1
|
Upton M, Reddy N, Aker M, James K, Wang M, Mendelsohn AH. Laryngeal cancer treatment decision making: A conjoint analysis of general public attitudes and priorities. Laryngoscope Investig Otolaryngol 2023; 8:886-894. [PMID: 37621286 PMCID: PMC10446275 DOI: 10.1002/lio2.1103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 05/09/2023] [Accepted: 06/08/2023] [Indexed: 08/26/2023] Open
Abstract
Objective Patients with advanced laryngeal cancer are typically presented with divergent treatment options, namely chemoradiation versus total laryngectomy. This study aims to understand general perspectives of the factors involved in this decision-making process. Methods Surveys were constructed using specialized conjoint analysis software. Seven attributes integral to the decision-making process for advanced laryngeal cancer treatment were included. Results Three hundred one healthy adult volunteers completed the decision-making program. The relative impact of each treatment attribute on decision making across all participants was scored with an average importance score (standard deviation) as follows: Lifespan 22.2% (±8.5), Voicing 21.4% (±5.9), Swallowing 19.1% (±7.3), Cancer Cure 14.9% (±6.2), Mode of Breathing 11.0% (±3.7), Self-Image 6.7% (±2.9), and Treatment Type 4.8% (±3.0). Conclusions General public opinion ranked lifespan, voicing, and swallowing aspects as similarly important, and all were ranked more important than probability of cure. These data demonstrate a variety of priorities among participants and the need for tailored discussions when determining treatment choice for advanced laryngeal cancer. Level of Evidence Level 4.
Collapse
Affiliation(s)
- Montana Upton
- Department of Otolaryngology—Head and Neck SurgeryVanderbilt UniversityNashvilleTennesseeUSA
| | - Neha Reddy
- UCLA Department of Head and Neck SurgeryLos AngelesCaliforniaUSA
| | - Mamdouh Aker
- UCLA Department of Head and Neck SurgeryLos AngelesCaliforniaUSA
| | - Kevin James
- UCLA Department of Head and Neck SurgeryLos AngelesCaliforniaUSA
| | - Marilene Wang
- UCLA Department of Head and Neck SurgeryLos AngelesCaliforniaUSA
| | | |
Collapse
|
2
|
Chang DH, Wang YH, Hsieh CY, Chang CW, Chang KC, Chen YS. Incorporating Patient Preferences into a Decision-Making Model of Hand Trauma Reconstruction. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111081. [PMID: 34769601 PMCID: PMC8582850 DOI: 10.3390/ijerph182111081] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 10/12/2021] [Accepted: 10/16/2021] [Indexed: 11/24/2022]
Abstract
Background: Few studies have addressed patient preferences in emergent surgical decision making. Aim of the study: Analyzing patient preferences for hand trauma reconstruction to propose a decision-making model. Methods: A conjoint analysis survey was developed with Sawtooth Software. Three common flaps—i.e., a cross-finger flap (CFF), a dorsal metacarpal artery perforator flap (DMAPF), and an arterialized venous flap (AVF)—were listed as treatment alternatives. Five attributes corresponding to these flaps were recovery time, total procedure, postoperative care methods, postoperative scar condition, and complication rate. Utility and importance scores were generated from the software, and preference characteristics were evaluated using cluster analysis. Results: The survey was completed by 197 participants with hand trauma. Complication risk received the highest importance score (42.87%), followed by scar condition (21.55%). Cluster analysis classified the participants as “conservative,” “practical,” and “dual-concern”. The dual-concern and conservative groups had more foreign laborers and highly educated participants, respectively, than the other groups. Most participants in the conservative and practical groups preferred DMAPF, whereas those in the dual-concern group favored CFF. Our proposed model consisted of shared decision-making and treatment recommendation pathways. Conclusion: Incorporating patient preferences into the decision-making model can strengthen patient-centered care. Further research on the applications of the proposed model is warranted.
Collapse
Affiliation(s)
- Dun-Hao Chang
- Division of Plastic and Aesthetic Surgery, Department of Surgery, Far Eastern Memorial Hospital, No. 21, Section 2, Nanya S. Road, Banciao District, New Taipei City 22060, Taiwan; (D.-H.C.); (C.-Y.H.); (C.-W.C.); (K.-C.C.)
- Department of Information Management, Yuan Ze University, No. 135 Yuan-Tung Road, Chung-Li, Taoyuan City 32003, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, No. 155, Section 2, Linong Street, Taipei 11221, Taiwan
| | - Yu-Hsiang Wang
- Department of Surgery, Chung Shan Medical University Hospital, No. 110, Section 1, Jianguo North Road, Taichung City 40201, Taiwan;
| | - Chi-Ying Hsieh
- Division of Plastic and Aesthetic Surgery, Department of Surgery, Far Eastern Memorial Hospital, No. 21, Section 2, Nanya S. Road, Banciao District, New Taipei City 22060, Taiwan; (D.-H.C.); (C.-Y.H.); (C.-W.C.); (K.-C.C.)
| | - Che-Wei Chang
- Division of Plastic and Aesthetic Surgery, Department of Surgery, Far Eastern Memorial Hospital, No. 21, Section 2, Nanya S. Road, Banciao District, New Taipei City 22060, Taiwan; (D.-H.C.); (C.-Y.H.); (C.-W.C.); (K.-C.C.)
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, No. 1, Section 4, Roosevelt Road, Taipei 10617, Taiwan
| | - Ke-Chung Chang
- Division of Plastic and Aesthetic Surgery, Department of Surgery, Far Eastern Memorial Hospital, No. 21, Section 2, Nanya S. Road, Banciao District, New Taipei City 22060, Taiwan; (D.-H.C.); (C.-Y.H.); (C.-W.C.); (K.-C.C.)
| | - Yo-Shen Chen
- Division of Plastic and Aesthetic Surgery, Department of Surgery, Far Eastern Memorial Hospital, No. 21, Section 2, Nanya S. Road, Banciao District, New Taipei City 22060, Taiwan; (D.-H.C.); (C.-Y.H.); (C.-W.C.); (K.-C.C.)
- School of Medicine, National Taiwan University, No. 1, Section 4, Roosevelt Road, Taipei 10617, Taiwan
- Correspondence: ; Tel.: +886-2-8966-7000
| |
Collapse
|
3
|
[Definition of the quality of hand surgery]. Chirurg 2021; 92:891-896. [PMID: 34228146 DOI: 10.1007/s00104-021-01455-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2021] [Indexed: 10/20/2022]
Abstract
The quality of treatment within the total concept of the healthcare system is subject to multifactorial influences. With the intention to improve the quality of hand surgery the German Society for Hand Surgery (DGH) has initiated a number of projects. These include the S3 guidelines codeveloped by the DGH, the hand trauma register of the DGH, the definition of criteria for hand surgical procedures to be performed in an outpatient setting within the framework of a consensus recommendation as well as participation in a large epidemiological study with the special documentation of pathological alterations of the hand to determine the prevalences (study of health in Pomerania, SHIP); however, within these projects the quality of treatment itself is not assessed. In the attempt to document the quality, the currently available quality indicators in hand surgery probably only evaluate the aspects really relevant for the patients to a limited extent. Therefore, the DGH participated at an early stage in the development of assessments within the international study named by the WHO as a lighthouse project. These developed and validated assessments are intended to include all aspects of the results including the individual patient view in order to precisely relate the quality of treatment to an exactly defined pattern of hand injury. The use of these assessments should permanently enable a prediction of outcome quality for each individual patient. All these projects require the largest involvement possible to collect as much data as possible. With this intention the DGH further coordinates and develops these projects within the committees of the extended executive board and attempts to motivate as many surgeons as possible to participate.
Collapse
|
4
|
Kaplan RM, Milstein A. Influence of a COVID-19 vaccine's effectiveness and safety profile on vaccination acceptance. Proc Natl Acad Sci U S A 2021; 118:e2021726118. [PMID: 33619178 PMCID: PMC7958192 DOI: 10.1073/pnas.2021726118] [Citation(s) in RCA: 125] [Impact Index Per Article: 41.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Although a safe and effective vaccine holds the greatest promise for resolving the COVID-19 pandemic, hesitancy to accept vaccines remains common. To explore vaccine acceptance decisions, we conducted a national survey of 1,000 people from all US states in August of 2020 and a replication in December of 2020. Using a 3 × 3 × 3 factorial experimental design, we estimated the impact of three factors: probability of 1) protection against COVID-19, 2) minor side effects, and 3) a serious adverse reactions. The outcome was respondents' reported likelihood of receiving a vaccine for the coronavirus. Probability of vaccine efficacy (50%, 70%, or 90%) had the largest effect among the three factors. The probability of minor side effects (50%, 75%, 90%) including fever and sore arm, did not significantly influence likelihood of receiving the vaccine. The chances of a serious adverse reaction, such as temporary or permanent paralysis, had a small but significant effect. A serious adverse reaction rate of 1/100,000 was more likely to discourage vaccine use in comparison to rates of 1/million or 1/100 million. All interactions between the factors were nonsignificant. A replication following the announcement that vaccines were 95% effective showed small, but significant increases in the likelihood of taking a vaccine. The main effects and interactions in the model remained unchanged. Expected benefit was more influential in respondents' decision making than expected side effects. The absence of interaction effects suggests that respondents consider the side effects and benefits independently.
Collapse
Affiliation(s)
- Robert M Kaplan
- Clinical Excellence Research Center, Stanford University School of Medicine, Stanford, CA 94305
| | - Arnold Milstein
- Clinical Excellence Research Center, Stanford University School of Medicine, Stanford, CA 94305
| |
Collapse
|
5
|
Kaplan RM, Milstein A. Influence of a COVID-19 vaccine's effectiveness and safety profile on vaccination acceptance. Proc Natl Acad Sci U S A 2021. [PMID: 33619178 DOI: 10.1073/pnas.2021726118/-/dcsupplemental] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Abstract
Although a safe and effective vaccine holds the greatest promise for resolving the COVID-19 pandemic, hesitancy to accept vaccines remains common. To explore vaccine acceptance decisions, we conducted a national survey of 1,000 people from all US states in August of 2020 and a replication in December of 2020. Using a 3 × 3 × 3 factorial experimental design, we estimated the impact of three factors: probability of 1) protection against COVID-19, 2) minor side effects, and 3) a serious adverse reactions. The outcome was respondents' reported likelihood of receiving a vaccine for the coronavirus. Probability of vaccine efficacy (50%, 70%, or 90%) had the largest effect among the three factors. The probability of minor side effects (50%, 75%, 90%) including fever and sore arm, did not significantly influence likelihood of receiving the vaccine. The chances of a serious adverse reaction, such as temporary or permanent paralysis, had a small but significant effect. A serious adverse reaction rate of 1/100,000 was more likely to discourage vaccine use in comparison to rates of 1/million or 1/100 million. All interactions between the factors were nonsignificant. A replication following the announcement that vaccines were 95% effective showed small, but significant increases in the likelihood of taking a vaccine. The main effects and interactions in the model remained unchanged. Expected benefit was more influential in respondents' decision making than expected side effects. The absence of interaction effects suggests that respondents consider the side effects and benefits independently.
Collapse
Affiliation(s)
- Robert M Kaplan
- Clinical Excellence Research Center, Stanford University School of Medicine, Stanford, CA 94305
| | - Arnold Milstein
- Clinical Excellence Research Center, Stanford University School of Medicine, Stanford, CA 94305
| |
Collapse
|
6
|
Spradling K, Bhambhvani HP, Chang T, Pao AC, Liao J, Leppert JT, Welk B, Harris CR, Conti SL, Elliott CS. Evaluation of Patient Treatment Preferences for 15 to 20 mm Kidney Stones: A Conjoint Analysis. J Endourol 2021; 35:706-711. [PMID: 32867549 DOI: 10.1089/end.2020.0370] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Introduction and Objective: Ureteroscopy (URS) and percutaneous nephrolithotomy (PCNL) are standard treatments for intermediate-size (15-20 mm) kidney stones but differ in their postoperative recovery, stone-free rates, and complication risks. We aimed to evaluate what affects patient treatment preferences. Methods: Patients with urinary stone disease completed a choice-based conjoint analysis exercise assessing four treatment attributes associated with URS and PCNL. A sensitivity analysis using a market simulator was performed, and the relative importance of each attribute was calculated. Differences in treatment preferences by demographic subgroup were assessed. Results: A total of 58 patients completed the conjoint analysis exercise. Stone-free rate was the most important treatment attribute, while the length of hospital stay and cosmesis were less important. Overall, sensitivity analysis based on market simulation scenarios predicted an almost equal preference for URS (52.4%) compared with PCNL (47.6%) for treatment of an intermediate-size stone. Older patients (>65 years old) expressed their stronger preferences for lower infection rates and shorter hospital stays, and were more likely to prefer URS (67.2%, 95% confidence interval [CI]: 52% to 82.5%) compared with younger patients (20-34 years old) (20.3%, 95% CI: 0% to 41.5%) who preferred higher procedure success rates and fewer repeat procedures. Conclusion: Conjoint analysis predicts nearly equal patient preference for URS or PCNL for the treatment of intermediate-size kidney stones. Older patients prefer the lower urinary tract infection risk and shorter hospital stay associated with URS, while younger patients prefer higher stone-free rates associated with PCNL. These results can help guide urologists in counseling patients and improve the shared decision-making process.
Collapse
Affiliation(s)
- Kyle Spradling
- Department of Urology, Stanford University School of Medicine, Stanford, California, USA
| | - Hriday P Bhambhvani
- Department of Urology, Stanford University School of Medicine, Stanford, California, USA
| | - Timothy Chang
- Department of Urology, Stanford University School of Medicine, Stanford, California, USA.,Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | - Alan C Pao
- Department of Urology, Stanford University School of Medicine, Stanford, California, USA.,Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA.,Department of Medicine (Nephrology), Stanford University School of Medicine, Stanford, California, USA
| | - Joseph Liao
- Department of Urology, Stanford University School of Medicine, Stanford, California, USA.,Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | - John T Leppert
- Department of Urology, Stanford University School of Medicine, Stanford, California, USA.,Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA.,Department of Medicine (Nephrology), Stanford University School of Medicine, Stanford, California, USA
| | - Blayne Welk
- Department of Surgery, Western University, London, Canada
| | - Catherine R Harris
- Department of Urology, Stanford University School of Medicine, Stanford, California, USA.,Division of Urology, Santa Clara Valley Medical Center, San Jose, California, USA
| | - Simon L Conti
- Department of Urology, Stanford University School of Medicine, Stanford, California, USA
| | - Christopher S Elliott
- Department of Urology, Stanford University School of Medicine, Stanford, California, USA.,Division of Urology, Santa Clara Valley Medical Center, San Jose, California, USA
| |
Collapse
|
7
|
Naunheim MR, Randolph GW, Shin JJ. Evidence-Based Medicine in Otolaryngology Part XII: Assessing Patient Preferences. Otolaryngol Head Neck Surg 2020; 164:473-481. [PMID: 32895002 DOI: 10.1177/0194599820950723] [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] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To provide a contemporary resource to update clinicians and researchers on the current state of assessment of patient preferences. DATA SOURCES Published studies and literature regarding patient preferences, evidence-based practice, and patient-centered management in otolaryngology. REVIEW METHODS Patients make choices based on both physician input and their own preferences. These preferences are informed by personal values and attitudes, and they ideally result from a deliberative evaluation of the risks, benefits, and other outcomes pertaining to medical care. To date, rigorous evaluation of patient preferences for otolaryngologic conditions has not been integrated into clinical practice or research. This installment of the "Evidence-Based Medicine in Otolaryngology" series focuses on formal assessment of patient preferences and the optimal methods to determine them. CONCLUSIONS Methods have been developed to optimize our understanding of patient preferences. IMPLICATIONS FOR PRACTICE Understanding these patient preferences may help promote an evidence-based approach to the care of individual patients.
Collapse
Affiliation(s)
- Matthew R Naunheim
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Gregory W Randolph
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer J Shin
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
8
|
Mertz K, Shah RF, Eppler SL, Yao J, Safran M, Palanca A, Hu SS, Gardner M, Amanatullah DF, Kamal RN. A Simple Goal Elicitation Tool Improves Shared Decision Making in Outpatient Orthopedic Surgery: A Randomized Controlled Trial. Med Decis Making 2020; 40:766-773. [PMID: 32744134 DOI: 10.1177/0272989x20943520] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction. Shared decision making involves educating the patient, eliciting their goals, and collaborating on a decision for treatment. Goal elicitation is challenging for physicians as previous research has shown that patients do not bring up their goals on their own. Failure to properly elicit patient goals leads to increased patient misconceptions and decisional conflict. We performed a randomized controlled trial to test the efficacy of a simple goal elicitation tool in improving patient involvement in decision making. Methods. We conducted a randomized, single-blind study of new patients presenting to a single, outpatient surgical center. Prior to their consultation, the intervention group received a demographics questionnaire and a goal elicitation worksheet. The control group received a demographics questionnaire only. After the consultation, both groups were asked to complete the Perceived Involvement in Care Scale (PICS) survey. We compared the mean PICS scores for the intervention and control groups using a nonparametric Mann-Whitney Wilcoxon test. Secondary analysis included a qualitative content analysis of the patient goals. Results. Our final cohort consisted of 96 patients (46 intervention, 50 control). Both groups were similar in terms of demographic composition. The intervention group had a significantly higher mean (SD) PICS score compared to the control group (9.04 [2.15] v. 7.54 [2.27], P < 0.01). Thirty-nine percent of patient goals were focused on receiving a diagnosis or treatment, while 21% of patients wanted to receive education regarding their illness or their treatment options. Discussion. A single-step goal elicitation tool was effective in improving patient-perceived involvement in their care. This tool can be efficiently implemented in both academic and nonacademic settings.
Collapse
Affiliation(s)
- Kevin Mertz
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, CA, USA
| | - Romil F Shah
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, CA, USA
| | - Sara L Eppler
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, CA, USA
| | - Jeffrey Yao
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, CA, USA
| | - Marc Safran
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, CA, USA
| | - Ariel Palanca
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, CA, USA
| | - Serena S Hu
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, CA, USA
| | - Michael Gardner
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, CA, USA
| | - Derek F Amanatullah
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, CA, USA
| | - Robin N Kamal
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, CA, USA
| |
Collapse
|
9
|
Shapiro LM, Eppler SL, Baker LC, Harris AS, Gardner MJ, Kamal RN. The Usability and Feasibility of Conjoint Analysis to Elicit Preferences for Distal Radius Fractures in Patients 55 Years and Older. J Hand Surg Am 2019; 44:846-852. [PMID: 31495523 DOI: 10.1016/j.jhsa.2019.07.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 05/10/2019] [Accepted: 07/23/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE Eliciting patient preferences is one part of the shared decision-making process-a process of decision making focused on the values and preferences of the patient. We evaluated the usability and feasibility of a point-of-care conjoint analysis tool for preference elicitation for shared decision making in the treatment of distal radius fractures in patients over the age of 55 years. METHODS Twenty-seven patients 55 years of age or older with a displaced distal radius fracture were recruited from a hand and upper extremity clinic. A conjoint analysis tool was created describing the attributes of care (eg, return of grip strength) of surgical and nonsurgical treatment. This tool was administered to patients to determine their preferences for the treatment attributes when choosing between surgical and nonsurgical treatment. Patients completed a System Usability Scale (SUS) to evaluate usability, and time to complete the tool was measured to evaluate feasibility. RESULTS Patients considered the conjoint analysis tool to be usable (SUS, 91.4; SD, 10.9). Mean time to complete the tool was 5.1 minutes (SD, 1.4 minutes). The most important attributes driving the decision for surgical treatment were return of grip strength at 1 year and time spent in a cast or brace. The most important attributes driving the decision for nonsurgical treatment were use of anesthesia during treatment and return of grip strength at 1 year. CONCLUSIONS A point-of-care conjoint analysis tool for distal radius fractures in patients 55 years and older can be used to elicit patient preferences to inform the shared decision-making process. Further investigation evaluating the effect of preference elicitation on treatment choice, involvement in decision making, and patient-reported outcomes are needed. CLINICAL RELEVANCE A conjoint analysis tool is a simple, structured process physicians can use during shared decision making to highlight trade-offs between treatment options and elicit patient preferences to inform treatment choices.
Collapse
Affiliation(s)
- Lauren M Shapiro
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, Redwood City, CA
| | - Sara L Eppler
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, Redwood City, CA
| | - Laurence C Baker
- Department of Health Research & Policy, Stanford University, Stanford, CA
| | - Alex S Harris
- Department of Surgery, Stanford University, Stanford, CA
| | - Michael J Gardner
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, Redwood City, CA
| | - Robin N Kamal
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, Redwood City, CA.
| |
Collapse
|
10
|
Kaplan RM, Crespi CM, Dahan E, Saucedo JD, Pagan C, Saigal CS. Comparison of Rating Scale, Time Tradeoff, and Conjoint Analysis Methods for Assessment of Preferences in Prostate Cancer. Med Decis Making 2019; 39:816-826. [PMID: 31556793 DOI: 10.1177/0272989x19873667] [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] [Indexed: 12/17/2022]
Abstract
Background. Conjoint analysis is widely used in studies of consumer preference but has only recently been applied to measure patient utilities for health outcomes. We compared the reliability, feasibility, and internal and predictive validity of conjoint scaling methods against better established rating scale and time tradeoff methods for assessing prostate cancer utilities in men at risk for prostate cancer. Methods. In total, 194 men who were biopsy negative for prostate cancer were randomly assigned to complete 2 preference assessment modules, either conjoint analysis and a rating scale module or conjoint analysis and a time tradeoff module. Each participant's most important attribute was identified and evaluated in relation to age group (age <65, age 65 and older), education (high school, some college, college graduate), race/ethnicity (white, black, Latino), and relationship status (in significant relationship v. not). The methods were also evaluated in terms of ease of use and satisfaction. Results. Rating scales were rated as easiest to use and respondents were more satisfied with rating scales and conjoint in comparison to time tradeoffs. Rating scales and conjoint measures demonstrated significantly higher internal validity compared to time tradeoff when evaluated through R2 of the fitted utility function. The 3 methods were similar in terms of predictive validity, but conjoint analysis outperformed the rating scale method when patients were presented with novel combinations of attribute levels (68% correct v. 43%, P = 0.003). Conclusions. Rating scales and conjoint analysis exercises offer greater ease of use and higher satisfaction when measuring patient preferences in men biopsied for prostate cancer in comparison to time tradeoff exercises. Conjoint analysis may be a more robust approach to preference measurement for men at risk for prostate cancer.
Collapse
Affiliation(s)
- Robert M Kaplan
- Clinical Excellence Research Center, Department of Medicine, Stanford University, Stanford, CA USA
| | - Catherine M Crespi
- Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | | | - Josemanuel D Saucedo
- Department of Urology, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Casey Pagan
- Department of Urology, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Christopher S Saigal
- Department of Urology, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| |
Collapse
|
11
|
Shapiro LM, Eppler SL, Kamal RN. The Feasibility and Usability of a Ranking Tool to Elicit Patient Preferences for the Treatment of Trigger Finger. J Hand Surg Am 2019; 44:480-486.e1. [PMID: 30797655 PMCID: PMC6551231 DOI: 10.1016/j.jhsa.2019.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 10/25/2018] [Accepted: 01/02/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE Shared decision making is an approach where physicians and patients collaborate to make decisions based on patient values. This requires eliciting patients' preferences for each treatment attribute before making decisions; a structured process for preference elicitation does not exist in hand surgery. We tested the feasibility and usability of a ranking tool to elicit patient preferences for the treatment of trigger finger. We hypothesized that the tool would be usable and feasible at the point of care. METHODS Thirty patients with a trigger finger without prior treatment were recruited from a hand surgery clinic. A preference elicitation tool was created that presented 3 treatment options (surgical release, injection, and therapy and orthosis) and described attributes of each treatment extracted from literature review (eg, success rate, complications). We presented these attributes to patients using the tool and patients ranked the relative importance (preference) of these attributes to aid in their decision making. The System Usability Scale and tool completion time were used to evaluate usability and feasibility, respectively. RESULTS The tool demonstrated excellent usability (System Usability Scale: 88.7). The mean completion time was 3.05 minutes. Five (16.7%) patients chose surgery, 20 (66.7%) chose an injection, and 5 (16.7%) chose therapy and orthosis. Patients ranked treatment success and cost as the most and least important attributes, respectively. Twenty-nine (96.7%) patients were very to extremely satisfied with the tool. CONCLUSIONS A preference elicitation tool for patients to rank treatment attributes by relative importance is feasible and usable at the point of care. A structured process for preference elicitation ensures that patients understand the trade-offs between choices and can assist physicians in aligning treatment decisions with patient preferences. CLINICAL RELEVANCE A ranking tool is a simple, structured process physicians can use to elicit preferences during shared decision making and highlight trade-offs between treatment options to inform treatment choices.
Collapse
Affiliation(s)
- Lauren M. Shapiro
- Department of Orthopaedic Surgery, Stanford University, Redwood City, CA
| | - Sara L. Eppler
- Department of Orthopaedic Surgery, Stanford University, Redwood City, CA
| | - Robin N. Kamal
- Department of Orthopaedic Surgery, Stanford University, Redwood City, CA
| |
Collapse
|
12
|
Eppler SL, Kakar S, Sheikholeslami N, Sun B, Pennell H, Kamal RN. Defining Quality in Hand Surgery From the Patient's Perspective: A Qualitative Analysis. J Hand Surg Am 2019; 44:311-320.e4. [PMID: 30031599 DOI: 10.1016/j.jhsa.2018.06.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE Quality measures are used to evaluate health care delivery. They are traditionally developed from the physician and health system viewpoint. This approach can lead to quality measures that promote care that may be misaligned with patient values and preferences. We completed an exploratory, qualitative study to identify how patients with hand problems define high-quality care. Our purpose was to develop a better understanding of the surgery and recovery experience of hand surgery patients, specifically focusing on knowledge gaps, experience, and the surgical process. METHODS A steering committee (n = 10) of patients who had previously undergone hand surgery reviewed and revised an open-ended survey. Ninety-nine patients who had undergone hand surgery at 2 tertiary care institutions completed the open-ended, structured questionnaire during their 6- to 8-week postoperative clinic visit. Two reviewers completed a thematic analysis to generate subcodes and codes to identify themes in high-quality care from the patient's perspective. RESULTS We identified 4 themes of high-quality care: (1) Being prepared and informed for the process of surgery, (2) Regaining hand function without pain or complication, (3) Patients and caregivers negotiating the physical and psychological challenges of recovery, and (4) Financial and logistical burdens of undergoing hand surgery. CONCLUSIONS Multiple areas that patients identify as representing high-quality care are not reflected in current quality measures for hand surgery. The patient-derived themes of high-quality care can inform future patient-centered quality measure development. CLINICAL RELEVANCE Efforts to improve health care delivery may have the greatest impact by addressing areas of care that are most valued by patients. Such areas include patient education, system navigation, the recovery process, and cost.
Collapse
Affiliation(s)
- Sara L Eppler
- Department of Orthopaedic Surgery, Stanford University, Redwood City, CA
| | - Sanjeev Kakar
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN
| | | | - Beatrice Sun
- Department of Orthopaedic Surgery, Stanford University, Redwood City, CA
| | - Hillary Pennell
- Department of Communication, University of Missouri, Columbia, MO
| | - Robin N Kamal
- Department of Orthopaedic Surgery, Stanford University, Redwood City, CA.
| |
Collapse
|
13
|
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.
Collapse
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.
| |
Collapse
|
14
|
Shammas RL, Mela N, Wallace S, Tong BC, Huber J, Mithani SK. Conjoint Analysis of Treatment Preferences for Nondisplaced Scaphoid Fractures. J Hand Surg Am 2018; 43:678.e1-678.e9. [PMID: 29456053 DOI: 10.1016/j.jhsa.2017.12.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 11/23/2017] [Accepted: 12/20/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE We used conjoint analysis to assess the relative importance of factors that influence a patient's decision between surgical or nonsurgical management of a nondisplaced scaphoid fracture. Our hypothesis was that out-of-pocket costs will have a greater influence on decision making than the time spent in a cast or brace, degree of soreness, or the risk of treatment failure. METHODS Two-hundred and fifty participants were recruited using Amazon Mechanical Turk and asked to assume that they had experienced a nondisplaced scaphoid waist fracture. They then indicated their relative preferences among 13 pairs of alternatives with variations in the following attributes: time in a cast, time in a brace, duration of ongoing soreness, risk of treatment failure (by which we meant scaphoid nonunion), out-of-pocket costs based on estimates of direct costs ($500-2,500), and apprehension about surgery. A conjoint analysis was used to determine the relative importance of these factors when choosing between surgical or nonsurgical management. RESULTS The factor with the greatest influence on treatment choice was the cost of the procedure. After assessing the respondent's apprehension to undergo surgery, a sensitivity analysis showed the proportion of respondents who would choose surgery given different outcomes. To make the predicted share of those who are "not worried" about surgery equal to those who are "somewhat worried" or "a little worried" would require that the cost of surgery increase by $2,700. In addition, 2 weeks in a cast, 3 weeks in a brace, 2 months of soreness, or a 2% increase in the risk of fracture nonunion generates the same surgical choice probability as a $2,000 increase in the out-of-pocket cost of surgery. CONCLUSIONS As conceptualized in this conjoint analysis, out-of-pocket costs and apprehension about surgery seem to have a greater impact on a decision for surgery than the time spent in a brace or cast and the risk of treatment failure. TYPE OF STUDY/LEVEL OF EVIDENCE Economic and decision analysis III.
Collapse
Affiliation(s)
| | - Nathan Mela
- Fuqua School of Business, Duke University, Durham, NC
| | - Scott Wallace
- Fuqua School of Business, Duke University, Durham, NC
| | - Betty C Tong
- Division of Thoracic and Cardiovascular Surgery, Duke University Medical Center, Durham, NC
| | - Joel Huber
- Fuqua School of Business, Duke University, Durham, NC
| | - Suhail K Mithani
- Division of Plastic, Maxillofacial, and Oral Surgery, Duke University Medical Center, Durham, NC.
| |
Collapse
|
15
|
Calegari LP, Barbosa J, Marodin GA, Fettermann DC. A conjoint analysis to consumer choice in Brazil: Defining device attributes for recognizing customized foods characteristics. Food Res Int 2018; 109:1-13. [PMID: 29803431 DOI: 10.1016/j.foodres.2018.03.080] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 03/27/2018] [Accepted: 03/30/2018] [Indexed: 01/20/2023]
Abstract
the availability of information about food products may be an essential factor in the consumer's value perception in their purchasing decision. As the food product becomes personalized, the customization of this information becomes complex due to the possible combinations of product components. The use of smart technology in devices is one way to provide customers with customized food information. In the following research five attributes were identified in the composition of these devices: (A) portability; (B) precision; (C) diet customization; (D) food quality analysis; and (E) price. This study aims to identify the appropriate combination of possible functionalities or attributes that must be present in a device in order to detect the food composition of customized foods and their relation to market characteristics. One experiment used fractional factorial project to present the attributes in the form of scenarios following the Choice-Based Conjoint Analysis (CBCA) method. The data collection was done using survey methodology, through online questionnaire, with some 303 Brazilian respondents. So, the Logistic Regression was applied to data analysis. The moderating variables-gender, age, gluten restriction, lactose restriction and other restrictions-were also added to verify potential interactions with the primary attributes. From the results obtained, it was possible to observe higher significance for the primary attributes of diet personalization and quality food analyzes function. Our study contributes to the literature by enhancing the understanding about what the attributes should be in a technological device that has the purpose of recognizing food characteristics and is capable of generating information about customized food products. Furthermore, this device can enabler the production of mass customized food with the nutritional labels for each possible combination.
Collapse
Affiliation(s)
- L P Calegari
- Department of Industrial Engineering and Systems, Federal University of Santa Catarina, Florianópolis, Brazil.
| | - J Barbosa
- Department of Industrial Engineering and Systems, Federal University of Santa Catarina, Florianópolis, Brazil
| | - G A Marodin
- Departament of Management Science, University of South Carolina, Columbia, USA..
| | - D C Fettermann
- Department of Industrial Engineering and Systems, Federal University of Santa Catarina, Florianópolis, Brazil.
| |
Collapse
|
16
|
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.
Collapse
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
| |
Collapse
|
17
|
Hampson LA, Lin TK, Wilson L, Allen IE, Gaither TW, Breyer BN. Understanding patients' preferences for surgical management of urethral stricture disease. World J Urol 2017; 35:1799-1805. [PMID: 28664240 PMCID: PMC6452859 DOI: 10.1007/s00345-017-2066-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 06/15/2017] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES To understand how prioritization of treatment attributes and treatment choice varies by patient characteristics, we sought to specifically determine how demographic variables affect patient treatment preference. PATIENTS AND METHODS Male patients with urethral stricture disease participated in a choice-based conjoint (CBC) analysis exercise evaluating six treatment attributes associated with internal urethrotomy and urethroplasty. Demographic and past symptom data were collected. Stratified analysis of demographic variables, including age, education, income, was conducted using a mixed effect logistic regression model to evaluate the coefficient size and confidence intervals between the treatments attribute preferences of each strata. RESULTS 169 patients completed the CBC exercise and were included in our analysis. Overall success of the procedure is the most important treatment attribute to patients and this persists across strata. Older patients (≥65) express preferences for better success rates and fewer future procedures, whereas younger patients prefer a less invasive approach and are more willing to accept additional procedures if needed. Patients with lower levels of education preferred open reconstruction and had a stronger preference against multiple future procedures, whereas those with higher levels of education preferred endoscopic treatment and had a less strong preference against multiple future procedures. Low-income individuals express statistically significant stronger negative preferences against high copay costs compared to high-income individuals. CONCLUSION These results can help to inform physicians' counseling about surgical management of urethral stricture disease to better align patient preferences with treatment selection and encourage shared decision making.
Collapse
Affiliation(s)
- Lindsay A Hampson
- Department of Urology, UCSF School of Medicine, 400 Parnassus Ave, A638, Box 0738, San Francisco, CA, 94143, USA.
| | - Tracy K Lin
- Department of Clinical Pharmacy, UCSF School of Pharmacy, San Francisco, USA
| | - Leslie Wilson
- Department of Clinical Pharmacy, UCSF School of Pharmacy, San Francisco, USA
| | - Isabel E Allen
- Department of Epidemiology and Biostatistics, UCSF School of Medicine, San Francisco, USA
| | | | - Benjamin N Breyer
- Department of Urology, UCSF School of Medicine, 400 Parnassus Ave, A638, Box 0738, San Francisco, CA, 94143, USA
| |
Collapse
|