delazer M, Ehling R, Pertl MT, Bsteh G, Wenter J, Glatzl S, Brenneis C, Benke T, Berger T. Improvement of medical judgments by numerical training in patients with multiple sclerosis. Eur J Neurol 2018; 26:106-112. [PMID: 30117230 PMCID: PMC6586155 DOI: 10.1111/ene.13778] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 08/09/2018] [Indexed: 11/30/2022]
Abstract
Background and purpose People with multiple sclerosis (MS) have to face important decisions with regard to their medical treatment. The aim of this study was to evaluate whether a targeted cognitive training reduces framing effects and thus improves medical judgments. Methods This was a randomized, double‐blind, cross‐over study enrolling patients with relapsing‐remitting MS and healthy controls (HCs). Participants were randomly assigned to training order A (first week, numerical training; second week, control training) or B (reverse order). The primary endpoint was changed in a framing task score (framing effect). In the framing task, participants evaluated the success of fictive medications on a 7‐point scale. Medications were described in either positive or negative terms. Results A total of 37 patients and 73 HCs performed either training order A (n = 56) or B (n = 54). The framing effect decreased after the numerical training regardless of training order. No such decrease was found after the control training. Mean change in framing effect was −0.3 ± 0.8 after the numerical training and 0.03 ± 0.6 after the control training. This specific effect of training type was comparable between groups. Conclusion Judgments of medical information improve in both patients with relapsing‐remitting MS and HCs after a targeted numerical training. Thus, a specific cognitive intervention may help patients making informed decisions.
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Affiliation(s)
- L Zamarian
- Medical University of Innsbruck, Innsbruck, Austria
| | - M Delazer
- Medical University of Innsbruck, Innsbruck, Austria
| | - R Ehling
- Clinic for Rehabilitation Münster, Münster, Austria
| | - M-T Pertl
- Medical University of Innsbruck, Innsbruck, Austria
| | - G Bsteh
- Medical University of Innsbruck, Innsbruck, Austria
| | - J Wenter
- Clinic for Rehabilitation Münster, Münster, Austria
| | - S Glatzl
- Clinic for Rehabilitation Münster, Münster, Austria
| | - C Brenneis
- Clinic for Rehabilitation Münster, Münster, Austria
| | - T Benke
- Medical University of Innsbruck, Innsbruck, Austria
| | - T Berger
- Medical University of Innsbruck, Innsbruck, Austria
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Hincapie AL, Penm J, Burns CF. Factors Associated with Patient Preferences for Disease-Modifying Therapies in Multiple Sclerosis. J Manag Care Spec Pharm 2018; 23:822-830. [PMID: 28737987 PMCID: PMC10398239 DOI: 10.18553/jmcp.2017.23.8.822] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Treatment adherence in patients with multiple sclerosis (MS) is essential to reduce the rate of acute neurological attacks, severity of relapses, and hospitalizations and to slow its progression. Adherence rates in MS patients have been shown to be affected by multiple factors, including physical or cognitive difficulties, perceived lack of treatment efficacy, treatment-related adverse events, injection anxiety, and frequency of administration. OBJECTIVE To elicit the preferences of MS patients for noneconomic and economic attributes of current disease-modifying therapies (DMTs). METHODS We used conjoint analysis to estimate preferences from a convenience sample through a web-based online survey. Patients were invited to participate in the study using web portals and newsletters for MS patients. The conjoint survey included the following 6 attributes: (1) overall efficacy based on autoimmune disease progression stabilization; (2) acute increase in disease activity (flare-up); (3) rate of respiratory tract infections; (4) rate of serious respiratory tract infections (leading to hospitalization); (5) medication use; and (6) patient monthly out-of-pocket medication costs. Using a fractional factorial design, 24 product profiles were created. Each respondent reviewed a random selection of 8 profiles. With each profile, subjects were asked to indicate their likelihood to try the hypothetical products on a scale from 0 to 100. Random effects linear regression was used to elicit preferences. RESULTS After exclusion of respondents with incomplete information, data from 129 subjects were included in the analysis. The overall relative importance of each attribute for the ranges presented were (1) 38.4% for monthly out-of-pocket cost; (2) 21.5% for route and frequency of administration; (3) 15.9% for risk of hospitalization by infection; (4) 11.9% for risk of respiratory tract infection; (5) 7.4% for risk of flare-ups; and (6) 5.0% for disease progression stabilization. Preference weights indicated that subjects favored subcutaneous (beta coefficient [β] = -2.26, 95% CI = -4.22 to -0.22) and oral administration (β = 7.93, 95% CI = 5.95 to 10.2) over intramuscular (β = -5.67, 95% CI = -8.67 to -3.56), but no significant differences were found between subcutaneous over intramuscular administration. Monthly out-of-pocket cost was the most influential attribute, with an overall relative importance of 38%. The most preferred level was $75 (β = 12.85, 95% CI = 10.64 to 15.06) followed by $150 (β = 3.41, 95% CI = 0.98 to 5.84) when compared between $75, $150, $300, and $450 a month. CONCLUSIONS Conjoint analysis proved to be a convenient tool to quantify respondents' relative preferences for DMT characteristics. Respondents gave higher weight to DMT monthly out-of-pocket costs and mode of administration than to adverse effects or efficacy. These findings may assist in the development of DMT cost-sharing strategies and shared decision making at the point of care. DISCLOSURES No outside funding supported this study. The authors declare no potential conflicts of interest. Study concept and design were contributed by Hincapie and Burns. Data were collected by Hincapie and Burns, and interpreted by all the authors. The manuscript was written by Hincapie, Penm, and Burns and revised by Penm, Hincapie, and Burns. At the time of data collection, Burns was a PhD candidate at The University of Oklahoma, College of Pharmacy.
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Affiliation(s)
- Ana L Hincapie
- 1 James L. Winkle College of Pharmacy, University of Cincinnati, Cincinnati, Ohio
| | - Jonathan Penm
- 1 James L. Winkle College of Pharmacy, University of Cincinnati, Cincinnati, Ohio
| | - Craig F Burns
- 2 College of Pharmacy, University of Oklahoma, Tulsa
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Rahimi F, Rasekh HR, Abbasian E, Peiravian F, Etemadifar M, Ashtari F, Sabzghabaee AM, Amirsadri MR. Patient preferences for Interferon-beta in Iran: A discrete choice experiment. PLoS One 2018; 13:e0193090. [PMID: 29590134 PMCID: PMC5873931 DOI: 10.1371/journal.pone.0193090] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Accepted: 02/04/2018] [Indexed: 01/13/2023] Open
Abstract
Multiple sclerosis is a chronic, progressive, and common disease affecting the central nervous system in young adults. Interferon-beta is one of the most widely used medicines to reduce the disease progression. Given the variety of drugs in this category, we aimed to identify the preferences of patients for IFN-β that play an important role in policymaking in this area. Discrete choice experiment method was used in the present study to identify and prioritize those attributes that are of interest to MS patients and increases the utility of the use of IFN-β in their treatment. Questionnaires were given to 358 patients in Isfahan-Iran, who were asked to choose between the two treatment choices in each scenario. The results of the logit model showed that the changes in the efficacy lead to the most changes in the patient utility. Changes in side effects and ease of injection have been placed in the next rankings. Considering the drug attributes considered more desirable by patients can lead to greater medication adherence and possibly better treatment outcomes. Also, pharmaceutical companies, the health ministry, the Food and Drug Administration, insurance organizations, and neurologists can benefit from this information in production and importation, policymaking, and prescription.
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Affiliation(s)
- Farimah Rahimi
- Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
- Department of Pharmacoeconomics and Pharmaceutical Management, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- * E-mail:
| | - Hamid Reza Rasekh
- Department of Pharmacoeconomics and Pharmaceutical Management, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Farzad Peiravian
- Department of Pharmacoeconomics and Pharmaceutical Management, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Masoud Etemadifar
- Department of Neurology, Medical School, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fereshteh Ashtari
- Department of Neurology, Medical School, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Mohammad Sabzghabaee
- Isfahan Clinical Toxicology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Reza Amirsadri
- Department of Clinical Pharmacy and Pharmacy Practice, School of Pharmacy and Pharmaceutical and Health Management and Economics Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
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Wittink MN, Walsh P, Yilmaz S, Mendoza M, Street RL, Chapman BP, Duberstein P. Patient priorities and the doorknob phenomenon in primary care: Can technology improve disclosure of patient stressors? PATIENT EDUCATION AND COUNSELING 2018; 101:214-220. [PMID: 28844522 PMCID: PMC5803466 DOI: 10.1016/j.pec.2017.08.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 06/28/2017] [Accepted: 08/03/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Patients with multiple chronic conditions face many stressors (e.g. financial, safety, transportation stressors) that are rarely prioritized for discussion with the primary care provider (PCP). In this pilot randomized controlled trial we examined the effects of a novel technology-based intervention called Customized Care on stressor disclosure. METHODS The main outcomes were stressor disclosure, patient confidence and activation, as assessed by self-report and observational methods (transcribed and coded audio-recordings of the office visit). RESULTS Sixty patients were enrolled. Compared with care as usual, intervention patients were 6 times more likely to disclose stressors to the PCP (OR=6.16, 95% CI [1.53, 24.81], p=0.011) and reported greater stressor disclosure confidence (exp[B]=1.06, 95% CI [1.01, 1.12], p=0.028). No differences were found in patient activation or the length of the office visit. CONCLUSION Customized Care improved the likelihood of stressor disclosure without affecting the length of the PCP visit. PRACTICE IMPLICATIONS Brief technology-based interventions, like Customized Care could be made available through patient portals, or on smart phones, to prime patient-PCP discussion about difficult subjects, thereby improving the patient experience and efficiency of the visit.
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Affiliation(s)
- Marsha N Wittink
- Department of Psychiatry, University of Rochester Medical Center, Rochester, USA; Department of Family Medicine, University of Rochester Medical Center, Rochester, USA.
| | - Patrick Walsh
- Department of Psychiatry, University of Rochester Medical Center, Rochester, USA
| | - Sule Yilmaz
- Warner School for Education, University of Rochester, Rochester, USA
| | - Michael Mendoza
- Department of Family Medicine, University of Rochester Medical Center, Rochester, USA
| | - Richard L Street
- Department of Communication, Texas A&M University, College Station, USA; Houston VA Center for Innovation in Quality, Effectiveness and Safety, Houston, USA
| | - Benjamin P Chapman
- Department of Psychiatry, University of Rochester Medical Center, Rochester, USA
| | - Paul Duberstein
- Department of Psychiatry, University of Rochester Medical Center, Rochester, USA; Department of Family Medicine, University of Rochester Medical Center, Rochester, USA; Department of Medicine, University of Rochester Medical Center, Rochester, USA
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Col NF, Solomon AJ, Springmann V, Garbin CP, Ionete C, Pbert L, Alvarez E, Tierman B, Hopson A, Kutz C, Berrios Morales I, Griffin C, Phillips G, Ngo LH. Whose Preferences Matter? A Patient-Centered Approach for Eliciting Treatment Goals. Med Decis Making 2018; 38:44-55. [PMID: 28806143 PMCID: PMC5929460 DOI: 10.1177/0272989x17724434] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 07/01/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patients facing a high-stakes clinical decision are often confronted with an overwhelming array of options. High-quality decisions about treatment should reflect patients' preferences as well as their clinical characteristics. Preference-assessment instruments typically focus on pre-selected clinical outcomes and attributes chosen by the investigator. OBJECTIVE We sought to develop a patient-centered approach to elicit and compare the treatment goals of patients with multiple sclerosis (MS) and healthcare providers (HCPs). METHODS We conducted five nominal group technique (NGT) meetings to elicit and prioritize treatment goals from patients and HCPs. Five to nine participants in each group responded silently to one question about their treatment goals. Responses were shared, consolidated, and ranked to develop a prioritized list for each group. The ranked lists were combined. Goals were rated and sorted into categories. Multidimensional scaling and hierarchical cluster analysis were used to derive a visual representation, or cognitive map, of the data and to identify conceptual clusters, reflecting how frequently items were sorted into the same category. RESULTS Five NGT groups yielded 34 unique patient-generated treatment goals and 31 unique HCP-generated goals. There were differences between patients and HCPs in the goals generated and how they were clustered. Patients' goals tended to focus on the impact of specific symptoms on their day-to-day lives, whereas providers' goals focused on slowing down the course of disease progression. CONCLUSIONS Differences between the treatment goals of patients and HCPs underscore the limitations of using HCP- or investigator-identified goals. This new adaptation of cognitive mapping is a patient-centered approach that can be used to generate and organize the outcomes and attributes for values clarification exercises while minimizing investigator bias and maximizing relevance to patients.
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Affiliation(s)
- Nananda F. Col
- Nananda F. Col, Five Islands Consulting LLC, Georgetown, ME, USA; ()
| | - Andrew J. Solomon
- />Five Islands Consulting LLC, Georgetown, ME (NFC, VS, BT, AH)
- />Neurological Sciences, University of Vermont College of Medicine, Burlington, VT (AJS)
- />Department of Psychology, University of Nebraska-Lincoln, Lincoln, Nebraska (CPG)
- />University of Massachusetts Medical School, Worcester, MA (LP)
- />University of Massachusetts Memorial Medical Center, Worcester, MA (LP, IBM, CPG)
- />Neurology, University of Colorado, Aurora, CO (CI, EA)
- />Colorado Springs Neurological Associates, Colorado Springs, CO (CK)
- />Biogen Inc., Weston, MA, USA, Cambridge, MA (CK, GH)
- />Harvard Medical School, Boston, MA (LPN)
| | - Vicky Springmann
- />Five Islands Consulting LLC, Georgetown, ME (NFC, VS, BT, AH)
- />Neurological Sciences, University of Vermont College of Medicine, Burlington, VT (AJS)
- />Department of Psychology, University of Nebraska-Lincoln, Lincoln, Nebraska (CPG)
- />University of Massachusetts Medical School, Worcester, MA (LP)
- />University of Massachusetts Memorial Medical Center, Worcester, MA (LP, IBM, CPG)
- />Neurology, University of Colorado, Aurora, CO (CI, EA)
- />Colorado Springs Neurological Associates, Colorado Springs, CO (CK)
- />Biogen Inc., Weston, MA, USA, Cambridge, MA (CK, GH)
- />Harvard Medical School, Boston, MA (LPN)
| | - Calvin P. Garbin
- />Five Islands Consulting LLC, Georgetown, ME (NFC, VS, BT, AH)
- />Neurological Sciences, University of Vermont College of Medicine, Burlington, VT (AJS)
- />Department of Psychology, University of Nebraska-Lincoln, Lincoln, Nebraska (CPG)
- />University of Massachusetts Medical School, Worcester, MA (LP)
- />University of Massachusetts Memorial Medical Center, Worcester, MA (LP, IBM, CPG)
- />Neurology, University of Colorado, Aurora, CO (CI, EA)
- />Colorado Springs Neurological Associates, Colorado Springs, CO (CK)
- />Biogen Inc., Weston, MA, USA, Cambridge, MA (CK, GH)
- />Harvard Medical School, Boston, MA (LPN)
| | - Carolina Ionete
- />Five Islands Consulting LLC, Georgetown, ME (NFC, VS, BT, AH)
- />Neurological Sciences, University of Vermont College of Medicine, Burlington, VT (AJS)
- />Department of Psychology, University of Nebraska-Lincoln, Lincoln, Nebraska (CPG)
- />University of Massachusetts Medical School, Worcester, MA (LP)
- />University of Massachusetts Memorial Medical Center, Worcester, MA (LP, IBM, CPG)
- />Neurology, University of Colorado, Aurora, CO (CI, EA)
- />Colorado Springs Neurological Associates, Colorado Springs, CO (CK)
- />Biogen Inc., Weston, MA, USA, Cambridge, MA (CK, GH)
- />Harvard Medical School, Boston, MA (LPN)
| | - Lori Pbert
- />Five Islands Consulting LLC, Georgetown, ME (NFC, VS, BT, AH)
- />Neurological Sciences, University of Vermont College of Medicine, Burlington, VT (AJS)
- />Department of Psychology, University of Nebraska-Lincoln, Lincoln, Nebraska (CPG)
- />University of Massachusetts Medical School, Worcester, MA (LP)
- />University of Massachusetts Memorial Medical Center, Worcester, MA (LP, IBM, CPG)
- />Neurology, University of Colorado, Aurora, CO (CI, EA)
- />Colorado Springs Neurological Associates, Colorado Springs, CO (CK)
- />Biogen Inc., Weston, MA, USA, Cambridge, MA (CK, GH)
- />Harvard Medical School, Boston, MA (LPN)
| | - Enrique Alvarez
- />Five Islands Consulting LLC, Georgetown, ME (NFC, VS, BT, AH)
- />Neurological Sciences, University of Vermont College of Medicine, Burlington, VT (AJS)
- />Department of Psychology, University of Nebraska-Lincoln, Lincoln, Nebraska (CPG)
- />University of Massachusetts Medical School, Worcester, MA (LP)
- />University of Massachusetts Memorial Medical Center, Worcester, MA (LP, IBM, CPG)
- />Neurology, University of Colorado, Aurora, CO (CI, EA)
- />Colorado Springs Neurological Associates, Colorado Springs, CO (CK)
- />Biogen Inc., Weston, MA, USA, Cambridge, MA (CK, GH)
- />Harvard Medical School, Boston, MA (LPN)
| | - Brenda Tierman
- />Five Islands Consulting LLC, Georgetown, ME (NFC, VS, BT, AH)
- />Neurological Sciences, University of Vermont College of Medicine, Burlington, VT (AJS)
- />Department of Psychology, University of Nebraska-Lincoln, Lincoln, Nebraska (CPG)
- />University of Massachusetts Medical School, Worcester, MA (LP)
- />University of Massachusetts Memorial Medical Center, Worcester, MA (LP, IBM, CPG)
- />Neurology, University of Colorado, Aurora, CO (CI, EA)
- />Colorado Springs Neurological Associates, Colorado Springs, CO (CK)
- />Biogen Inc., Weston, MA, USA, Cambridge, MA (CK, GH)
- />Harvard Medical School, Boston, MA (LPN)
| | - Ashli Hopson
- />Five Islands Consulting LLC, Georgetown, ME (NFC, VS, BT, AH)
- />Neurological Sciences, University of Vermont College of Medicine, Burlington, VT (AJS)
- />Department of Psychology, University of Nebraska-Lincoln, Lincoln, Nebraska (CPG)
- />University of Massachusetts Medical School, Worcester, MA (LP)
- />University of Massachusetts Memorial Medical Center, Worcester, MA (LP, IBM, CPG)
- />Neurology, University of Colorado, Aurora, CO (CI, EA)
- />Colorado Springs Neurological Associates, Colorado Springs, CO (CK)
- />Biogen Inc., Weston, MA, USA, Cambridge, MA (CK, GH)
- />Harvard Medical School, Boston, MA (LPN)
| | - Christen Kutz
- />Five Islands Consulting LLC, Georgetown, ME (NFC, VS, BT, AH)
- />Neurological Sciences, University of Vermont College of Medicine, Burlington, VT (AJS)
- />Department of Psychology, University of Nebraska-Lincoln, Lincoln, Nebraska (CPG)
- />University of Massachusetts Medical School, Worcester, MA (LP)
- />University of Massachusetts Memorial Medical Center, Worcester, MA (LP, IBM, CPG)
- />Neurology, University of Colorado, Aurora, CO (CI, EA)
- />Colorado Springs Neurological Associates, Colorado Springs, CO (CK)
- />Biogen Inc., Weston, MA, USA, Cambridge, MA (CK, GH)
- />Harvard Medical School, Boston, MA (LPN)
| | - Idanis Berrios Morales
- />Five Islands Consulting LLC, Georgetown, ME (NFC, VS, BT, AH)
- />Neurological Sciences, University of Vermont College of Medicine, Burlington, VT (AJS)
- />Department of Psychology, University of Nebraska-Lincoln, Lincoln, Nebraska (CPG)
- />University of Massachusetts Medical School, Worcester, MA (LP)
- />University of Massachusetts Memorial Medical Center, Worcester, MA (LP, IBM, CPG)
- />Neurology, University of Colorado, Aurora, CO (CI, EA)
- />Colorado Springs Neurological Associates, Colorado Springs, CO (CK)
- />Biogen Inc., Weston, MA, USA, Cambridge, MA (CK, GH)
- />Harvard Medical School, Boston, MA (LPN)
| | - Carolyn Griffin
- />Five Islands Consulting LLC, Georgetown, ME (NFC, VS, BT, AH)
- />Neurological Sciences, University of Vermont College of Medicine, Burlington, VT (AJS)
- />Department of Psychology, University of Nebraska-Lincoln, Lincoln, Nebraska (CPG)
- />University of Massachusetts Medical School, Worcester, MA (LP)
- />University of Massachusetts Memorial Medical Center, Worcester, MA (LP, IBM, CPG)
- />Neurology, University of Colorado, Aurora, CO (CI, EA)
- />Colorado Springs Neurological Associates, Colorado Springs, CO (CK)
- />Biogen Inc., Weston, MA, USA, Cambridge, MA (CK, GH)
- />Harvard Medical School, Boston, MA (LPN)
| | - Glenn Phillips
- />Five Islands Consulting LLC, Georgetown, ME (NFC, VS, BT, AH)
- />Neurological Sciences, University of Vermont College of Medicine, Burlington, VT (AJS)
- />Department of Psychology, University of Nebraska-Lincoln, Lincoln, Nebraska (CPG)
- />University of Massachusetts Medical School, Worcester, MA (LP)
- />University of Massachusetts Memorial Medical Center, Worcester, MA (LP, IBM, CPG)
- />Neurology, University of Colorado, Aurora, CO (CI, EA)
- />Colorado Springs Neurological Associates, Colorado Springs, CO (CK)
- />Biogen Inc., Weston, MA, USA, Cambridge, MA (CK, GH)
- />Harvard Medical School, Boston, MA (LPN)
| | - Long H. Ngo
- />Five Islands Consulting LLC, Georgetown, ME (NFC, VS, BT, AH)
- />Neurological Sciences, University of Vermont College of Medicine, Burlington, VT (AJS)
- />Department of Psychology, University of Nebraska-Lincoln, Lincoln, Nebraska (CPG)
- />University of Massachusetts Medical School, Worcester, MA (LP)
- />University of Massachusetts Memorial Medical Center, Worcester, MA (LP, IBM, CPG)
- />Neurology, University of Colorado, Aurora, CO (CI, EA)
- />Colorado Springs Neurological Associates, Colorado Springs, CO (CK)
- />Biogen Inc., Weston, MA, USA, Cambridge, MA (CK, GH)
- />Harvard Medical School, Boston, MA (LPN)
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Roman C, Menning K. Treatment and disease management of multiple sclerosis patients: A review for nurse practitioners. J Am Assoc Nurse Pract 2017; 29:629-638. [PMID: 29029375 DOI: 10.1002/2327-6924.12514] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 07/31/2017] [Accepted: 08/01/2017] [Indexed: 11/09/2022]
Abstract
BACKGROUND AND PURPOSE This review discusses the role of the nurse practitioner (NP) in evaluating the clinical effects, potential side effects, and monitoring requirements for treatment options in multiple sclerosis (MS) and provides guidance on how to help patients understand these issues. METHODS A literature search was conducted on PubMed to identify publications on monitoring and disease management of MS patients. Additional resources included drug information web sites and package inserts. CONCLUSIONS NPs play an active role in the management of MS patients via effective monitoring and communication throughout the patient's treatment regimen and disease course. In the shared decision-making model of MS treatment, NPs ensure that patients understand the implications of their disease-modifying therapies (DMTs). As patients move through treatments during the course of their disease, the importance of this role increases, and it is critical that NPs follow the guidelines in each medication's product label and take into account any potential lingering effects of prior medications. IMPLICATIONS FOR PRACTICE It is critical for NPs to promote patient adherence, to ensure that patients understand treatment side effects and monitoring requirements, and to take sequencing and reversibility implications of DMTs into account when making clinical decisions.
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Carlin CS, Higuera L, Anderson S. Improving Patient-Centered Care by Assessing Patient Preferences for Multiple Sclerosis Disease-Modifying Agents: A Stated-Choice Experiment. Perm J 2017; 21:16-102. [PMID: 28406788 DOI: 10.7812/tpp/16-102] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
CONTEXT Long-term adherence to pharmaceutical treatment for multiple sclerosis (MS) is poor. A focus on patient preferences when determining the patient's therapeutic plan may improve this experience. OBJECTIVE To identify factors important to patients with MS when evaluating their options for pharmaceutical agents that deliver disease-modifying therapy. DESIGN Stated-choice experiment to a sample of patients with MS from privately and publicly insured enrollees in a regional health plan. The experiment presented each respondent with a set of 8 drug choices for MS, asking them to select their preferred disease-modifying agent (DMA). Each respondent was randomized to 1 of 6 possible sets of 8 drug choices, for a total of 48 drug pairings in the experiment. Each choice included 2 hypothetical DMAs and a "no drug" option. Drug attributes included dosage type and modality, efficacy, relapse risk, and drug side effects. RESULTS The "no drug" alternative was a stronger substitute than the alternative drug when the focal drug characteristics changed, and the most important drivers of choice were type of side effects and risk of severe relapse. DISCUSSION The heterogeneity of our sample and the inclusion of a "no drug" alternative in the DMA choice scenarios make this study an important contribution to this body of literature. The importance of the "no drug" alternative in our results is consistent with poor long-term adherence to DMAs. CONCLUSION Patient-centered MS therapy using DMAs should include discussion of side effects and relapse risk.
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Affiliation(s)
- Caroline S Carlin
- Research Investigator for the Medica Research Institute in Minneapolis, MN.
| | - Lucas Higuera
- Research Associate for the Medica Research Institute in Minneapolis, MN.
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Visvanathan A, Dennis M, Mead G, Whiteley WN, Lawton J, Doubal FN. Shared decision making after severe stroke—How can we improve patient and family involvement in treatment decisions? Int J Stroke 2017; 12:920-922. [DOI: 10.1177/1747493017730746] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
People who are well may regard survival with disability as being worse than death. However, this is often not the case when those surviving with disability (e.g. stroke survivors) are asked the same question. Many routine treatments provided after an acute stroke (e.g. feeding via a tube) increase survival, but with disability. Therefore, clinicians need to support patients and families in making informed decisions about the use of these treatments, in a process termed shared decision making. This is challenging after acute stroke: there is prognostic uncertainty, patients are often too unwell to participate in decision making, and proxies may not know the patients’ expressed wishes (i.e. values). Patients’ values also change over time and in different situations. There is limited evidence on successful methods to facilitate this process. Changes targeted at components of shared decision making (e.g. decision aids to provide information and discussing patient values) increase patient satisfaction. How this influences decision making is unclear. Presumably, a “shared decision-making tool” that introduces effective changes at various stages in this process might be helpful after acute stroke. For example, by complementing professional judgement with predictions from prognostic models, clinicians could provide information that is more accurate. Decision aids that are personalized may be helpful. Further qualitative research can provide clinicians with a better understanding of patient values and factors influencing this at different time points after a stroke. The evaluation of this tool in its success to achieve outcomes consistent with patients’ values may require more than one clinical trial.
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Affiliation(s)
- Akila Visvanathan
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Martin Dennis
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Gillian Mead
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - William N Whiteley
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Julia Lawton
- Usher Institute for Population Sciences, Edinburgh, UK
| | - Fergus Neil Doubal
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
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Kremer IEH, Evers SMAA, Jongen PJ, Hiligsmann M. Comparison of preferences of healthcare professionals and MS patients for attributes of disease-modifying drugs: A best-worst scaling. Health Expect 2017; 21:171-180. [PMID: 28734004 PMCID: PMC5750752 DOI: 10.1111/hex.12599] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2017] [Indexed: 12/19/2022] Open
Abstract
Background The choice between disease‐modifying drugs (DMDs) for the treatment of multiple sclerosis (MS) becomes more often a shared decision between the patient and the neurologist and MS nurse. This study aimed to assess which DMD attributes are most important for the healthcare professionals in selecting a DMD for a patient. Subsequently, within this perspective, the neurologists’ and nurses’ perspectives were compared. Lastly, the healthcare professionals’ perspective was compared with the patients’ perspective to detect any differences that may need attention in the communication about DMDs. Design A best‐worst scaling (BWS) was conducted among 27 neurologists and 33 MS nurses treating patients with MS to determine the importance of 27 DMD attributes. These attributes were identified through three focus groups with MS patients in a previous study (N=19). Relative importance scores (RISs) were estimated for each attribute. Multivariable linear regression analyses were used to compare the different perspectives. Results According to the neurologists and nurses, safety of the DMD was the most important DMD attribute in the treatment decision, closely followed by effect on disability progression, quality of life and relapse rate. Patients with MS agreed with the importance of the last three attributes, but valued safety significantly lower (b=−2.59, P<.001). Conclusions This study suggests that, overall, neurologists and nurses regard the same DMD attributes as important as MS patients with the notable exception of safety. This study provides valuable information for the development of interventions to support shared decision making and highlights which attributes of DMDs may need additional attention.
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Affiliation(s)
- Ingrid E H Kremer
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Silvia M A A Evers
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.,Center for Economic Evaluations, Trimbos Institute Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Peter J Jongen
- MS4 Research Institute, Nijmegen, The Netherlands.,Department of Community & Occupational Medicine, University Medical Centre Groningen, Groningen, The Netherlands
| | - Mickaël Hiligsmann
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
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Mansfield C, Thomas N, Gebben D, Lucas M, Hauber AB. Preferences for Multiple Sclerosis Treatments: Using a Discrete-Choice Experiment to Examine Differences Across Subgroups of US Patients. Int J MS Care 2017; 19:172-183. [PMID: 28835741 DOI: 10.7224/1537-2073.2016-039] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND The growing number of treatments for relapsing multiple sclerosis (MS) provides opportunities to consider patient preferences in treatment decisions. METHODS We designed a Web-based, discrete-choice experiment survey to analyze treatment preferences in patients with relapsing-remitting MS (RRMS). The survey presented hypothetical MS treatments defined by six attributes: risk of MS progression, time between relapses, risk of serious infection, treatment-related flu-like symptoms and gastrointestinal symptoms, and route and frequency of administration. Preference weights estimated with random-parameters logit were used to calculate importance scores and preference shares among three pairs of subsamples. RESULTS Patients with a self-reported physician diagnosis of RRMS (N = 301) completed the survey: 56% rated their disability level as normal or mild; 43% currently used a self-injectable treatment. Respondents with normal or mild disability levels placed greater weight on avoiding injections with flu-like symptoms and risk of progression, whereas patients with worse disability placed greater weight on reducing risk of progression and risk of serious infection. Patients taking injectables placed the most weight on risk of progression and risk of serious infection, whereas respondents not taking injectables placed the most weight on route and frequency of administration. Differences in preferences between subgroups were significant (P < .05). The presence of common adverse events associated with daily pills and injectables altered predicted preferences for route of administration. CONCLUSIONS Preferences of patients with RRMS varied depending on current treatment and disability level, especially regarding mode of administration. Considering patient preferences for treatment features may lead to higher treatment satisfaction and adherence.
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Reen GK, Silber E, Langdon DW. Interventions to support risk and benefit understanding of disease-modifying drugs in Multiple Sclerosis patients: A systematic review. PATIENT EDUCATION AND COUNSELING 2017; 100:1031-1048. [PMID: 28108125 DOI: 10.1016/j.pec.2016.12.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 11/29/2016] [Accepted: 12/25/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE The present review evaluates interventions that have been designed to improve understanding of the complex risk-benefit profiles of disease-modifying drugs (DMDs) in patients with Multiple Sclerosis (MS). METHODS A systematic search conducted using PubMed, Embase, Google Scholar and PsycINFO identified 15 studies. Interventions which provided treatment information were present across a range of study designs. A narrative synthesis was conducted due to heterogeneity of research findings. RESULTS Interventions providing treatment information ranged from comprehensive education programmes to booklets of a few pages. MS patients favoured the interventions they received. Understanding of overall treatment information and treatment risks specifically, generally improved following interventions. Yet overestimation of treatment benefits persisted. There was no conclusive effect on DMD decisions. No superior intervention was identified. CONCLUSION Interventions designed to improve understanding of DMD risk and benefit information are moderately successful. PRACTICE IMPLICATIONS Additional support provided to MS patients beyond routine healthcare can generally improve understanding of the complex risk-benefit profiles of DMDs. Future interventions need to ensure that patients with symptoms that may confound understanding can also benefit from this additional information.
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Affiliation(s)
- Gurpreet K Reen
- Department of Psychology, Royal Holloway, University of London, Egham, UK.
| | - Eli Silber
- Department of Neurology, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK
| | - Dawn W Langdon
- Department of Psychology, Royal Holloway, University of London, Egham, UK
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Heesen C, Kleiter I, Meuth SG, Krämer J, Kasper J, Köpke S, Gaissmaier W. Benefit-risk perception of natalizumab therapy in neurologists and a large cohort of multiple sclerosis patients. J Neurol Sci 2017; 376:181-190. [DOI: 10.1016/j.jns.2017.03.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 02/07/2017] [Accepted: 03/02/2017] [Indexed: 01/27/2023]
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Multiple sclerosis patients' understanding and preferences for risks and benefits of disease-modifying drugs: A systematic review. J Neurol Sci 2017; 375:107-122. [DOI: 10.1016/j.jns.2016.12.038] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 11/28/2016] [Accepted: 12/21/2016] [Indexed: 11/17/2022]
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Arroyo R, Sempere AP, Ruiz-Beato E, Prefasi D, Carreño A, Roset M, Maurino J. Conjoint analysis to understand preferences of patients with multiple sclerosis for disease-modifying therapy attributes in Spain: a cross-sectional observational study. BMJ Open 2017; 7:e014433. [PMID: 28274968 PMCID: PMC5353311 DOI: 10.1136/bmjopen-2016-014433] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 12/20/2016] [Accepted: 01/16/2017] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To assess patients' preferences for a range of disease-modifying therapy (DMT) attributes in multiple sclerosis (MS). DESIGN A cross-sectional observational study. SETTING The data reported were from 17 MS units throughout Spain. PARTICIPANTS Adult patients with relapsing-remitting MS. MAIN OUTCOME A conjoint analysis was applied to assess preferences. A total of 221 patients completed a survey with 10 hypothetical DMT profiles developed using an orthogonal design and rating preferences from 1 (most acceptable) to 10 (least acceptable). Medication attributes included preventing relapse, preventing disease progression, side effect risk, route and frequency of administration. RESULTS Patients placed the greatest relative importance on the side effect risk domain (32.9%), followed by route of administration (26.1%), frequency of administration (22.7%), prevention of disease progression (10.0%) and prevention of relapse (8.3%). These results were independent of the Expanded Disability Status Scale score. The importance assigned to side effect risk was highest for patients with a recent diagnosis. Patients who had previously received more than one DMT gave a higher importance to relapse rate reduction than patients receiving their first DMT. CONCLUSIONS Patient DMT preferences were mainly driven by risk minimisation, route of administration and treatment schedule. The risk-benefit spectrum of available DMT for MS is becoming increasingly complicated. Understanding which treatment characteristics are meaningful to patients may help to tailor information for them and facilitate shared decision-making in clinical practice.
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Affiliation(s)
- Rafael Arroyo
- Department of Neurology, Hospital Universitario Quirónsalud, Madrid, Spain
| | - Angel P Sempere
- Department of Neurology, Hospital General Universitario de Alicante, Alicante, Spain
| | - Elena Ruiz-Beato
- Health Economics and Outcomes Research Unit, Roche Farma SA, Madrid, Spain
| | | | - Agata Carreño
- Health Economics and Outcomes Research, IMS Health, Barcelona, Spain
| | - Montse Roset
- Health Economics and Outcomes Research, IMS Health, Barcelona, Spain
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De Abreu Lourenco R, Haas M, Hall J, Viney R. Valuing Meta-Health Effects for Use in Economic Evaluations to Inform Reimbursement Decisions: A Review of the Evidence. PHARMACOECONOMICS 2017; 35:347-362. [PMID: 27858368 DOI: 10.1007/s40273-016-0470-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE This review explores the evidence from the literature regarding how meta-health effects (effects other than health resulting from the consumption of health care) are valued for use in economic evaluations. METHODS A systematic review of the published literature (the EMBASE, MEDLINE, PsycINFO, CINAHL, EconLit and SocINDEX databases were searched for publications in March 2016, plus manual searching) investigated the associations between study methods and the resulting values for meta-health effects estimated for use in economic evaluations. The review considered which meta-health effects were being valued and how this differed by evaluation approach, intervention investigated, source of funds and year of publication. Detailed reasons for differences observed between values for comparable meta-health effects were explored, accounting for the method of valuation. RESULTS The search of the literature revealed 71 studies of interest; 35% involved drug interventions, with convenience, information and process of care the three meta-health effects most often investigated. Key associations with the meta-health effects were the evaluation method, the intervention, and the source of funds. Relative values for meta-health effects ranged from 0.9% to 68% of the overall value reported in a study. For a given meta-health effect, the magnitude of the effect evaluated and how the meta-health effect was described and framed relative to overall health explained the differences in relative values. CONCLUSIONS Evidence from the literature shows variability in how meta-health effects are being measured for use in economic evaluations. Understanding the sources of that variability is important if decision makers are to have confidence in how meta-health effects are valued.
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Affiliation(s)
- Richard De Abreu Lourenco
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Level 2, Block 5D, Quay St, Haymarket, Sydney, NSW, Australia.
| | - Marion Haas
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Level 2, Block 5D, Quay St, Haymarket, Sydney, NSW, Australia
| | - Jane Hall
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Level 2, Block 5D, Quay St, Haymarket, Sydney, NSW, Australia
| | - Rosalie Viney
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Level 2, Block 5D, Quay St, Haymarket, Sydney, NSW, Australia
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Wu C, Scott Hultman C, Diegidio P, Hermiz S, Garimella R, Crutchfield TM, Lee CN. What Do Our Patients Truly Want? Conjoint Analysis of an Aesthetic Plastic Surgery Practice Using Internet Crowdsourcing. Aesthet Surg J 2017; 37:105-118. [PMID: 27651401 DOI: 10.1093/asj/sjw143] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2016] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND What do patients want when looking for an aesthetic surgeon? When faced with attributes like reputation, years in practice, testimonials, photos, and pricing, which is more valuable? Moreover, are attributes procedure-specific? Currently, inadequate evidence exists on which attributes are most important to patients, and to our knowledge, none on procedure-specific preferences. OBJECTIVES First, to determine the most important attributes to breast augmentation, combined breast/abdominal surgery, and facelift patients using conjoint analysis. Second, to test the conjoint using an internet crowdsourcing service (Amazon Mechanical Turk [MTurk]). METHODS Anonymous university members were asked, via mass electronic survey, to pick a surgeon for facelift surgery based on five attributes. Attribute importance and preference was calculated. Once pre-tested, the facelift, breast augmentation and combined breast/abdominal surgery surveys were administered worldwide to MTurk. RESULTS The university facelift cohort valued testimonials (33.9%) as the most important, followed by photos (31.6%), reputation (18.2%), pricing (14.4%), and practice years (1.9%). MTurk breast augmentation participants valued photos (35.3%), then testimonials (33.9%), reputation (15.7%), pricing (12.2%), and practice years (3%). MTurk combined breast/abdominal surgery and facelift participants valued testimonials (38.3% and 38.1%, respectively), then photos (27.9%, 29.4%), reputation (17.5%, 15.8%), pricing (13.9%, 13.9%), practice years (2.4%, 2.8%). CONCLUSIONS Breast augmentation patients placed higher importance on photos; combined breast/abdominal surgery and facelift patients valued testimonials. Conjoint analysis has had limited application in plastic surgery. To our knowledge, internet crowdsourcing is a novel participant recruitment method in plastic surgery. Its unique benefits include broad, diverse and anonymous participant pools, low-cost, rapid data collection, and high completion rate.
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Affiliation(s)
- Cindy Wu
- Division of Plastic and Reconstructive Surgery, The University of North Carolina, Chapel Hill, NC
| | - C Scott Hultman
- Division of Plastic and Reconstructive Surgery, The University of North Carolina, Chapel Hill, NC
| | - Paul Diegidio
- Division of Plastic and Reconstructive Surgery, The University of North Carolina, Chapel Hill, NC
| | | | | | - Trisha M Crutchfield
- Center for Health Promotion and Disease Prevention, The University of North Carolina, Chapel Hill, NC
| | - Clara N Lee
- Division of Plastic and Reconstructive Surgery, The University of North Carolina, Chapel Hill, NC
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Sempere AP, Vera-Lopez V, Gimenez-Martinez J, Ruiz-Beato E, Cuervo J, Maurino J. Using a multidimensional unfolding approach to assess multiple sclerosis patient preferences for disease-modifying therapy: a pilot study. Patient Prefer Adherence 2017; 11:995-999. [PMID: 28615928 PMCID: PMC5460668 DOI: 10.2147/ppa.s129356] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
PURPOSE Multidimensional unfolding is a multivariate method to assess preferences using a small sample size, a geometric model locating individuals and alternatives as points in a joint space. The objective was to evaluate relapsing-remitting multiple sclerosis (RRMS) patient preferences toward key disease-modifying therapy (DMT) attributes using multidimensional unfolding. PATIENTS AND METHODS A cross-sectional pilot study in RRMS patients was conducted. Drug attributes included relapse prevention, disease progression prevention, side-effect risk and route and schedule of administration. Assessment of preferences was performed through a five-card game. Patients were asked to value attributes from 1 (most preferred) to 5 (least preferred). RESULTS A total of 37 patients were included; the mean age was 38.6 years, and 78.4% were female. Disease progression prevention was the most important factor (51.4%), followed by relapse prevention (40.5%). The frequency of administration had the lowest preference rating for 56.8% of patients. Finally, 19.6% valued the side-effect risk attribute as having low/very low importance. CONCLUSION Patients' perspective for DMT attributes may provide valuable information to facilitate shared decision-making. Efficacy attributes were the most important drug characteristics for RRMS patients. Multidimensional unfolding seems to be a feasible approach to assess preferences in multiple sclerosis patients. Further elicitation studies using multidimensional unfolding with other stated choice methods are necessary to confirm these findings.
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Affiliation(s)
- Angel Perez Sempere
- Department of Neurology, Hospital General Universitario de Alicante, Alicante
| | | | | | - Elena Ruiz-Beato
- Health Economics and Outcomes Research Unit, Roche Farma SA, Madrid
| | | | - Jorge Maurino
- Medical Department, Roche Farma SA, Madrid, Spain
- Correspondence: Jorge Maurino, Medical Department, Roche Farma SA, Eucalipto 33, Madrid 28016, Spain, Tel +34 91 324 8173, Email
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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.
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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
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Lee Mortensen G, Rasmussen PV. The impact of quality of life on treatment preferences in multiple sclerosis patients. Patient Prefer Adherence 2017; 11:1789-1796. [PMID: 29089746 PMCID: PMC5656344 DOI: 10.2147/ppa.s142373] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Multiple sclerosis (MS) is a demyelinating disorder with an unpredictable and often disabling course. MS symptoms are very heterogeneous and may lead to reduced physical, cognitive, and psychosocial functioning decreasing patients' quality of life (QoL). Today, various disease-modifying treatments (DMTs) may prevent disease progression. However, it is increasingly complex to select the right therapy for a given patient and patient preferences should be considered when making treatment decisions. This study aimed to explore the main factors affecting patients' preferences regarding MS treatment and health care. METHODS Five qualitative focus group interviews were carried out with a total of 40 participants from across Denmark. A semistructured question guide included questions that were identified in a systematic literature study about QoL and treatment preferences in patients with MS. The participants were asked to describe their disease experiences, their health-related QoL, and reasons behind their preferences with regard to treatment and care. The data were analyzed using content analysis and a constructivist approach. RESULTS The participants' physical, cognitive, and psychosocial QoL and functioning were reduced by disease symptoms, treatment side effects, and mode of administration. Their ability to uphold meaningful role functioning was crucial to their treatment priorities. The preeminence of anticipated efficacy, ie, the patients' hope that DMT might prevent disease deterioration in the future, was modified by their present QoL and functioning when ultimately framing their treatment preferences. There was an unmet information and support need from neurology clinics, particularly at the time of diagnosis. CONCLUSION The participants' treatment preferences were influenced by a matrix of treatment and QoL-related factors and evolved with time and along with personal and professional changes in life. The patients preferred to receive a clear recommendation of DMT from the neurologist taking into account their individual functioning and present QoL priorities.
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Affiliation(s)
- Gitte Lee Mortensen
- Medical Anthropology Department, AnthroConsult
- Correspondence: Gitte Lee Mortensen, Medical Anthropology Department, AnthroConsult, Fynsgade 24, 8000 Aarhus C, Denmark, Tel +45 2396 4252, Email
| | - Peter V Rasmussen
- Department of Neurology, University Hospital of Aarhus, Aarhus C, Denmark
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D'Amico E, Leone C, Patti F. Disability may influence patient willingness to participate in decision making on first-line therapy in multiple sclerosis. FUNCTIONAL NEUROLOGY 2016; 31:21-3. [PMID: 27027890 DOI: 10.11138/fneur/2016.31.1.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Patient autonomy is a concept that implies variable degrees of patient participation in different aspects of health and healthcare, including the choice of therapy. This study, conducted in patients with multiple sclerosis (MS), examined several factors in relation to the patient's role in the therapeutic decision-making process. One hundred newly diagnosed patients with MS attending their first ever specialist consultation at the MS center of Catania, Italy, were consecutively enrolled in a single-center, open, observational study. Clinical and demographic data were collected as part of this routine first consultation. Through administration of the Control Preferences Scale, we ascertained the patients' willingness to participate in the decision-making process on their first-line treatment, classifying them, on the basis of their attitude, as passive, collaborative or active. Of 100 patients with MS, 40 had a passive attitude, while 35 were willing to collaborate and 25 wanted to play an active role in the decision-making process. The patients showing an active attitude had a significantly higher Expanded Disability Status Scale score and a significantly higher number of relapses (p<0.5 for both) than those who showed other attitudes. Persons with MS prefer to know the benefits and risks related to the first-line treatment. Those with higher disability prefer to be active in the decision-making process.
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