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Rauseo C, Cheng MS. Unlocking Patient Voices: Advancing Physical Therapist Practice With Discrete Choice Experiments. Phys Ther 2024; 104:pzae063. [PMID: 38624225 DOI: 10.1093/ptj/pzae063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 01/07/2024] [Accepted: 03/19/2024] [Indexed: 04/17/2024]
Abstract
As health care moves away from volume-based to value-based delivery, the role of the patient in determining value in health care is now paramount. Thus, health care should be aligned with what matters most to patients. Ascertaining patient preferences is therefore critical if we are to provide patients with care that is meaningful to them. However, preferences are difficult to measure and traditional methods of preference measurement in physical therapy face challenges when attempting to measure such. This perspective makes a case for greater use of the discrete choice experiment (DCE) in physical therapy as a research method to measure patient preferences. The DCE is a research method used to elicit preferences for services or goods. This article addresses the importance of eliciting patient preferences as part of person-centered care in the value-based space, the challenges faced in preference measurement in physical therapy, and how the DCE can alleviate some of those challenges. It also provides examples of the DCE in health care and suggests ways in which it can be effectively used in physical therapist practice to improve the delivery of meaningful rehabilitation services to patients. Implementing greater use of the DCE in physical therapy can improve person-centered physical therapist service delivery and inform policy development that creates cost-effective care which is meaningful to patients. It can further help to highlight the value of physical therapy to population health, and to policy makers as health care moves toward more value-based models.
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Affiliation(s)
- Carla Rauseo
- Department of Physical Therapy, Nova Southeastern University, Fort Lauderdale, Florida, USA
| | - Mingshun Samuel Cheng
- Department of Physical Therapy, Nova Southeastern University, Fort Lauderdale, Florida, USA
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Bérubé M, Verret M, Bourque L, Côté C, Guénette L, Richard-Denis A, Ouellet S, Singer LN, Gauthier L, Gagnon MP, Gagnon MA, Martorella G. Educational needs and preferences of adult patients with acute pain: a mixed-methods systematic review. Pain 2024:00006396-990000000-00630. [PMID: 38888742 DOI: 10.1097/j.pain.0000000000003288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 04/28/2024] [Indexed: 06/20/2024]
Abstract
ABSTRACT Many patients experience acute pain, which has been associated with numerous negative consequences. Pain education has been proposed as a strategy to improve acute pain management. However, studies report limited effects with educational interventions for acute pain in adults, which can be explained by the underuse of the person-centered approach. Thus, we aimed to systematically review and synthetize current evidence from quantitative, qualitative and mixed-methods studies describing patients' needs and preferences for acute pain education in adults. We searched original studies and gray literature in 7 databases, from January 1990 to October 2023. Methodological quality was assessed with the Mixed Methods Appraisal Tool. A total of 32 studies were included (n = 1847 patients), two-thirds of which were qualitative studies of high methodological quality. Most of the studies were conducted over the last 15 years in patients with postsurgical and posttraumatic pain, identified as White, with a low level of education. Patients expressed the greatest need for education when it came to what to expect in pain intensity and duration, as well how to take the medication and its associated adverse effects. The most frequently reported educational preferences were for in-person education while involving caregivers and to obtain information first from physicians, then by other professionals. This review has highlighted the needs and preferences to be considered in pain education interventions, which should be embedded in an approach cultivating communication and partnership with patients and their caregivers. The results still need to be confirmed with different patient populations.
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Affiliation(s)
- Mélanie Bérubé
- Population Health and Optimal Practices Research Unit, Research Centre of the CHU de Québec-Université Laval, Quebec City, QC, Canada
- Faculty of Nursing, Université Laval, Quebec City, QC, Canada
- Quebec Pain Research Network, Sherbrooke, QC, Canada
| | - Michael Verret
- Population Health and Optimal Practices Research Unit, Research Centre of the CHU de Québec-Université Laval, Quebec City, QC, Canada
- Faculty of Medicine, Clinical Epidemiology Program, University of Ottawa, Ottawa, ON, Canada
- Department of Anesthesiology and Critical Care Medicine, Université Laval, Quebec City, QC, Canada
| | - Laurence Bourque
- Population Health and Optimal Practices Research Unit, Research Centre of the CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - Caroline Côté
- Population Health and Optimal Practices Research Unit, Research Centre of the CHU de Québec-Université Laval, Quebec City, QC, Canada
- Faculty of Nursing, Université Laval, Quebec City, QC, Canada
| | - Line Guénette
- Population Health and Optimal Practices Research Unit, Research Centre of the CHU de Québec-Université Laval, Quebec City, QC, Canada
- Quebec Pain Research Network, Sherbrooke, QC, Canada
- Faculty of Pharmacy, Université Laval, Québec, QC, Canada
| | - Andréane Richard-Denis
- Department of Medicine, Université de Montréal, Montréal, QC, Canada
- Research Centre, CIUSSS du Nord-de-l'île-de-Montréal, Montréal, QC, Canada
| | - Simon Ouellet
- Population Health and Optimal Practices Research Unit, Research Centre of the CHU de Québec-Université Laval, Quebec City, QC, Canada
- Faculty of Nursing, Université Laval, Quebec City, QC, Canada
- Department of Health Sciences, Université du Québec à Rimouski, Rimouski, QC, Canada
| | - Lesley Norris Singer
- Quebec Pain Research Network, Sherbrooke, QC, Canada
- School of Physical and Occupational Therapy, McGill University, Montréal, QC, Canada
| | - Lynn Gauthier
- Population Health and Optimal Practices Research Unit, Research Centre of the CHU de Québec-Université Laval, Quebec City, QC, Canada
- Quebec Pain Research Network, Sherbrooke, QC, Canada
- Department of Family and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec City, QC, Canada
- VITAM-Centre de Recherche en Santé durable, Université Laval, Québec, QC, Canada
- Oncology Division, Research Centre of the CHU de Québec-Université Laval, Quebec City, QC, Canada
- Cancer Research Centre, Université Laval, Québec City, QC, Canada
| | - Marie-Pierre Gagnon
- Population Health and Optimal Practices Research Unit, Research Centre of the CHU de Québec-Université Laval, Quebec City, QC, Canada
- Faculty of Nursing, Université Laval, Quebec City, QC, Canada
- VITAM-Centre de Recherche en Santé durable, Université Laval, Québec, QC, Canada
| | - Marc-Aurèle Gagnon
- Population Health and Optimal Practices Research Unit, Research Centre of the CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - Géraldine Martorella
- College of Nursing, Florida State University, Tallahassee, FL, United States
- Florida State University Brain Science and Symptom Management Center, Tallahassee, FL, United States
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Zhuge J, Zheng D, Li X, Nie X, Liu J, Liu R. Parental preferences for the procedural sedation of children in dentistry: a discrete choice experiment. Front Pediatr 2023; 11:1132413. [PMID: 38116578 PMCID: PMC10728602 DOI: 10.3389/fped.2023.1132413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 11/16/2023] [Indexed: 12/21/2023] Open
Abstract
Purpose The aim of this study was to explore parental preferences for the procedural sedation of children in dentistry through a discrete choice experiment (DCE) to inform clinical decisions and oral health management. Methods Based on literature reviews, interviews with parents of pediatric dental patients, and expert consultation, six attributes, including fasting time, recovery time, sedative administration routes, adverse reactions, sedation depth and procedure cost, were incorporated into the DCE questionnaire. The DCE questionnaire collected data on parental preferences for pediatric dental sedation treatment from June to August 2022. A conditional logit model was used to analyze preference and willingness to pay (WTP) for each attribute and its level. Subgroup analyses assessing the impact of parents' dental anxiety on procedural sedation preferences were also conducted using conditional logit models. Results A total of 186 valid questionnaires were gathered. Parents' preferences for fewer adverse reactions, a milder sedation depth, lower out-of-pocket cost, shorter fasting and recovery times and administration by inhalation were significantly associated with their choice of sedation model. The conditional logit model showed that parents were most interested in treatments with no adverse reactions (0% vs. 15%) (Coef, 1.033; 95% CI, 0.833-1.233), followed by those providing minimal sedation (vs. deep sedation) (Coef, 0.609; 95% CI, 0.448-0.769). Moreover, the relative importance of adverse reactions and fasting time was higher among anxious than nonanxious parents. The study found a WTP threshold of ¥1,538 for reducing adverse reactions (15% to 0%). The WTP threshold for the best sedation procedure scenario (no fasting requirement, 10 min recovery time, administration by inhalation, 0% adverse reaction incidence and minimal sedation) was ¥3,830. Conclusion Reducing the adverse reactions and depth of sedation are predominant considerations for parents regarding procedural sedation in pediatric dentistry, followed by lower cost, shorter fasting and recovery times and inhalation sedation. Parents with dental anxiety had a stronger preference for options with a lower incidence of adverse reactions and shorter fasting time than parents without dental anxiety. This discovery is helpful for doctors and can promote collaborative decision-making among parents and doctors.
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Affiliation(s)
- Jinru Zhuge
- Department of Anesthesiology, The Affiliated Stomatology Hospital of Wenzhou Medical University, Wenzhou, China
| | - Dongyue Zheng
- Department of Nursing, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xingwang Li
- Department of Anesthesiology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xin Nie
- Department of Stomatology, The Affiliated Stomatology Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jiefan Liu
- Department of Stomatology, The Affiliated Stomatology Hospital of Wenzhou Medical University, Wenzhou, China
| | - Ruohai Liu
- Department of Anesthesiology, The Affiliated Stomatology Hospital of Wenzhou Medical University, Wenzhou, China
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Seghers PAL, Hamaker ME, van der Wal-Huisman H, Stegmann ME, Portielje JEA, de Graeff P, Festen S. Development and testing of the Outcome Prioritization Tool adjusted to older patients with cancer: A pilot study. J Geriatr Oncol 2023; 14:101590. [PMID: 37481403 DOI: 10.1016/j.jgo.2023.101590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 06/20/2023] [Accepted: 07/07/2023] [Indexed: 07/24/2023]
Affiliation(s)
| | - Marije E Hamaker
- Department of Geriatric Medicine, Diakonessenhuis, 3582 KE Utrecht, the Netherlands
| | - Hanneke van der Wal-Huisman
- Department of Surgery, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, the Netherlands
| | - Mariken E Stegmann
- University of Groningen, University Medical Center Groningen, Department of General Practice and Elderly Care Medicine, 9700 RB Groningen, the Netherlands
| | - Johanneke E A Portielje
- Department of Medical Oncology, Leiden University Medical Center-LUMC, 2333 ZA Leiden, the Netherlands
| | - Pauline de Graeff
- University of Groningen, University Medical Center Groningen, University Center for Geriatric Medicine, 9700 RB Groningen, the Netherlands
| | - Suzanne Festen
- University of Groningen, University Medical Center Groningen, University Center for Geriatric Medicine, 9700 RB Groningen, the Netherlands.
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Bérubé M, Verret M, Martorella G, Gagnon MA, Bourque L, Déry MP, Hudon A, Singer LN, Richard-Denis A, Ouellet S, Côté C, Gauthier L, Guénette L, Gagnon MP. Educational needs and preferences of adult patients with acute or chronic pain: a mixed methods systematic review protocol. JBI Evid Synth 2023; 21:2092-2098. [PMID: 37128807 DOI: 10.11124/jbies-22-00298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
OBJECTIVES This review will aim to synthesize the available quantitative and qualitative evidence on the educational needs and preferences of adult patients with acute or chronic pain. INTRODUCTION Acute and chronic pain are prevalent problems and are associated with significant individual and societal consequences. Education is a critical component of pain management. However, the impact of educational interventions on pain outcomes remains limited. The lack of patient input--what patients want to know and how they want to be informed--is one of the main issues underlying intervention design. INCLUSION CRITERIA We will include qualitative, quantitative, and mixed methods studies describing the educational needs and preferences of adult patients with acute or chronic pain. METHODS This review will follow the JBI guidelines for mixed methods systematic reviews. We will search MEDLINE (PubMed), Embase (Ovid), PsycINFO (Ovid), CINAHL (EBSCO), the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, and ProQuest Dissertations and Theses. The search strategy will commence from the year 1990 onward and there will be no language restrictions. The retrieved titles, abstracts, and full-text reports will be screened by pairs of independent reviewers. These pairs of reviewers will also independently extract data using the JBI tools for mixed methods systematic reviews. Methodological quality will be assessed using the mixed methods appraisal tool. A convergent integrated approach to synthesis and integration of the quantitative and qualitative data will be used. REVIEW REGISTRATION PROSPERO CRD42022303834.
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Affiliation(s)
- Mélanie Bérubé
- Population Health and Optimal Practices Research Unit Research Unit, Research Centre of the CHU de Québec-Université Laval, Quebec City, QC, Canada
- Faculty of Nursing, Université Laval, Quebec City, QC, Canada
| | - Michael Verret
- Faculty of Medicine, Clinical Epidemiology Program, University of Ottawa, Ottawa, ON, Canada
- Department of Anesthesiology and Critical Care Medicine, Université Laval, Quebec City, QC, Canada
| | - Géraldine Martorella
- College of Nursing, Florida State University, Tallahassee, FL, USA
- Department of Nursing, CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - Marc-Aurèle Gagnon
- Population Health and Optimal Practices Research Unit Research Unit, Research Centre of the CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - Laurence Bourque
- Population Health and Optimal Practices Research Unit Research Unit, Research Centre of the CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - Marie-Philippe Déry
- Department of Nursing, CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - Anne Hudon
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
- Centre de Recherche Interdisciplinaire en Réadaptation du Montréal Métropolitain, Montreal, QC, Canada
| | - Lesley Norris Singer
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Andréane Richard-Denis
- Department of Medicine, Université de Montréal, Montreal, QC, Canada
- Research Centre, Hôpital du Sacré-Cœur de Montréal, Montreal, QC, Canada
| | - Simon Ouellet
- Population Health and Optimal Practices Research Unit Research Unit, Research Centre of the CHU de Québec-Université Laval, Quebec City, QC, Canada
- Faculty of Nursing, Université Laval, Quebec City, QC, Canada
| | - Caroline Côté
- Population Health and Optimal Practices Research Unit Research Unit, Research Centre of the CHU de Québec-Université Laval, Quebec City, QC, Canada
- Faculty of Nursing, Université Laval, Quebec City, QC, Canada
| | - Lynn Gauthier
- Population Health and Optimal Practices Research Unit Research Unit, Research Centre of the CHU de Québec-Université Laval, Quebec City, QC, Canada
- Department of Family and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec City, QC, Canada
| | - Line Guénette
- Population Health and Optimal Practices Research Unit Research Unit, Research Centre of the CHU de Québec-Université Laval, Quebec City, QC, Canada
- Faculty of Pharmacy, Université Laval, Quebec City, QC, Canada
| | - Marie-Pierre Gagnon
- Faculty of Nursing, Université Laval, Quebec City, QC, Canada
- VITAM-Centre de recherche en santé durable, Université Laval, Quebec City, QC, Canada
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Abbasi-Perez A, Alvarez-Mon MA, Donat-Vargas C, Ortega MA, Monserrat J, Perez-Gomez A, Alvarez-Mon M. Using Twitter Data Analysis to Understand the Perceptions, Beliefs, and Attitudes about Pharmacotherapy Used in Rheumatology: An Observational Study. Healthcare (Basel) 2023; 11:1526. [PMID: 37297665 PMCID: PMC10252953 DOI: 10.3390/healthcare11111526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/18/2023] [Accepted: 05/20/2023] [Indexed: 06/12/2023] Open
Abstract
Twitter has become an important platform for disseminating information about rheumatology drugs by patients, health professionals, institutions, and other users. The aim of this study was to analyze tweets related to 16 drugs used in rheumatology, including their volume, content, and type of user (patients, patients' relatives, health professionals, health institutions, pharmaceutical industry, general press, scientific journals and patients' associations), and to detect inappropriate medical content. A total of 8829 original tweets were obtained, with a random sample of 25% of the total number of tweets for each drug (at least 100 tweets) analyzed. Methotrexate (MTX) accounted for a quarter of all tweets, and there were significant differences in the proportion of tweets issued according to the type of user. Patients and their relatives mainly tweeted about MTX, while professionals, institutions, and patient associations posted more about TNF inhibitors. In contrast, the pharmaceutical industry focused on IL-17 inhibitors. Medical content prevailed in all drugs except anti-CD20 and IL-1 inhibitors and the most discussed medical topic was efficacy, followed by posology and adverse effects. Inappropriate or fake content was found to be very low. In conclusion, the majority of the tweets were about MTX, which is a first-line treatment for several diseases. The distribution of medical content varied according to the type of user. In contrast to other studies, the amount of medically inappropriate content was very low.
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Affiliation(s)
- Adrian Abbasi-Perez
- Service of Internal Medicine, Rheumatology and Autoimmune Diseases, University Hospital “Príncipe de Asturias”, 28805 Alcala de Henares, Spain; (A.A.-P.); (A.P.-G.); (M.A.-M.)
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcala, 28805 Alcala de Henares, Spain; (M.A.O.); (J.M.)
| | - Miguel Angel Alvarez-Mon
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcala, 28805 Alcala de Henares, Spain; (M.A.O.); (J.M.)
- Institute Ramon y Cajal for Health Research (IRYCIS), 28034 Madrid, Spain
| | - Carolina Donat-Vargas
- Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institute, 17177 Stockholm, Sweden;
- IMDEA-Food Institute, Campus of International Excellence, Universidad Autónoma de Madrid, Consejo Superior de Investigaciones Científicas, 28049 Madrid, Spain
| | - Miguel A. Ortega
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcala, 28805 Alcala de Henares, Spain; (M.A.O.); (J.M.)
- Institute Ramon y Cajal for Health Research (IRYCIS), 28034 Madrid, Spain
| | - Jorge Monserrat
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcala, 28805 Alcala de Henares, Spain; (M.A.O.); (J.M.)
- Institute Ramon y Cajal for Health Research (IRYCIS), 28034 Madrid, Spain
| | - Ana Perez-Gomez
- Service of Internal Medicine, Rheumatology and Autoimmune Diseases, University Hospital “Príncipe de Asturias”, 28805 Alcala de Henares, Spain; (A.A.-P.); (A.P.-G.); (M.A.-M.)
| | - Melchor Alvarez-Mon
- Service of Internal Medicine, Rheumatology and Autoimmune Diseases, University Hospital “Príncipe de Asturias”, 28805 Alcala de Henares, Spain; (A.A.-P.); (A.P.-G.); (M.A.-M.)
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcala, 28805 Alcala de Henares, Spain; (M.A.O.); (J.M.)
- Institute Ramon y Cajal for Health Research (IRYCIS), 28034 Madrid, Spain
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Wilson TA, Hazlewood GS, Sajobi TT, Wilton SB, Pearson WE, Connolly C, Javaheri PA, Finlay JL, Levin A, Graham MM, Tonelli M, James MT. Preferences of Patients With Chronic Kidney Disease for Invasive Versus Conservative Treatment of Acute Coronary Syndrome: A Discrete Choice Experiment. J Am Heart Assoc 2023; 12:e028492. [PMID: 36892063 PMCID: PMC10111540 DOI: 10.1161/jaha.122.028492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
Background Patients with chronic kidney disease (CKD) can experience acute coronary syndromes (ACS) with high morbidity and mortality. Early invasive management of ACS is recommended for most high-risk patients; however, choosing between an early invasive versus conservative management approach may be influenced by the unique risk of kidney failure for patients with CKD. Methods and Results This discrete choice experiment measured the preferences of patients with CKD for future cardiovascular events versus acute kidney injury and kidney failure following invasive heart procedures for ACS. The discrete choice experiment, consisting of 8 choice tasks, was administered to adult patients attending 2 CKD clinics in Calgary, Alberta. The part-worth utilities of each attribute were determined using multinomial logit models, and preference heterogeneity was explored using latent class analysis. A total of 140 patients completed the discrete choice experiment. The mean age of patients was 64 years, 52% were male, and mean estimated glomerular filtration rate was 37 mL/min per 1.73 m2. Across the range of levels, risk of mortality was the most important attribute, followed by risk of end-stage kidney disease and risk of recurrent myocardial infarction. Latent class analysis identified 2 distinct preference groups. The largest group included 115 (83%) patients, who placed the greatest value on treatment benefits and expressed the strongest preference for reducing mortality. A second group of 25 (17%) patients was identified who were procedure averse and had a strong preference toward conservative management of ACS and avoiding acute kidney injury requiring dialysis. Conclusions The preferences of most patients with CKD for management of ACS were most influenced by lowering mortality. However, a distinct subgroup of patients was strongly averse to invasive management. This highlights the importance of clarifying patient preferences to ensure treatment decisions are aligned with patient values.
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Affiliation(s)
- Todd A Wilson
- Department of Medicine University of Calgary Calgary Alberta Canada
| | - Glen S Hazlewood
- Department of Medicine University of Calgary Calgary Alberta Canada
| | - Tolulope T Sajobi
- Department of Community Health Sciences University of Calgary Calgary Alberta Canada
| | - Stephen B Wilton
- Department of Community Health Sciences University of Calgary Calgary Alberta Canada
- Department of Cardiac Sciences University of Calgary Calgary Alberta Canada
| | - Winnie E Pearson
- Patient and Community Engagement Research Program, O'Brien Institute of Public Health University of Calgary Calgary Alberta Canada
| | - Carol Connolly
- Patient and Community Engagement Research Program, O'Brien Institute of Public Health University of Calgary Calgary Alberta Canada
| | | | - Juli L Finlay
- Department of Medicine University of Calgary Calgary Alberta Canada
| | - Adeera Levin
- Division of Nephrology University of British Columbia Vancouver British Columbia Canada
| | - Michelle M Graham
- Department of Medicine, Division of Cardiology University of Alberta Edmonton Alberta Canada
| | - Marcello Tonelli
- Department of Medicine University of Calgary Calgary Alberta Canada
| | - Matthew T James
- Department of Medicine University of Calgary Calgary Alberta Canada
- Department of Community Health Sciences University of Calgary Calgary Alberta Canada
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Wu M, Li Y, Ma C. Patients' choice preferences for specialist outpatient online consultations: A discrete choice experiment. Front Public Health 2023; 10:1075146. [PMID: 36684861 PMCID: PMC9850164 DOI: 10.3389/fpubh.2022.1075146] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 12/13/2022] [Indexed: 01/07/2023] Open
Abstract
Background Internet hospitals are multiplying with solid support from the Chinese government. In internet hospitals, specialist outpatient online consultations (SOOC) are the primary services. However, the acceptance and utilization rates of this service are still low. Thus, the study of patients' choice preferences for SOOC is needed. Objective To analyze the choice preference of patients' SOOC via a discrete choice experiment, understand the influence of each factor and promote the development of internet hospitals. Methods Via a discrete selection experiment, a total of 162 patients from two general hospitals and three specialized hospitals in Beijing were selected for the questionnaire survey. The choice preferences were analyzed by conditional logit regression. Results From high to low, patients' willingness to pay (WTP) for the attributes of SOOC is as follows: doctors' recommendation rate (β highly recommend = 0.999), the convenience of applying SOOC services (β Convenient = 0.760), the increasing ratio of medical insurance payment for online services compared to offline (β Increase by 10% = 0.545), and the disease's severity (β severe = -3.024). The results of the subgroup analysis showed differences in patient choice preference by age, whether the patients had chronic diseases, income, and medical insurance types. Conclusion Both price and nonprice attributes influence the choice preference of SOOC for patients. Among them, patients are more inclined to choose SOOC when doctors highly recommend it, when it is convenient to apply, when medical insurance increases by 10%, and when disease severity is mild. The current findings show the government and medical institutions formulate auxiliary policies and welfare strategies by clarifying core attributes and adjusting the levels of different attributes to improve patients' acceptance of SOOC. The utility of SOOC and the further development of internet hospitals are radically promoted.
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Affiliation(s)
- Mengqiu Wu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Laboratory of Genetics, Peking University Cancer Hospital and Institute, Beijing, China
| | - Yuhan Li
- School of Public Health, Capital Medical University, Beijing, China
| | - Chengyu Ma
- School of Public Health, Capital Medical University, Beijing, China
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Thomas M, Marshall DA, Choudhary D, Bartlett SJ, Sanchez AL, Hazlewood GS. The Application of Preference Elicitation Methods in Clinical Trial Design to Quantify Trade-Offs: A Scoping Review. THE PATIENT 2022; 15:423-434. [PMID: 34927216 DOI: 10.1007/s40271-021-00560-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/10/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND AND OBJECTIVE Patients can express preferences for different treatment options in a healthcare context, and these can be measured with quantitative preference elicitation methods. OBJECTIVE Our objective was to conduct a scoping review to determine how preference elicitation methods have been used in the design of clinical trials. METHODS We conducted a scoping review to identify primary research studies, involving any health condition, that used quantitative preference elicitation methods, including direct utility-based approaches, and stated preference studies, to value health trade-offs in the context of clinical trial design. Studies were identified by screening existing systematic and scoping reviews and with a primary literature search in MEDLINE from 2010 to the present. We extracted study characteristics and the application of preference elicitation methods to clinical trial design according to the SPIRIT checklist from primary studies and summarized the findings descriptively. RESULTS We identified 18 eligible studies. The included studies applied patient preferences to five areas of clinical trial design: intervention selection (n = 1), designing N-of-1 trials (n = 1), outcome selection and weighting composite and ordinal outcomes (n = 12), sample size calculations (n = 2), and recruitment (n = 2). Using preference elicitation methods led to different decisions being made, such as using preference-weighted composite outcomes instead of equally weighted composite outcomes. CONCLUSION Preference elicitation methods are infrequently used to design clinical trials but may lead to changes throughout the trial that could affect the evidence generated. Future work should consider measurement challenges and explore stakeholder perceptions.
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Affiliation(s)
- Megan Thomas
- Department of Community Health Sciences, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
| | - Deborah A Marshall
- Department of Community Health Sciences, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Daksh Choudhary
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Susan J Bartlett
- Department of Medicine, McGill University, Montreal, QC, Canada
- Centre for Outcomes Research & Evaluation, Research Institute McGill University Health Centre, Montreal, QC, Canada
| | - Adalberto Loyola Sanchez
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Glen S Hazlewood
- Department of Community Health Sciences, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada.
- Department of Medicine, University of Calgary, Calgary, AB, Canada.
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Seghers PAL(N, Wiersma A, Festen S, Stegmann ME, Soubeyran P, Rostoft S, O’Hanlon S, Portielje JEA, Hamaker ME. Patient Preferences for Treatment Outcomes in Oncology with a Focus on the Older Patient-A Systematic Review. Cancers (Basel) 2022; 14:cancers14051147. [PMID: 35267455 PMCID: PMC8909757 DOI: 10.3390/cancers14051147] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/16/2022] [Accepted: 02/18/2022] [Indexed: 01/27/2023] Open
Abstract
Simple Summary In oncology, treatment outcomes can be competing, which means that one treatment could benefit one outcome, like survival, and negatively influence another, like independence. The choice of treatment therefore depends on the patient’s preference for outcomes, which needs to be assessed explicitly. Especially in older patients, patient preferences are important. Our systematic review summarizes all studies that assessed patient preferences for various treatment outcome categories. A total of 28 studies with 4374 patients were included, of which only six studies included mostly older patients. Although quality of life was only included in half of the studies, overall quality of life (79%) was most frequently prioritized as highest or second highest, followed by overall survival (67%), progression- and disease-free survival (56%), absence of severe or persistent treatment side effects (54%), treatment response (50%), and absence of transient short-term side effects (16%). In shared decision-making, these results can be used by healthcare professionals to better tailor the information provision and treatment recommendations to the individual patient. Abstract For physicians, it is important to know which treatment outcomes are prioritized overall by older patients with cancer, since this will help them to tailor the amount of information and treatment recommendations. Older patients might prioritize other outcomes than younger patients. Our objective is to summarize which outcomes matter most to older patients with cancer. A systematic review was conducted, in which we searched Embase and Medline on 22 December 2020. Studies were eligible if they reported some form of prioritization of outcome categories relative to each other in patients with all types of cancer and if they included at least three outcome categories. Subsequently, for each study, the highest or second-highest outcome category was identified and presented in relation to the number of studies that included that outcome category. An adapted Newcastle–Ottawa Scale was used to assess the risk of bias. In total, 4374 patients were asked for their priorities in 28 studies that were included. Only six of these studies had a population with a median age above 70. Of all the studies, 79% identified quality of life as the highest or second-highest priority, followed by overall survival (67%), progression- and disease-free survival (56%), absence of severe or persistent treatment side effects (54%), and treatment response (50%). Absence of transient short-term side effects was prioritized in 16%. The studies were heterogeneous considering age, cancer type, and treatment settings. Overall, quality of life, overall survival, progression- and disease-free survival, and severe and persistent side effects of treatment are the outcomes that receive the highest priority on a group level when patients with cancer need to make trade-offs in oncologic treatment decisions.
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Affiliation(s)
| | - Anke Wiersma
- Department of Internal Medicine, Diakonessenhuis, 3582 KE Utrecht, The Netherlands;
| | - Suzanne Festen
- University Center for Geriatric Medicine, University Medical Hospital Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands;
| | - Mariken E. Stegmann
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands;
| | - Pierre Soubeyran
- Department of Oncology, Institut Bergonié, Université de Bordeaux, 33076 Bordeaux, France;
| | - Siri Rostoft
- Department of Geriatric Medicine, Oslo University Hospital, 0424 Oslo, Norway;
- Institute of Clinical Medicine, University of Oslo, 0318 Oslo, Norway
| | - Shane O’Hanlon
- Department of Geriatric Medicine, St. Vincent’s University Hospital, D04 T6F4 Dublin, Ireland;
- School of Medicine, University College Dublin, D04 V1W8 Dublin, Ireland
| | - Johanneke E. A. Portielje
- Department of Medical Oncology, Leiden University Medical Center-LUMC, 2333 ZA Leiden, The Netherlands;
| | - Marije E. Hamaker
- Department of Geriatric Medicine, Diakonessenhuis, 3582 KE Utrecht, The Netherlands
- Correspondence: (P.A.L.S.); (M.E.H.)
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Asiago-Reddy EA, McPeak J, Scarpa R, Braksmajer A, Ruszkowski N, McMahon J, London AS. Perceived access to PrEP as a critical step in engagement: A qualitative analysis and discrete choice experiment among young men who have sex with men. PLoS One 2022; 17:e0258530. [PMID: 35081116 PMCID: PMC8791519 DOI: 10.1371/journal.pone.0258530] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 09/29/2021] [Indexed: 11/24/2022] Open
Abstract
Young Men who have Sex with Men (MSM) continue to face disproportionate HIV risk. Despite its well accepted role in HIV prevention, pre-exposure prophylaxis (PrEP) uptake remains below desired goals. Systemic barriers to PrEP access, including insurance complexity, cost, and wait times to start PrEP may contribute to low PrEP engagement. We conducted in-depth interviews and designed a discrete choice experiment (DCE) to assess preferences for and barriers to PrEP access in the United States. Methods: We conducted in-depth interviews with 18 MSM aged 18–30 years old who were not on PrEP and created a DCE based on the results. For the DCE, a convenience sample of young MSM in the United States who reported recent condomless anal sex was recruited through social media applications. Consenting participants provided sociodemographic information and responded to a series of 10 choice tasks about PrEP access. Preferences were analyzed utilizing marginal willingness-to-pay (mWTP) methods. Results: In-depth interviews revealed preferences for highly effective PrEP and concerns about barriers to access due to insurance coverage and privacy. The online DCE was completed by 236 eligible MSM aged 18–30. The most-preferred PrEP package—with all elements significantly preferred over other options—was insurance covered, could be maintained confidential from parents and employers, was available immediately, and had an online option. Need to take out new insurance or add a supplemental insurance in order to cover PrEP significantly detracted from willingness to pay for a PrEP program. Attributes most associated with willingness to pay for PrEP were PrEP being covered by an insurance the client already has and insurance coverage that was private. Conclusions: Young MSM at high risk for HIV in the United States who are not currently on PrEP showed strong preferences for PrEP options that were covered by insurance and could be kept confidential from parents and employers. Lack of these options may present major barriers to PrEP access among young MSM who are at particularly high risk. Rapid access to PrEP, as well as the option of receiving some care online, may also enhance PrEP uptake.
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Affiliation(s)
- Elizabeth A. Asiago-Reddy
- Division of Infectious Disease, Department of Medicine, SUNY Upstate Medical University Hospital, Syracuse, New York, United States of America
- * E-mail:
| | - John McPeak
- Maxwell School of Citizenship and Public Affairs, Syracuse University, Syracuse, New York, United States of America
| | - Riccardo Scarpa
- Waikato Management School, University of Waikato, Waikato, New Zealand
| | - Amy Braksmajer
- Department of Sociology, SUNY Geneseo, Geneseo, New York, United States of America
| | - Nicola Ruszkowski
- Division of Infectious Disease, Department of Pediatrics, SUNY Upstate Medical University Hospital, Syracuse, New York, United States of America
| | - James McMahon
- University of Rochester School of Nursing, Rochester, New York, United States of America
| | - Andrew S. London
- Maxwell School of Citizenship and Public Affairs, Syracuse University, Syracuse, New York, United States of America
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12
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Functional capacity vs side effects: treatment attributes to consider when individualising treatment for patients with rheumatoid arthritis. Clin Rheumatol 2021; 41:695-704. [PMID: 34655004 PMCID: PMC8873051 DOI: 10.1007/s10067-021-05961-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 10/06/2021] [Accepted: 10/07/2021] [Indexed: 12/21/2022]
Abstract
Introduction Individualisation of rheumatoid arthritis (RA) treatment needs to take account of individual patients’ preferences to increase patient-centeredness in treatment decisions. The aim of this study was to identify patient-relevant treatment attributes to consider when individualising treatment for patients with RA. Method Patients with RA in Sweden were invited to rank the most important treatment attributes in an online survey (April to May 2020). Semi-structured interviews were conducted (October to November 2020) to further identify and frame potential attributes for shared decision-making. The interviews were audio-recorded, transcribed and analysed using thematic framework analysis. Patient research partners and rheumatologists supported the selection and framing of the treatment attributes across the assessment. Results The highest ranked attributes (N = 184) were improved functional capacity, reduced inflammation, reduced pain and fatigue and the risk of getting a severe side effect. The framework analysis revealed two overarching themes for further exploration: treatment goals and side effects. ‘Treatment goals’ emerged from functional capacity, revealing two dimensions: physical functional capacity and psychosocial functional capacity. ‘Side effects’ revealed that mild and severe side effects were the most important to discuss in shared decision-making. Conclusions Functional capacity (physical and psychosocial) and potential side effects (mild and severe) are important treatment attributes to consider when individualising RA treatment. Future research should assess how patients with RA weigh benefits and risks against each other, in order to increase patient-centeredness early on the treatment trajectory.
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13
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Discrete Choice Experiments to Elicit Patient Preferences for Decision Making in Transplantation. Transplantation 2021; 105:960-967. [PMID: 33093407 DOI: 10.1097/tp.0000000000003500] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Providing care for transplant recipients is challenging given the need to maintain optimal graft function and survival while managing the debilitating side effects and complications associated with immunosuppression including infection, cancer, new-onset diabetes mellitus, and cardiovascular disease. Given the complexity of treatment options and the uncertainty about long-term benefits and harms of treatment, understanding patient preferences and values are key to ensuring that clinical decisions take into consideration patient priorities to support shared decision making and self-management. Choice experiments are increasingly used to quantify patient and community preferences, including in the field of transplantation. Discrete choice experiments (DCEs) are a well-established, validated methodology used to elicit preferences for decision making in health and other settings. In transplantation, for example, DCEs have been used to elicit patient preferences for outcomes following kidney transplantation, to identify community preferences factors for organ allocation and in establishing core outcomes. This article provides an overview of the concepts and methods used in the design of DCEs and how patients' preferences can be applied in shared decision making in transplantation.
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Katz N, Dworkin RH, North R, Thomson S, Eldabe S, Hayek SM, Kopell BH, Markman J, Rezai A, Taylor RS, Turk DC, Buchser E, Fields H, Fiore G, Ferguson M, Gewandter J, Hilker C, Jain R, Leitner A, Loeser J, McNicol E, Nurmikko T, Shipley J, Singh R, Trescot A, van Dongen R, Venkatesan L. Research design considerations for randomized controlled trials of spinal cord stimulation for pain: Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials/Institute of Neuromodulation/International Neuromodulation Society recommendations. Pain 2021; 162:1935-1956. [PMID: 33470748 PMCID: PMC8208090 DOI: 10.1097/j.pain.0000000000002204] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 12/10/2020] [Accepted: 12/15/2020] [Indexed: 12/17/2022]
Abstract
ABSTRACT Spinal cord stimulation (SCS) is an interventional nonpharmacologic treatment used for chronic pain and other indications. Methods for evaluating the safety and efficacy of SCS have evolved from uncontrolled and retrospective studies to prospective randomized controlled trials (RCTs). Although randomization overcomes certain types of bias, additional challenges to the validity of RCTs of SCS include blinding, choice of control groups, nonspecific effects of treatment variables (eg, paresthesia, device programming and recharging, psychological support, and rehabilitative techniques), and safety considerations. To address these challenges, 3 professional societies (Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials, Institute of Neuromodulation, and International Neuromodulation Society) convened a meeting to develop consensus recommendations on the design, conduct, analysis, and interpretation of RCTs of SCS for chronic pain. This article summarizes the results of this meeting. Highlights of our recommendations include disclosing all funding source and potential conflicts; incorporating mechanistic objectives when possible; avoiding noninferiority designs without internal demonstration of assay sensitivity; achieving and documenting double-blinding whenever possible; documenting investigator and site experience; keeping all information provided to patients balanced with respect to expectation of benefit; disclosing all information provided to patients, including verbal scripts; using placebo/sham controls when possible; capturing a complete set of outcome assessments; accounting for ancillary pharmacologic and nonpharmacologic treatments in a clear manner; providing a complete description of intended and actual programming interactions; making a prospective ascertainment of SCS-specific safety outcomes; training patients and researchers on appropriate expectations, outcome assessments, and other key aspects of study performance; and providing transparent and complete reporting of results according to applicable reporting guidelines.
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Affiliation(s)
- Nathaniel Katz
- Corresponding author. Address: WCG Analgesic Solutions, Wayland, MA, USA. Tel.: 1-617-948-5161. E-mail address: (N. Katz)
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15
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Hazlewood GS, Loyola-Sanchez A, Bykerk V, Hull PM, Marshall D, Pham T, Barber CEH, Barnabe C, Sirois A, Pope J, Schieir O, Richards D, Proulx L, Bartlett SJ. Patient and Rheumatologist Perspectives on Tapering DMARDs in Rheumatoid Arthritis: A Qualitative Study. Rheumatology (Oxford) 2021; 61:606-616. [PMID: 33878168 DOI: 10.1093/rheumatology/keab330] [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] [Received: 11/09/2020] [Revised: 03/06/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To understand the perspectives of patients and rheumatologists for tapering DMARDs in RA. METHODS Using semi-structured interview guides, we conducted individual interviews and focus groups with RA patients and rheumatologists, which were audiotaped and transcribed. We conducted a pragmatic thematic analysis to identify major themes, comparing and contrasting different views on DMARD tapering between patients and rheumatologists. RESULTS We recruited 28 adult patients with RA (64% women; disease duration 1-54 years) and 23 rheumatologists (52% women). Attitudes across both groups towards tapering DMARDs were ambivalent, ranging from wary to enthusiastic. Both groups expressed concerns, particularly the inability to 'recapture' the same level of disease control, while also acknowledging potential positive outcomes such as reduced drug harms. Patient tapering perspectives (whether to and when) changed over time and commonly included non-biologic DMARDs. Patient preferences were influenced by lived experiences, side effects, previous tapering experiences, disease trajectory, remission duration, and current life roles. Rheumatologists' perspectives varied on timing and patient profile to initiate tapering, and were informed by both data and clinical experience. Patients expressed interest in shared decision making (SDM) and close monitoring during tapering, with ready access to their healthcare team if problems arose. Rheumatologists were generally open to tapering (not stopping), though sometimes only when requested by their patients. CONCLUSION The perspectives of patients and rheumatologists on tapering DMARDs in RA vary and evolve over time. Rheumatologists should periodically discuss DMARD tapering with patients as part of SDM, and ensure monitoring and flare management plans are in place.
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Affiliation(s)
- Glen S Hazlewood
- Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Arthritis Research Canada, Richmond, BC, Canada.,McCaig Institute for Bone and Joint Health, Calgary, Canada
| | - Adalberto Loyola-Sanchez
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Vivian Bykerk
- Hospital for Special Surgery, Weill Cornell Medical College, New York New York, USA
| | - Pauline M Hull
- Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Deborah Marshall
- Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Arthritis Research Canada, Richmond, BC, Canada.,McCaig Institute for Bone and Joint Health, Calgary, Canada
| | - Tram Pham
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Claire E H Barber
- Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Arthritis Research Canada, Richmond, BC, Canada.,McCaig Institute for Bone and Joint Health, Calgary, Canada
| | - Cheryl Barnabe
- Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Arthritis Research Canada, Richmond, BC, Canada.,McCaig Institute for Bone and Joint Health, Calgary, Canada
| | - Alexandra Sirois
- Faculty of Graduate Studies, McGill University, Montreal, Quebec, Canada
| | - Janet Pope
- St. Joseph's Health Care London, University of Western Ontario, London, Ontario, Canada
| | - Orit Schieir
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Dawn Richards
- Canadian Arthritis Patient Alliance, Toronto, Ontario, Canada
| | - Laurie Proulx
- Canadian Arthritis Patient Alliance, Toronto, Ontario, Canada
| | - Susan J Bartlett
- Division of Clinical Epidemiology, Department of Medicine, McGill University and Centre for Outcomes Research and Evaluation, Research Institute-McGill University Health Centre, Montreal, Quebec, Canada
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16
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Wilson T, Javaheri P, Finlay J, Hazlewood G, Wilton SB, Sajobi T, Levin A, Pearson W, Connolly C, James MT. Treatment Preferences for Cardiac Procedures of Patients With Chronic Kidney Disease in Acute Coronary Syndrome: Design and Pilot Testing of a Discrete Choice Experiment. Can J Kidney Health Dis 2021; 8:2054358120985375. [PMID: 33552527 PMCID: PMC7844446 DOI: 10.1177/2054358120985375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 11/27/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Chronic kidney disease is associated with a high incidence of acute coronary syndrome and related morbidity and mortality. Treatment choices for patients with chronic kidney disease involve trade-offs in the potential benefits and harms of invasive management options. OBJECTIVE The objective was to quantify preferences of patients with chronic kidney disease toward invasive heart procedures. DESIGN Design and pilot a discrete choice experiment. SETTING We piloted the discrete choice experiment in 2 multidisciplinary chronic kidney disease clinics in Calgary, Alberta, using an 8-question survey. PATIENTS Eligible patients included those aged 18 years and older, an estimated glomerular filtration rate < 45 mL/min/1.73 m2, not currently receiving dialysis, and able to communicate in English. MEASUREMENTS Quantification of the average importances of key attributes of invasive heart procedures. METHODS We identified attributes most important to patients and physicians concerning invasive versus conservative management for acute coronary syndrome, using semi-structured qualitative interviews. Levels for each attribute were derived from analysis of early invasive versus conservative acute coronary syndrome management clinical trials and cohort studies, where subgroups of patients with chronic kidney disease were reported. We designed the pilot study with patient partners with relevant lived experience and considered statistical efficiency to estimate main effects and interactions, as well as response efficiency. Hierarchical Bayesian estimation was used to quantify average importances of attributes. RESULTS We recruited 43 patients with chronic kidney disease, mean (SD) age 67 (14) years, 67% male, and 35% with a history of cardiovascular disease, of whom 39 completed the survey within 2 weeks of enrollment. The results of the pilot revealed acute kidney injury requiring dialysis and permanent kidney replacement therapy, as well as death within 1 year were the most important attributes. Measures of internal validity for the pilot discrete choice experiment were comparable to those for other published discrete choice experiments. LIMITATIONS Discrete choice experiments are complex instruments and often cognitively demanding for patients. This survey included multiple risk attributes which may have been challenging for some patients to understand. CONCLUSIONS This pilot study demonstrates the feasibility of a discrete choice experiment to quantify preferences of patients with chronic kidney disease toward the benefits and trade-offs related to invasive versus conservative management for acute coronary syndrome. These preliminary findings suggest that patients with chronic kidney disease may be on average similarly risk averse toward kidney replacement therapy and death. This pilot information will be used to inform a larger discrete choice experiment that will refine these estimates of patient preferences and characterize subgroups with distinct treatment preferences, which should provide new knowledge that can facilitate shared decision-making between patients with chronic kidney disease and their care providers in the setting of acute coronary syndrome.
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Affiliation(s)
- T. Wilson
- Department of Community Health Sciences, University of Calgary, AB, Canada
| | - P. Javaheri
- Department of Medicine, University of Calgary, AB, Canada
| | - J. Finlay
- Department of Medicine, University of Calgary, AB, Canada
| | - G. Hazlewood
- Department of Medicine, University of Calgary, AB, Canada
| | - S. B. Wilton
- Department of Cardiac Sciences, University of Calgary, AB, Canada
| | - T. Sajobi
- Department of Community Health Sciences, University of Calgary, AB, Canada
| | - A. Levin
- Division of Nephrology, The University of British Columbia, Vancouver, Canada
| | - W. Pearson
- Patient and Community Engagement Research Program, O’Brien Institute of Public Health, University of Calgary, AB, Canada
| | - C. Connolly
- Department of Cardiac Sciences, University of Calgary, AB, Canada
| | - M. T. James
- Department of Medicine, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, AB, Canada
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Tünneßen M, Hiligsmann M, Stock S, Vennedey V. Patients' preferences for the treatment of anxiety and depressive disorders: a systematic review of discrete choice experiments. J Med Econ 2020; 23:546-556. [PMID: 32011209 DOI: 10.1080/13696998.2020.1725022] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Introduction: Matching available mental health services to patients' preferences, as well as is possible, may increase patient satisfaction and help increase adherence to certain treatments. This study systematically reviewed discrete-choice experiments (DCEs) on patients' preferences for treatment of depressive and anxiety disorders and assessed the relative importance of outcome, process and cost attributes to improve the current and future treatment situations.Methods: A systematic literature review using PubMed, EMBASE and PsychInfo was conducted to retrieve all relevant DCEs published up to 15 April 2019, eliciting patient preferences for treatment of depressive and anxiety disorders. Data were extracted using an extraction sheet, and attributes were classified into outcome, process and cost attributes. The relative importance of each attribute category was then assessed, and studies were evaluated according to their reporting quality, using validated checklists.Results: A total of 11 studies were identified for qualitative analysis. All studies received an aggregate score of 4 on the five-point PREFS checklist (Purpose, Respondents, Explanation, Findings and Significance). Most attributes were outcome related (52%), followed by process (42%) and cost (6%) attributes. Comparing the attribute categories and summing up the relative importance weights for each category within the studies, process attributes were ranked as most important, followed by cost and outcome attributes.Conclusions: In this systematic review, heterogeneous results were observed regarding the inclusion and framing of different attributes across studies. Overall, patients considered process and cost attributes to be more important than outcome attributes. Outcomes and process are important for patients, and thus clinicians should be particularly aware of this and take patients' preferences into account, although the attribute importance may depend on chosen attributes and related levels.
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Affiliation(s)
- Maike Tünneßen
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Mickaël Hiligsmann
- Department of Health Services Research, CAPHRI - Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Stephanie Stock
- Institute of Health Economics and Clinical Epidemiology, University of Cologne, Cologne, Germany
| | - Vera Vennedey
- Institute of Health Economics and Clinical Epidemiology, University of Cologne, Cologne, Germany
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Abstract
PURPOSE OF REVIEW To provide an overview of recent articles discussing patient preferences for rheumatoid arthritis (RA) treatment. RECENT FINDINGS Recent studies examined patient preferences for RA treatment in several populations, finding that most participants were willing to accept certain risks of adverse effects to gain potential benefits. Perspectives regarding cannabis were studied, with patients describing medical marijuana as an alternative therapy to be used with prescription medications or as means of tapering off these medications. Treatment preferences for different RA therapies were explored using a conjoint analysis survey and five distinct preference phenotypes emerged, with members of the largest group most concerned with the cost of medications. Other discrete choice studies demonstrated route of administration as an important attribute influencing treatment preferences, with patients expressing preference for various modes in different studies. Patient preferences for route of administration have demonstrated preference for newer autoinjectors over prefilled syringes as well as currently marketed autoinjectors. Incorporating patient preferences in clinical practice recommendations was described in the development of the 2015 American College of Rheumatology (ACR) RA treatment guidelines as well as the 2017 ACR/American Association of Hip and Knee Surgeons guidelines for perioperative management of antirheumatic medications. In addition, other studies explored preferences with regard to predictive testing, medication intensification and tapering, treatment goals, and psychological support. SUMMARY Our review of recent studies show variability in patient preferences for RA treatment, highlighting the importance of incorporating patient input into the treatment approach.
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Conrad K, Shoenfeld Y, Fritzler MJ. Precision health: A pragmatic approach to understanding and addressing key factors in autoimmune diseases. Autoimmun Rev 2020; 19:102508. [PMID: 32173518 DOI: 10.1016/j.autrev.2020.102508] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 11/06/2019] [Indexed: 02/07/2023]
Abstract
The past decade has witnessed a significant paradigm shift in the clinical approach to autoimmune diseases, lead primarily by initiatives in precision medicine, precision health and precision public health initiatives. An understanding and pragmatic implementation of these approaches require an understanding of the drivers, gaps and limitations of precision medicine. Gaining the trust of the public and patients is paramount but understanding that technologies such as artificial intelligences and machine learning still require context that can only be provided by human input or what is called augmented machine learning. The role of genomics, the microbiome and proteomics, such as autoantibody testing, requires continuing refinement through research and pragmatic approaches to their use in applied precision medicine.
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Affiliation(s)
- Karsten Conrad
- Institute of Immunology, Medical Faculty "Carl Gustav Carus", Technical University of Dresden, Dresden, Germany
| | - Yehuda Shoenfeld
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel; Department of Medicine, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Marvin J Fritzler
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
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20
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Hazlewood GS, Pokharel G, Deardon R, Marshall DA, Bombardier C, Tomlinson G, Ma C, Seow CH, Panaccione R, Kaplan GG. Patient preferences for maintenance therapy in Crohn's disease: A discrete-choice experiment. PLoS One 2020; 15:e0227635. [PMID: 31945089 PMCID: PMC6964885 DOI: 10.1371/journal.pone.0227635] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 12/24/2019] [Indexed: 12/30/2022] Open
Abstract
Objective To quantify patient preferences for maintenance therapy of Crohn’s disease and understand the impact on treatment selection. Methods We conducted a discrete-choice experiment in patients with Crohn’s disease (n = 155) to measure the importance of attributes relevant to choosing between different medical therapies for maintenance of Crohn’s disease. The attributes included efficacy and withdrawals due to adverse events, as well as dosing and other rare risks of treatment. From the discrete-choice experiment we estimated the part-worth (importance) of each attribute level, and explored preference heterogeneity through latent class analysis. We then used the part-worths to apply weights across each outcome from a prior network meta-analysis to estimate patients’ preferred treatment in pairwise comparisons and for the overall group of treatments. Results The discrete-choice experiment revealed that maintaining remission was the most important attribute. Patients would accept a rare risk of infection or cancer for a 14% absolute increased chance of remission. Latent class analysis demonstrated that 45% of the cohort was risk averse, either to adverse events or requiring a course of prednisone. When these preferences were used in modelling studies to compare pairs of treatments, there was a ≥ 78% probability that all biologic treatments were preferred to azathioprine and methotrexate, based on the balance of benefits and harms. When comparing all treatments, adalimumab was preferred by 53% of patients, who were motivated by efficacy, and vedolizumab was preferred by 30% who were driven by the preference to avoid risks. However, amongst biologic treatment options, there was considerable uncertainty regarding the preferred treatment at the individual patient level. Conclusion Patients with Crohn’s disease from our population were, on average, focused on the benefits of treatment, supporting intensive treatment approaches aimed at maintaining remission. Important preference heterogeneity was identified, however, highlighting the importance of shared decision making when selecting treatments.
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Affiliation(s)
- Glen S. Hazlewood
- Department of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- * E-mail: (GK); (GH)
| | - Gyanendra Pokharel
- Department of Mathematics and Statistics, University of Calgary, Calgary, Alberta, Canada
| | - Robert Deardon
- Department of Mathematics and Statistics, University of Calgary, Calgary, Alberta, Canada
- Department of Production of Animal Health, Faculty of Veterinary Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Deborah A. Marshall
- Department of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Claire Bombardier
- Department of Medicine and Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada
| | - George Tomlinson
- Department of Medicine and Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Christopher Ma
- Inflammatory Bowel Disease Unit, Division of Gastroenterology and Hepatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Cynthia H. Seow
- Department of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Remo Panaccione
- Inflammatory Bowel Disease Unit, Division of Gastroenterology and Hepatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Gilaad G. Kaplan
- Department of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Inflammatory Bowel Disease Unit, Division of Gastroenterology and Hepatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- * E-mail: (GK); (GH)
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Durand C, Eldoma M, Marshall DA, Bansback N, Hazlewood GS. Patient Preferences for Disease-modifying Antirheumatic Drug Treatment in Rheumatoid Arthritis: A Systematic Review. J Rheumatol 2019; 47:176-187. [DOI: 10.3899/jrheum.181165] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2019] [Indexed: 11/22/2022]
Abstract
Objective.To summarize patients’ preferences for disease-modifying antirheumatic drug (DMARD) therapy in rheumatoid arthritis (RA).Methods.We conducted a systematic review to identify English-language studies of adult patients with RA that measured patients’ preferences for DMARD or health states and treatment outcomes relevant to DMARD decisions. Study quality was assessed using a published quality assessment tool. Data on the importance of treatment attributes and associations with patient characteristics were summarized across studies.Results.From 7951 abstracts, we included 36 studies from a variety of countries. Most studies were in patients with established RA and were rated as medium- (n = 19) or high-quality (n = 12). The methods to elicit preferences varied, with the most common being discrete choice experiment (DCE; n = 13). Despite the heterogeneity of attributes in DCE studies, treatment benefits (disease improvement) were usually more important than both non-serious (6 of 8 studies) and serious adverse events (5 of 8), and route of administration (7 of 9). Among the non-DCE studies, some found that patients placed high importance on treatment benefits, while others (in patients with established RA) found that patients were quite risk averse. Subcutaneous therapy was often but not always preferred over intravenous therapy. Patient preferences were variable and commonly associated with the sociodemographic characteristics.Conclusion.Overall, the results showed that many patients place a high value on treatment benefits over other treatment attributes, including serious or minor side effects, cost, or route of administration. The variability in patient preferences highlights the need to individualize treatment choices in RA.
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