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Bridges JFP, de Bekker-Grob EW, Hauber B, Heidenreich S, Janssen E, Bast A, Hanmer J, Danyliv A, Low E, Bouvy JC, Marshall DA. A Roadmap for Increasing the Usefulness and Impact of Patient-Preference Studies in Decision Making in Health: A Good Practices Report of an ISPOR Task Force. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:153-162. [PMID: 36754539 DOI: 10.1016/j.jval.2022.12.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 12/07/2022] [Indexed: 06/18/2023]
Abstract
Many qualitative and quantitative methods are readily available to study patient preferences in health. These methods are now being used to inform a wide variety of decisions, and there is a growing body of evidence showing studies of patient preferences can be used for decision making in a wide variety of contexts. This ISPOR Task Force report synthesizes current good practices for increasing the usefulness and impact of patient-preference studies in decision making. We provide the ISPOR Roadmap for Patient Preferences in Decision Making that invites patient-preference researchers to work with decision makers, patients and patient groups, and other stakeholders to ensure that studies are useful and impactful. The ISPOR Roadmap consists of 5 key elements: (1) context, (2) purpose, (3) population, (4) method, and (5) impact. In this report, we define these 5 elements and provide good practices on how patient-preference researchers and others can actively contribute to increasing the usefulness and impact of patient-preference studies in decision making. We also present a set of key questions that can support researchers and other stakeholders (eg, funders, reviewers, readers) to assess efforts that promote the ongoing impact (both intended and unintended) of a particular preference study and additional studies in the future.
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Affiliation(s)
- John F P Bridges
- The Ohio State University College of Medicine, Columbus, OH, USA.
| | | | | | | | - Ellen Janssen
- Janssen Research & Development, LLC, New Brunswick, NJ, USA
| | | | | | | | - Eric Low
- Eric Low Consulting, Haddington, Scotland, UK
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Ferguson MC, McNicol E, Kleykamp BA, Sandoval K, Haroutounian S, Holzer KJ, Kerns RD, Veasley C, Turk DC, Dworkin RH. Perspectives on Participation in Clinical Trials Among Individuals With Pain, Depression, and/or Anxiety: An ACTTION Scoping Review. THE JOURNAL OF PAIN 2023; 24:24-37. [PMID: 36152760 DOI: 10.1016/j.jpain.2022.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 08/10/2022] [Accepted: 09/04/2022] [Indexed: 02/08/2023]
Abstract
For individuals experiencing pain, the decision to engage in clinical trials may be influenced by a number of factors including current and past care, illness severity, physical functioning, financial stress, and caregiver support. Co-occurring depression and anxiety may add to these challenges. The aim of this scoping review was to describe perspectives about clinical trial participation, including recruitment and retention among individuals with pain and pain comorbidities, including depression and/or anxiety. We searched PubMed, CINAHL, PsycINFO, and Cochrane CENTRAL databases. Study features, sample demographics, perspectives, barriers and/or motivations were collected and described. A total of 35 assessments were included in this scoping review with 24 focused on individuals with pain (24/35, 68.6%), 9 on individuals with depression and/or anxiety (9/35, 25.7%), and 2 on individuals with pain and co-occurring depression/anxiety (2/35, 5.7%). Barriers among participants with pain and those with depression included: research team's communication of information, fear of interventional risks, distrust (only among respondents with pain), too many procedures, fear of inadequate treatment, disease-life stressors, and embarrassment with study procedures (more commonly reported in participants with depression). Facilitators in both groups included: altruism and supportive staff, better access to care, and the ability to have outcome feedback (more commonly among individuals with depression). Individuals with pain and depression experience challenges that affect trial recruitment and retention. Engaging individuals with pain within research planning may assist in addressing these barriers and the needs of individuals affected by pain and/or depression. PERSPECTIVE: This review highlights the need to address barriers and facilitators to participation in clinical trials, including the need for an assessment of perspectives from underserved or marginalized populations.
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Affiliation(s)
- McKenzie C Ferguson
- School of Pharmacy, Southern Illinois University Edwardsville, Edwardsville, Illinois.
| | - Ewan McNicol
- School of Pharmacy, MCPHS University, Boston, Massachusetts
| | - Bethea A Kleykamp
- Department of Anesthesiology and Perioperative Medicine, University of Rochester Medical Center, Rochester, New York
| | - Karin Sandoval
- School of Pharmacy, Southern Illinois University Edwardsville, Edwardsville, Illinois
| | - Simon Haroutounian
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri
| | - Katherine J Holzer
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri
| | - Robert D Kerns
- Departments of Psychiatry, Neurology and Psychology, Yale University, New Haven, Connecticut
| | - Christin Veasley
- Co-founder and Director, Chronic Pain Research Alliance, North Kingstown, Rhode Island
| | - Dennis C Turk
- University of Washington School of Medicine, Seattle, Washington
| | - Robert H Dworkin
- Department of Anesthesiology and Perioperative Medicine, University of Rochester Medical Center, Rochester, New York
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Knoerl R, Berry D, Meyerhardt JA, Reyes K, Salehi E, Thornton K, Gewandter JS. Identifying participants' preferences for modifiable chemotherapy-induced peripheral neuropathy prevention clinical trial factors: an adaptive choice-based conjoint analysis. Support Care Cancer 2022; 30:9963-9973. [PMID: 36355216 PMCID: PMC9648439 DOI: 10.1007/s00520-022-07447-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 10/31/2022] [Indexed: 11/11/2022]
Abstract
PURPOSE There are no recommended treatments for chemotherapy-induced peripheral neuropathy (CIPN) prevention. Recruitment to CIPN prevention clinical trials is challenging because it is difficult to enroll patients between the time of cancer diagnosis and the initiation of neurotoxic chemotherapy. The purpose of this exploratory-sequential mixed-methods study was to determine patients' preferences that could affect the choice to participate in CIPN prevention clinical trials. METHODS First, twenty cognitive interviews were conducted with adults who completed less than three neurotoxic chemotherapy infusions to clarify clinical trial attributes and levels thought to be important to patients when deciding whether to enroll in CIPN prevention trials (i.e., type of treatment, clinical tests, reimbursement, survey delivery; length of visits, timing of follow-up, when to begin treatment). Second, another eighty-eight patients completed an adaptive choice-based conjoint analysis survey that incorporated the finalized attributes and levels. Each level was assigned a part-worth utility score using Hierarchical Bayes Estimation. The relative importance of each attribute was calculated. RESULTS The attributes with the highest relative importance values were type of treatment (27.1%) and length of study visits (20.2%). The preferred levels included non-medicine treatment (53.49%), beginning treatment after experiencing CIPN (60.47%), email surveys (63.95%), assessments that include surveys and clinical exams (39.53%), under 30-min visits (44.19%), $50/week reimbursement (39.53%), and 1-month post-chemotherapy follow-up visits (32.56%). CONCLUSIONS Patients' preferences for participation may be included in the design of future CIPN prevention clinical trials to potentially bolster study enrollment.
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Affiliation(s)
- Robert Knoerl
- Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, 450 Brookline Ave LW518, Boston, MA, 02215, USA.
- Present Address: University of Michigan School of Nursing, 400 North Ingalls St, Office 2350;, MI, 48109, Ann Arbor, USA.
| | - Donna Berry
- Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA, 98195, USA
| | | | - Kaitlen Reyes
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, 02215, USA
| | - Elahe Salehi
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, 02215, USA
| | - Katherine Thornton
- Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jennifer S Gewandter
- Department of Anesthesiology and Perioperative Medicine, University of Rochester Medical Center, Rochester, NY, 14642, USA
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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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Fotheringham J, Vilar E, Bansal T, Laboi P, Davenport A, Dunn L, Hole AR. Patient Preferences for Longer or More Frequent In-Center Hemodialysis Regimens: A Multicenter Discrete Choice Study. Am J Kidney Dis 2022; 79:785-795. [PMID: 34699958 PMCID: PMC9153730 DOI: 10.1053/j.ajkd.2021.09.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 09/05/2021] [Indexed: 11/11/2022]
Abstract
RATIONALE & OBJECTIVE Longer and more frequent hemodialysis sessions are associated with both benefits and harms. However, their relative importance to patients and how they influence acceptability for patients have not been quantified. STUDY DESIGN Discrete-choice experiment in which a scenario followed by 12 treatment choice sets were presented to patients in conjunction with varying information about the clinical impact of the treatments offered. SETTING & PARTICIPANTS Patients with kidney failure treated with maintenance dialysis for≥1 year in 5 UK kidney centers. PREDICTORS Length and frequency of hemodialysis sessions and their prior reported associations with survival, quality of life, need for fluid restriction, hospitalization, and vascular access complications. OUTCOME Selection of longer (4.5 hours) or more frequent (4 sessions per week) hemodialysis regimens versus remaining on 3 sessions per week with session lengths of 4 hours. ANALYTICAL APPROACH Multinomial mixed effects logistic regression estimating the relative influence of different levels of the predictors on the selection of longer and more frequent dialysis, controlling for patient demographic characteristics. RESULTS Among 183 prevalent in-center hemodialysis patients (mean age of 63.7 years, mean dialysis vintage of 4.7 years), 38.3% (70 of 183) always chose to remain on regimens of 3 sessions per week with session duration of 4 hours. Depicted associations of increasing survival and quality of life, reduced need for fluid restriction, and avoiding additional access complications were all significantly associated with choosing longer or more frequent treatment regimens. Younger age, fatigue, previous experience of vascular access complications, absence of heart failure, and shorter travel time to dialysis centers were associated with preference for 4 sessions per week. Patients expressed willingness to trade up to 2 years of life to avoid regimens of 4 sessions per week or access complications. After applying estimated treatment benefits and harms from existing literature, the fully adjusted model revealed that 27.1% would choose longer regimens delivered 3 times per week and 34.3% would choose 4 hours 4 times per week. Analogous estimates for younger fatigued patients living near their unit were 23.5% and 62.5%, respectively. LIMITATIONS Estimates were based on stated preferences rather than observed behaviors. Predicted acceptance of regimens was derived from data on treatment benefits and harms largely sourced from observational studies. CONCLUSIONS Predicted acceptance of longer and more frequent hemodialysis regimens substantially exceeds their use in current clinical practice. These findings underscore the need for robust data on clinical effectiveness of these more intensive regimens and more extensive consideration of patient choice in the selection of dialysis regimens.
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Affiliation(s)
- James Fotheringham
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom; Sheffield Kidney Institute, Northern General Hospital, Sheffield, United Kingdom.
| | - Enric Vilar
- University of Hertfordshire, Hatfield, United Kingdom
| | - Tarun Bansal
- Bradford Teaching Hospitals NHS Trust, Bradford, United Kingdom
| | - Paul Laboi
- York Teaching Hospital NHS Foundation Trust, York, United Kingdom
| | - Andrew Davenport
- UCL Department of Nephrology, Royal Free Hospital, University College London, London, United Kingdom
| | - Louese Dunn
- Sheffield Kidney Institute, Northern General Hospital, Sheffield, United Kingdom
| | - Arne Risa Hole
- Department of Economics, University of Sheffield, Sheffield, United Kingdom
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Cahill PT, Reitzel M, Anaby DR, Camden C, Phoenix M, Romoff S, Campbell WN. Supporting rehabilitation stakeholders in making service delivery decisions: a rapid review of multi-criteria decision analysis methods. Disabil Rehabil 2022:1-14. [PMID: 35649688 DOI: 10.1080/09638288.2022.2080285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE This review aimed to synthesize knowledge about multi-criteria decision analysis methods for supporting rehabilitation service design and delivery decisions, including: (1) describing the use of these methods within rehabilitation, (2) identifying decision types that can be supported by these methods, (3) describing client and family involvement, and (4) identifying implementation considerations. METHODS We conducted a rapid review in collaboration with a knowledge partner, searching four databases for peer-reviewed articles reporting primary research. We extracted relevant data from included studies and synthesized it descriptively and with conventional content analysis. RESULTS We identified 717 records, of which 54 met inclusion criteria. Multi-criteria decision analysis methods were primarily used to understand the strength of clients' and clinicians' preferences (n = 44), and five focused on supporting decision making. Shared decision making with stakeholders was evident in only two studies. Clients and families were mostly engaged in data collection and sometimes in selecting the relevant criteria. Good practices for supporting external validity were inconsistently reported. Implementation considerations included managing cognitive complexity and offering authentic choices. CONCLUSIONS Multi-criteria decision analysis methods are promising for better understanding client and family preferences and priorities across rehabilitation professions, contexts, and caseloads. Further work is required to use these methods in shared decision making, for which increased use of qualitative methods and stakeholder engagement is recommended. IMPLICATIONS FOR REHABILITATIONMulti-criteria decision analysis methods are promising for evidence-based, shared decision making for rehabilitation.However, most studies to date have focused on estimating stakeholder preferences, not supporting shared decision making.Cognitive complexity and modelling authentic and realistic decision choices are major barriers to implementation.Stakeholder-engagement and qualitative methods are recommended to address these barriers.
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Affiliation(s)
- Peter T Cahill
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
| | - Meaghan Reitzel
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
| | - Dana R Anaby
- School of Physical and Occupational Therapy, McGill University, Montréal, Canada.,CanChild Centre for Child Disability Research, Hamilton, Canada
| | - Chantal Camden
- CanChild Centre for Child Disability Research, Hamilton, Canada.,School of Rehabilitation, University of Sherbrooke, Sherbrooke, Canada
| | - Michelle Phoenix
- School of Rehabilitation Science, McMaster University, Hamilton, Canada.,CanChild Centre for Child Disability Research, Hamilton, Canada
| | - Shelley Romoff
- Empowered Kids Ontario-Enfants Avenir Ontario, Toronto, Canada
| | - Wenonah N Campbell
- School of Rehabilitation Science, McMaster University, Hamilton, Canada.,CanChild Centre for Child Disability Research, Hamilton, Canada
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Alshamsi M, Mehta J, Nibali L. Study design and primary outcome in randomized controlled trials in periodontology. A systematic review. J Clin Periodontol 2021; 48:859-866. [PMID: 33570217 DOI: 10.1111/jcpe.13443] [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: 10/25/2020] [Revised: 01/15/2021] [Accepted: 02/08/2021] [Indexed: 12/14/2022]
Abstract
AIM The aim of this review is to assess study design and risk of bias related to primary outcome in recently published randomized controlled trials (RCTs) in periodontology. METHOD An electronic (Medline, EMBASE and Cochrane library) and a manual search were completed to detect RCTs in humans, with an outcome in the field of periodontology and published in English from January 2018 up to March 2020. RESULTS Data extraction of 318 publications meeting the inclusion criteria was performed by two reviewers. Most studies adopted a parallel-group superiority design in a university setting. Overall, 54% of papers reported the primary outcome and relative sample size calculation, while only 37% also included reproducibility estimates relative to the primary outcome. Papers published in journals with higher impact factors had better compliance with primary outcome reporting and lower overall risk of bias scores. CONCLUSION Improvements in the quality of RCTs in periodontology are still needed. The importance of defining a clinically relevant study primary outcome and building the study around it needs to be emphasized. Furthermore, RCTs in periodontology could consider, when appropriate, some of the study design options which facilitate application of the principles of personalized medicine.
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Affiliation(s)
- Maryam Alshamsi
- Periodontology Unit, Centre for Host-Microbiome Interactions, Dental Institute, King's College London, London, UK
| | - Jaimini Mehta
- Periodontology Unit, Centre for Host-Microbiome Interactions, Dental Institute, King's College London, London, UK
| | - Luigi Nibali
- Periodontology Unit, Centre for Host-Microbiome Interactions, Dental Institute, King's College London, London, UK
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Hepprich M, Donath MY, Hemkens LG. Patient involvement to inform the design of a clinical trial in postbariatric hypoglycaemia. BMC Med Res Methodol 2020; 20:290. [PMID: 33256627 PMCID: PMC7706264 DOI: 10.1186/s12874-020-01171-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 11/19/2020] [Indexed: 12/29/2022] Open
Abstract
Background Bariatric surgery may lead to symptomatic postprandial hypoglycaemia as a major side effect without established therapy so far. We aimed to develop an evidence-based study design of a clinical trial that tests treatment options and can provide useful patient-relevant evidence. Methods We searched systematically for guidance of core outcome sets to determine the most relevant types of outcomes and duration of such a trial. Our search comprised literature databases, a database of core outcome sets and self-help organizations. We then developed a simple online questionnaire based on interviews with German-speaking patients with postprandial hypoglycaemia after bariatric surgery. We recruited participants by reaching out to all German speaking endocrinologists in Switzerland and large Swiss bariatric centres. We asked for preferences regarding outcome types and acceptable duration of being included in a corresponding clinical trial. Results The literature search did not identify evidence-based guidance for informing our study design. Experience of clinical and research routine as well as patient interviews helped in identifying potential outcomes and the design of an online questionnaire. Therein, a total of 29 persons started the questionnaire and 22 answered questions related to the primary outcome. Of these, 17 (77.3%) deemed quality of life more relevant as primary outcome than the rate of hypoglycaemic episodes. A trial length of four weeks or longer was regarded as acceptable for 19 of 21 respondents to this question (91.4%) and of six months or longer for 12 respondents (56%). Conclusions In situations with no other guidance, a simple questionnaire may help to inform trial design decisions. This study identifies a patient preference for “quality of life” as a primary outcome and supports the evidence-based conception of a patient-centred clinical trial in postbariatric hypoglycaemia. Supplementary Information Supplementary information accompanies this paper at 10.1186/s12874-020-01171-z.
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Affiliation(s)
- Matthias Hepprich
- Division of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Petersgraben 4, 4053, Basel, Switzerland. .,Clinic of Endocrinology, Cantonal Hospital Olten, Basler Strasse 150, 4600, Olten, Switzerland.
| | - Marc Y Donath
- Division of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Petersgraben 4, 4053, Basel, Switzerland
| | - Lars G Hemkens
- Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University of Basel and University Hospital Basel, Basel, Switzerland.,Meta-Research Innovation Center Berlin (METRIC-B), Berlin Institute of Health, Berlin, Germany.,Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, USA
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Abstract
PURPOSE OF REVIEW The current review highlights the growing number of available methods used to measure patient preferences and discusses how this impacts preference research in rheumatology. Spurred by the growing role of preferences in regulatory decisions and drug development, researchers have begun applying preference methods to study questions beyond the clinical context. We explore these trends, provide case studies highlighting changes in measuring patient preferences, compare strengths and weaknesses of common stated-preference methods, and discuss considerations for the future use of these methods. RECENT FINDINGS Early literature on patient preferences often mimicked clinical practice, asking whether treatment A is better or worse than treatment B for a patient. Early applications of patient preference methods in rheumatology aimed to value different attributes of treatments, but remained focused on informing clinical questions. Spurred by interest in preferences by regulatory agencies and patient-centeredness throughout the product lifecycle, there are now a wide array of methods available to measure preference. SUMMARY Although these different preference methods have strengths and weaknesses, they serve to highlight the broad number of questions that could help rheumatology beyond the clinical context. Researchers in rheumatology now have the opportunity to better serve diverse stakeholders by considering how these methods could aid in clinical trial design, regulatory policy, and other elements of the medical product life cycle.
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van Overbeeke E, Janssens R, Whichello C, Schölin Bywall K, Sharpe J, Nikolenko N, Phillips BS, Guiddi P, Pravettoni G, Vergani L, Marton G, Cleemput I, Simoens S, Kübler J, Juhaeri J, Levitan B, de Bekker-Grob EW, Veldwijk J, Huys I. Design, Conduct, and Use of Patient Preference Studies in the Medical Product Life Cycle: A Multi-Method Study. Front Pharmacol 2019; 10:1395. [PMID: 31849657 PMCID: PMC6902285 DOI: 10.3389/fphar.2019.01395] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 10/31/2019] [Indexed: 12/30/2022] Open
Abstract
Objectives: To investigate stakeholder perspectives on how patient preference studies (PPS) should be designed and conducted to allow for inclusion of patient preferences in decision-making along the medical product life cycle (MPLC), and how patient preferences can be used in such decision-making. Methods: Two literature reviews and semi-structured interviews (n = 143) with healthcare stakeholders in Europe and the US were conducted; results of these informed the design of focus group guides. Eight focus groups were conducted with European patients, industry representatives and regulators, and with US regulators and European/Canadian health technology assessment (HTA) representatives. Focus groups were analyzed thematically using NVivo. Results: Stakeholder perspectives on how PPS should be designed and conducted were as follows: 1) study design should be informed by the research questions and patient population; 2) preferred treatment attributes and levels, as well as trade-offs among attributes and levels should be investigated; 3) the patient sample and method should match the MPLC phase; 4) different stakeholders should collaborate; and 5) results from PPS should be shared with relevant stakeholders. The value of patient preferences in decision-making was found to increase with the level of patient preference sensitivity of decisions on medical products. Stakeholders mentioned that patient preferences are hardly used in current decision-making. Potential applications for patient preferences across industry, regulatory and HTA processes were identified. Four applications seemed most promising for systematic integration of patient preferences: 1) benefit-risk assessment by industry and regulators at the marketing-authorization phase; 2) assessment of major contribution to patient care by European regulators; 3) cost-effectiveness analysis; and 4) multi criteria decision analysis in HTA. Conclusions: The value of patient preferences for decision-making depends on the level of collaboration across stakeholders; the match between the research question, MPLC phase, sample, and preference method used in PPS; and the sensitivity of the decision regarding a medical product to patient preferences. Promising applications for patient preferences should be further explored with stakeholders to optimize their inclusion in decision-making.
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Affiliation(s)
| | - Rosanne Janssens
- Clinical Pharmacology and Pharmacotherapy, KU Leuven, Leuven, Belgium
| | - Chiara Whichello
- School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands
| | | | | | - Nikoletta Nikolenko
- John Walton Muscular Dystrophy Research Centre, Newcastle University, Newcastle, United Kingdom
| | | | - Paolo Guiddi
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, Milan, Italy
| | - Gabriella Pravettoni
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, Milan, Italy.,Department of Oncology and Hematology Oncology, Faculty of Medicine and Surgery, University of Milan, Milan, Italy
| | - Laura Vergani
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, Milan, Italy.,Department of Oncology and Hematology Oncology, Faculty of Medicine and Surgery, University of Milan, Milan, Italy
| | - Giulia Marton
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, Milan, Italy.,Department of Oncology and Hematology Oncology, Faculty of Medicine and Surgery, University of Milan, Milan, Italy
| | | | - Steven Simoens
- Clinical Pharmacology and Pharmacotherapy, KU Leuven, Leuven, Belgium
| | - Jürgen Kübler
- Quantitative Scientific Consulting, Marburg, Germany
| | | | - Bennett Levitan
- Janssen Research & Development, Titusville, NJ, United States
| | | | - Jorien Veldwijk
- School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Isabelle Huys
- Clinical Pharmacology and Pharmacotherapy, KU Leuven, Leuven, Belgium
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11
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Janssens R, Huys I, van Overbeeke E, Whichello C, Harding S, Kübler J, Juhaeri J, Ciaglia A, Simoens S, Stevens H, Smith M, Levitan B, Cleemput I, de Bekker-Grob E, Veldwijk J. Opportunities and challenges for the inclusion of patient preferences in the medical product life cycle: a systematic review. BMC Med Inform Decis Mak 2019; 19:189. [PMID: 31585538 PMCID: PMC6778383 DOI: 10.1186/s12911-019-0875-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 07/23/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The inclusion of patient preferences (PP) in the medical product life cycle is a topic of growing interest to stakeholders such as academics, Health Technology Assessment (HTA) bodies, reimbursement agencies, industry, patients, physicians and regulators. This review aimed to understand the potential roles, reasons for using PP and the expectations, concerns and requirements associated with PP in industry processes, regulatory benefit-risk assessment (BRA) and marketing authorization (MA), and HTA and reimbursement decision-making. METHODS A systematic review of peer-reviewed and grey literature published between January 2011 and March 2018 was performed. Consulted databases were EconLit, Embase, Guidelines International Network, PsycINFO and PubMed. A two-step strategy was used to select literature. Literature was analyzed using NVivo (QSR international). RESULTS From 1015 initially identified documents, 72 were included. Most were written from an academic perspective (61%) and focused on PP in BRA/MA and/or HTA/reimbursement (73%). Using PP to improve understanding of patients' valuations of treatment outcomes, patients' benefit-risk trade-offs and preference heterogeneity were roles identified in all three decision-making contexts. Reasons for using PP relate to the unique insights and position of patients and the positive effect of including PP on the quality of the decision-making process. Concerns shared across decision-making contexts included methodological questions concerning the validity, reliability and cognitive burden of preference methods. In order to use PP, general, operational and quality requirements were identified, including recognition of the importance of PP and ensuring patient understanding in PP studies. CONCLUSIONS Despite the array of opportunities and added value of using PP throughout the different steps of the MPLC identified in this review, their inclusion in decision-making is hampered by methodological challenges and lack of specific guidance on how to tackle these challenges when undertaking PP studies. To support the development of such guidance, more best practice PP studies and PP studies investigating the methodological issues identified in this review are critically needed.
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Affiliation(s)
- Rosanne Janssens
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Herestraat 49, Box 521, 3000 Leuven, Belgium
| | - Isabelle Huys
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Herestraat 49, Box 521, 3000 Leuven, Belgium
| | - Eline van Overbeeke
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Herestraat 49, Box 521, 3000 Leuven, Belgium
| | - Chiara Whichello
- Erasmus School of Health Policy & Management (ESHPM) and Erasmus Choice Modelling Centre (ECMC), Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands
| | - Sarah Harding
- Takeda International, UK Branch, 61 Aldwych, London, WC2B 4AE UK
| | | | - Juhaeri Juhaeri
- Sanofi, 55 Corporate Drive, Bridgewater Township, NJ 08807 USA
| | - Antonio Ciaglia
- International Alliance of Patients’ Organizations, 49-51 East Rd, Hoxton, London, N1 6AH UK
| | - Steven Simoens
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Herestraat 49, Box 521, 3000 Leuven, Belgium
| | - Hilde Stevens
- Institute for Interdisciplinary Innovation in healthcare (I3h), Université libre de Bruxelles (ULB), Route de Lennik 808, 1070 Brussels, Belgium
| | | | - Bennett Levitan
- Global R&D Epidemiology, Janssen Research & Development, 1125 Trenton-Harbourton Road, PO Box 200, Titusville, NJ 08560 USA
| | - Irina Cleemput
- Belgian Health Care Knowledge Centre (KCE), Kruidtuinlaan 55, 1000 Brussels, Belgium
| | - Esther de Bekker-Grob
- Erasmus School of Health Policy & Management (ESHPM) and Erasmus Choice Modelling Centre (ECMC), Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands
| | - Jorien Veldwijk
- Erasmus School of Health Policy & Management (ESHPM) and Erasmus Choice Modelling Centre (ECMC), Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands
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12
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Whichello C, van Overbeeke E, Janssens R, Schölin Bywall K, Russo S, Veldwijk J, Cleemput I, Juhaeri J, Levitan B, Kübler J, Smith M, Hermann R, Englbrecht M, Hueber AJ, Comanescu A, Harding S, Simoens S, Huys I, de Bekker-Grob EW. Factors and Situations Affecting the Value of Patient Preference Studies: Semi-Structured Interviews in Europe and the US. Front Pharmacol 2019; 10:1009. [PMID: 31619989 PMCID: PMC6759933 DOI: 10.3389/fphar.2019.01009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 08/08/2019] [Indexed: 01/02/2023] Open
Abstract
Objectives: Patient preference information (PPI) is gaining recognition among the pharmaceutical industry, regulatory authorities, and health technology assessment (HTA) bodies/payers for use in assessments and decision-making along the medical product lifecycle (MPLC). This study aimed to identify factors and situations that influence the value of patient preference studies (PPS) in decision-making along the MPLC according to different stakeholders. Methods: Semi-structured interviews (n = 143) were conducted with six different stakeholder groups (physicians, academics, industry representatives, regulators, HTA/payer representatives, and a combined group of patients, caregivers, and patient representatives) from seven European countries (the United Kingdom, Sweden, Italy, Romania, Germany, France, and the Netherlands) and the United States. Framework analysis was performed using NVivo 11 software. Results: Fifteen factors affecting the value of PPS in the MPLC were identified. These are related to: study organization (expertise, financial resources, study duration, ethics and good practices, patient centeredness), study design (examining patient and/or other preferences, ensuring representativeness, matching method to research question, matching method to MPLC stage, validity and reliability, cognitive burden, patient education, attribute development), and study conduct (patients’ ability/willingness to participate and preference heterogeneity). Three types of situations affecting the use of PPS results were identified (stakeholder acceptance, market situations, and clinical situations). Conclusion: The factors and situation types affecting the value of PPS, as identified in this study, need to be considered when designing and conducting PPS in order to promote the integration of PPI into decision-making along the MPLC.
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Affiliation(s)
- Chiara Whichello
- Erasmus School of Health Policy & Management and Erasmus Choice Modelling Centre, Erasmus University, Rotterdam, Netherlands
| | - Eline van Overbeeke
- Department of Pharmaceutical and Pharmacological Sciences, University of Leuven, Leuven, Belgium
| | - Rosanne Janssens
- Department of Pharmaceutical and Pharmacological Sciences, University of Leuven, Leuven, Belgium
| | | | - Selena Russo
- Applied Research Division for Cognitive and Psychological Science, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Jorien Veldwijk
- Erasmus School of Health Policy & Management and Erasmus Choice Modelling Centre, Erasmus University, Rotterdam, Netherlands
| | | | | | - Bennett Levitan
- Global R&D Epidemiology, Janssen Research & Development, Titusville, United States
| | - Jürgen Kübler
- Quantitative Scientific Consulting, Marburg, Germany
| | - Meredith Smith
- Global Patient Safety and Labeling, Amgen Inc., Thousand Oaks, CA, United States
| | | | - Matthias Englbrecht
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Axel J Hueber
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
| | | | - Sarah Harding
- Global Patient Safety, Takeda, London, United Kingdom
| | - Steven Simoens
- Department of Pharmaceutical and Pharmacological Sciences, University of Leuven, Leuven, Belgium
| | - Isabelle Huys
- Department of Pharmaceutical and Pharmacological Sciences, University of Leuven, Leuven, Belgium
| | - Esther W de Bekker-Grob
- Erasmus School of Health Policy & Management and Erasmus Choice Modelling Centre, Erasmus University, Rotterdam, Netherlands
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13
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Copsey B, Buchanan J, Fitzpatrick R, Lamb SE, Dutton SJ, Cook JA. Duration of Treatment Effect Should Be Considered in the Design and Interpretation of Clinical Trials: Results of a Discrete Choice Experiment. Med Decis Making 2019; 39:461-473. [DOI: 10.1177/0272989x19841877] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective. This study examined whether duration of treatment effect should be considered in a benefit-risk assessment using a case study of osteoarthritis medications. Study Design and Setting. A discrete choice experiment was completed by 300 residents of the United Kingdom with hip and/or knee osteoarthritis. In 16 choice tasks, participants selected their preferred option from 2 medications. Medications were described in terms of effect on pain, stiffness, and function; duration of treatment effect; and risk of heart attack and stomach ulcer bleeding. The analysis used mixed-effects logistic regression. Results. Pain, disease severity, and duration of treatment effect had the greatest influence on medication preferences, whereas stiffness did not significantly affect medication choice. Participants were willing to accept an increase in the risk of heart attack of 2.6% (95% confidence interval: 2.0% to 3.2%) to increase the duration of treatment effect from 1 month to 12 months. Reducing pain from moderate to mild was valued the same as increasing duration of effect from 1 month to 3 months; both were seen as equivalent to an absolute reduction of 1.2% in the risk of heart attack in the next year. Subgroup analysis suggested disease severity influenced patient preferences. Conclusions. Along with treatment benefits and risks, the results suggest that duration of treatment effect is an important factor in the medication choices of people with osteoarthritis. This could have implications for the design and interpretation of clinical trials, for example, incorporating longer-term surveillance of trial participants and accounting for duration of treatment effect in risk-benefit assessments. Future research is needed to assess whether these findings are generalizable to other samples, disease areas, and levels of duration of effect.
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Affiliation(s)
- Bethan Copsey
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Botnar Research Centre, Windmill Road, Headington, Oxford, UK
| | - James Buchanan
- Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, UK
| | - Raymond Fitzpatrick
- Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, UK
| | - Sarah E. Lamb
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Botnar Research Centre, Windmill Road, Headington, Oxford, UK
| | - Susan J. Dutton
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Botnar Research Centre, Windmill Road, Headington, Oxford, UK
| | - Jonathan A. Cook
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Botnar Research Centre, Windmill Road, Headington, Oxford, UK
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14
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van Overbeeke E, Whichello C, Janssens R, Veldwijk J, Cleemput I, Simoens S, Juhaeri J, Levitan B, Kübler J, de Bekker-Grob E, Huys I. Factors and situations influencing the value of patient preference studies along the medical product lifecycle: a literature review. Drug Discov Today 2018; 24:57-68. [PMID: 30266656 DOI: 10.1016/j.drudis.2018.09.015] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 08/28/2018] [Accepted: 09/20/2018] [Indexed: 01/13/2023]
Abstract
Industry, regulators, health technology assessment (HTA) bodies, and payers are exploring the use of patient preferences in their decision-making processes. In general, experience in conducting and assessing patient preference studies is limited. Here, we performed a systematic literature search and review to identify factors and situations influencing the value of patient preference studies, as well as applications throughout the medical product lifecyle. Factors and situations identified in 113 publications related to the organization, design, and conduct of studies, and to communication and use of results. Although current use of patient preferences is limited, we identified possible applications in discovery, clinical development, marketing authorization, HTA, and postmarketing phases.
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Affiliation(s)
- Eline van Overbeeke
- Clinical Pharmacology and Pharmacotherapy, University of Leuven, Herestraat 49 Box 521, 3000 Leuven, Belgium.
| | - Chiara Whichello
- Erasmus School of Health Policy & Management (ESHPM) and Erasmus Choice Modelling Centre (ECMC), Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands
| | - Rosanne Janssens
- Clinical Pharmacology and Pharmacotherapy, University of Leuven, Herestraat 49 Box 521, 3000 Leuven, Belgium
| | - Jorien Veldwijk
- Erasmus School of Health Policy & Management (ESHPM) and Erasmus Choice Modelling Centre (ECMC), Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands
| | - Irina Cleemput
- Belgian Health Care Knowledge Centre (KCE), Kruidtuinlaan 55, 1000 Brussels, Belgium
| | - Steven Simoens
- Clinical Pharmacology and Pharmacotherapy, University of Leuven, Herestraat 49 Box 521, 3000 Leuven, Belgium
| | | | - Bennett Levitan
- Janssen Research & Development, 1125 Trenton-Harbourton Road, P.O. Box 200, Titusville, NJ 08560, USA
| | - Jürgen Kübler
- Quantitative Scientific Consulting, Europabadstr. 8, 35041 Marburg, Germany
| | - Esther de Bekker-Grob
- Erasmus School of Health Policy & Management (ESHPM) and Erasmus Choice Modelling Centre (ECMC), Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands
| | - Isabelle Huys
- Clinical Pharmacology and Pharmacotherapy, University of Leuven, Herestraat 49 Box 521, 3000 Leuven, Belgium
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