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Connor MJ, Genie M, Dudderidge T, Wu H, Sukumar J, Beresford M, Bianchini D, Goh C, Horan G, Innominato P, Khoo V, Klimowska-Nassar N, Madaan S, Mangar S, McCracken S, Ostler P, Paisey S, Robinson A, Rai B, Sarwar N, Srihari N, Jayaprakash KT, Varughese M, Winkler M, Ahmed HU, Watson V. Patients' Preferences for Cytoreductive Treatments in Newly Diagnosed Metastatic Prostate Cancer: The IP5-MATTER Study. Eur Urol Oncol 2024:S2588-9311(24)00158-5. [PMID: 38972831 DOI: 10.1016/j.euo.2024.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Accepted: 06/12/2024] [Indexed: 07/09/2024]
Abstract
BACKGROUND AND OBJECTIVE Cytoreductive treatments for patients diagnosed with de novo synchronous metastatic hormone-sensitive prostate cancer (mHSPC) confer incremental survival benefits over systemic therapy, but these may lead to added toxicity and morbidity. Our objective was to determine patients' preferences for, and trade-offs between, additional cytoreductive prostate and metastasis-directed interventions. METHODS A prospective multicentre discrete choice experiment trial was conducted at 30 hospitals in the UK between December 3, 2020 and January 25, 2023 (NCT04590976). The individuals were eligible for inclusion if they were diagnosed with de novo synchronous mHSPC within 4 mo of commencing androgen deprivation therapy and had performance status 0-2. A discrete choice experiment instrument was developed to elicit patients' preferences for cytoreductive prostate radiotherapy, prostatectomy, prostate ablation, and stereotactic ablative body radiotherapy to metastasis. Patients chose their preferred treatment based on seven attributes. An error-component conditional logit model was used to estimate the preferences for and trade-offs between treatment attributes. KEY FINDINGS AND LIMITATIONS A total of 352 patients were enrolled, of whom 303 completed the study. The median age was 70 yr (interquartile range [IQR] 64-76) and prostate-specific antigen was 94 ng/ml (IQR 28-370). Metastatic stages were M1a 10.9% (33/303), M1b 79.9% (242/303), and M1c 7.6% (23/303). Patients preferred treatments with longer survival and progression-free periods. Patients were less likely to favour cytoreductive prostatectomy with systemic therapy (Coef. -0.448; [95% confidence interval {CI} -0.60 to -0.29]; p < 0.001), unless combined with metastasis-directed therapy. Cytoreductive prostate radiotherapy or ablation with systemic therapy, number of hospital visits, use of a "day-case" procedure, or addition of stereotactic ablative body radiotherapy did not impact treatment choice. Patients were willing to accept an additional cytoreductive treatment with 10 percentage point increases in the risk of urinary incontinence and fatigue to gain 3.4 mo (95% CI 2.8-4.3) and 2.7 mo (95% CI 2.3-3.1) of overall survival, respectively. CONCLUSIONS AND CLINICAL IMPLICATIONS Patients are accepting of additional cytoreductive treatments for survival benefit in mHSPC, prioritising preservation of urinary function and avoidance of fatigue. PATIENT SUMMARY We performed a large study to ascertain how patients diagnosed with advanced (metastatic) prostate cancer at their first diagnosis made decisions regarding additional available treatments for their prostate and cancer deposits (metastases). Treatments would not provide cure but may reduce cancer burden (cytoreduction), prolong life, and extend time without cancer progression. We reported that most patients were willing to accept additional treatments for survival benefits, in particular treatments that preserved urinary function and reduced fatigue.
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Affiliation(s)
- Martin J Connor
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer Imperial College London, London, UK; Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK.
| | - Mesfin Genie
- Health Economics Research Unit (HERU), Institute of Applied Health Science, School of Medicine, Medical Science and Nutrition, University of Aberdeen, Aberdeen, UK; Newcastle Business School, University of Newcastle, Newcastle, NSW, Australia; Department of Population Health Sciences, Duke University, Durham, USA
| | - Tim Dudderidge
- Urology, University Hospital Southampton, Southampton, UK
| | - Hangjian Wu
- Health Economics Research Unit (HERU), Institute of Applied Health Science, School of Medicine, Medical Science and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Johanna Sukumar
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer Imperial College London, London, UK; Imperial College Clinical Trials Unit, Imperial College London, London, UK
| | - Mark Beresford
- Department of Oncology, Royal United Hospitals Bath, Bath, UK
| | - Diletta Bianchini
- Department of Oncology and Urology, Medway Maritime Hospital, Kent, UK
| | - Chee Goh
- Department of Oncology, East Surrey Hospital, Redhill, UK
| | - Gail Horan
- Department of Oncology, The Queen Elizabeth Hospital King's Lynn NHS Foundation Trust & The Cancer Centre, Addenbrooke's Hospital, Cambridge, UK
| | | | - Vincent Khoo
- Department of Oncology, The Royal Marsden Hospital, London, UK
| | | | - Sanjeev Madaan
- Department of Urology, Dartford and Gravesham NHS Trust, Kent, UK
| | - Stephen Mangar
- Department of Oncology, Imperial College Healthcare NHS Trust, London, UK
| | - Stuart McCracken
- Department of Urology, Sunderland Royal Hospital, Sunderland, UK
| | - Peter Ostler
- Department of Oncology, Luton and Dunstable University Hospital, Luton, UK
| | - Sangeeta Paisey
- Department of Oncology, Hampshire Hospitals NHS Foundation Trust, Basingstoke and Winchester, UK
| | - Angus Robinson
- Department of Oncology, Royal Sussex County Hospital, Brighton, UK
| | - Bhavan Rai
- Department of Urology, Newcastle Freeman Hospital, Newcastle, UK
| | - Naveed Sarwar
- Department of Oncology, Imperial College Healthcare NHS Trust, London, UK
| | | | - Kamal Thippu Jayaprakash
- Department of Oncology, The Queen Elizabeth Hospital King's Lynn NHS Foundation Trust & The Cancer Centre, Addenbrooke's Hospital, Cambridge, UK
| | - Mohini Varughese
- Department of Oncology, Royal Devon and Exeter NHS Foundation Trust, Oncology, Exeter, UK
| | - Mathias Winkler
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer Imperial College London, London, UK; Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK; Department of Urology, West Middlesex University Hospital, London, UK
| | - Hashim U Ahmed
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer Imperial College London, London, UK; Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Verity Watson
- Health Economics Research Unit (HERU), Institute of Applied Health Science, School of Medicine, Medical Science and Nutrition, University of Aberdeen, Aberdeen, UK
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Bullen A, Ryan M, Ennis H, Gray E, Loría-Rebolledo LE, McIntyre M, Hall P. Trade-offs between overall survival and side effects in the treatment of metastatic breast cancer: eliciting preferences of patients with primary and metastatic breast cancer using a discrete choice experiment. BMJ Open 2024; 14:e076798. [PMID: 38684245 PMCID: PMC11057309 DOI: 10.1136/bmjopen-2023-076798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 03/01/2024] [Indexed: 05/02/2024] Open
Abstract
OBJECTIVES There has been a recent proliferation in treatment options for patients with metastatic breast cancer. Such treatments often involve trade-offs between overall survival and side effects. Our study aims to estimate the trade-offs that could be used to inform decision-making at the individual and policy level. DESIGN We designed a discrete choice experiment (DCE) to look at preferences for avoiding severity levels of side effects when choosing treatment for metastatic breast cancer. Treatment attributes were: fatigue, nausea, diarrhoea, other side effects (peripheral neuropathy, hand-foot syndrome and mucositis) and urgent hospital admission and overall survival. Responses were analysed using an error component logit model. We estimated the relative importance of attributes and minimum acceptable survival for improvements in side effects. SETTING The DCE was completed online by UK residents with self-reported diagnoses of breast cancer. PARTICIPANTS 105 respondents participated, of which 72 patients had metastatic breast cancer and 33 patients had primary breast cancer. RESULTS Overall survival had the largest relative importance, followed by other side effects, diarrhoea, nausea and fatigue. The risk of urgent hospital admission was not significant. While overall survival was the most important attribute, respondents were willing to forgo some absolute probability of overall survival for reductions in all Grade 2 side effects (12.02% for hand-foot syndrome, 11.01% for mucositis, 10.42% for peripheral neuropathy, 6.33% for diarrhoea and 3.62% for nausea). Grade 1 side effects were not significant, suggesting respondents have a general tolerance for them. CONCLUSIONS Patients are willing to forgo overall survival to avoid particular severity levels of side effects. Our results have implications for data collected in research studies and can help inform person-centred care and shared decision-making.
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Affiliation(s)
- Alistair Bullen
- Edinburgh Clinical Trials Unit, The University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
| | - Mandy Ryan
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | | | - Ewan Gray
- The University of Edinburgh, Edinburgh, UK
| | | | | | - Peter Hall
- The University of Edinburgh, Edinburgh, UK
- Western General Hospital, Edinburgh, UK
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Zgouridou A, Kenanidis E, Potoupnis M, Tsiridis E. Global mapping of institutional and hospital-based (Level II-IV) arthroplasty registries: a scoping review. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1219-1251. [PMID: 37768398 PMCID: PMC10858160 DOI: 10.1007/s00590-023-03691-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 08/13/2023] [Indexed: 09/29/2023]
Abstract
PURPOSE Four joint arthroplasty registries (JARs) levels exist based on the recorded data type. Level I JARs are national registries that record primary data. Hospital or institutional JARs (Level II-IV) document further data (patient-reported outcomes, demographic, radiographic). A worldwide list of Level II-IV JARs must be created to effectively assess and categorize these data. METHODS Our study is a systematic scoping review that followed the PRISMA guidelines and included 648 studies. Based on their publications, the study aimed to map the existing Level II-IV JARs worldwide. The secondary aim was to record their lifetime, publications' number and frequency and recognise differences with national JARs. RESULTS One hundred five Level II-IV JARs were identified. Forty-eight hospital-based, 45 institutional, and 12 regional JARs. Fifty JARs were found in America, 39 in Europe, nine in Asia, six in Oceania and one in Africa. They have published 485 cohorts, 91 case-series, 49 case-control, nine cross-sectional studies, eight registry protocols and six randomized trials. Most cohort studies were retrospective. Twenty-three per cent of papers studied patient-reported outcomes, 21.45% surgical complications, 13.73% postoperative clinical and 5.25% radiographic outcomes, and 11.88% were survival analyses. Forty-four JARs have published only one paper. Level I JARs primarily publish implant revision risk annual reports, while Level IV JARs collect comprehensive data to conduct retrospective cohort studies. CONCLUSIONS This is the first study mapping all Level II-IV JARs worldwide. Most JARs are found in Europe and America, reporting on retrospective cohorts, but only a few report on studies systematically.
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Affiliation(s)
- Aikaterini Zgouridou
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, Greece
| | - Eustathios Kenanidis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece.
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, Greece.
| | - Michael Potoupnis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, Greece
| | - Eleftherios Tsiridis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, Greece
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Loría-Rebolledo LE, Ryan M, Bond C, Porteous T, Murchie P, Adam R. Using a discrete choice experiment to develop a decision aid tool to inform the management of persistent pain in pharmacy: a protocol for a randomised feasibility study. BMJ Open 2022; 12:e066379. [PMID: 36137622 PMCID: PMC9511577 DOI: 10.1136/bmjopen-2022-066379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION In an era of personalised healthcare, it has become increasingly important to elicit individual-level preferences. While discrete choice experiments (DCEs) are widely used to measure patient preferences in the delivery of healthcare, the focus has been sample-level analysis. Using the DCE methodology, this project has designed a digital decision aid tool (DAT) with the potential to estimate individual preferences in real time to inform clinical consultation decisions in persistent pain management. METHODS Using a feasibility randomised control trial, this study aims to assess the feasibility of using this Understanding Persistent Pain (UPP) DAT in a pharmacy-based clinical setting and to test processes for a future definite randomised trial. Community and practice-based pharmacists (up to 10) will be recruited in The National Health Service (NHS) Grampian and trained in the use of the digital UPP DAT. Pharmacists will recruit up to 60 patients who are living with persistent pain. Patients will be randomised to one of two groups: using the UPP DAT or usual care. Pharmacists will follow-up patients as needed according to clinical need and following standard practice. DCE response data collected by the UPP DAT will be analysed using the penalised logit model, allowing estimation of individual preferences in real time. We will follow-up pharmacists and patients who use the UPP DAT to gather feedback on their experiences. ETHICS AND DISSEMINATION This study received ethical approval from the North of Scotland Research Ethics Committee (21/NS/0059) and received Research & Development Management Permission to proceed from NHS Grampian (2021UA003E). The study has been registered in the ClinicalTrials.gov database. Findings will be disseminated in peer-reviewed publications, presentations and newsletters and made available in the University of Aberdeen and Pharmacy Research UK websites. Participants gave informed consent to participate in the study before taking part. TRIAL REGISTRATION NUMBER NCT05102578; clinicaltrials.gov.
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Affiliation(s)
| | - Mandy Ryan
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Christine Bond
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Terry Porteous
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Peter Murchie
- Academic Primary Care, University of Aberdeen, Aberdeen, UK
| | - Rosalind Adam
- Academic Primary Care, University of Aberdeen, Aberdeen, UK
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Davaris MT, Bunzli S, Trieu J, Dowsey MM, Choong PF. The role of digital health interventions to improve health literacy in surgical patients: a narrative review in arthroplasty. ANZ J Surg 2022; 92:2474-2486. [PMID: 35924880 DOI: 10.1111/ans.17931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 07/05/2022] [Accepted: 07/09/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Arthroplasty is a high-volume but costly treatment option for advanced osteoarthritis. Health literacy and patient education are modifiable factors that can improve patient outcomes in arthroplasty. Digital technologies show potential as an instrument for providing patients with reliable information. This narrative review aimed to identify the current evidence for how effective digital health interventions (DHIs) are in targeting health literacy and related constructs (including knowledge, decision-making and self-efficacy) in arthroplasty. METHODS Six databases were searched for published studies comprising health literacy and related constructs, arthroplasty, and DHIs. The main outcome measure was health literacy. Two reviewer-authors independently screened studies according to predefined inclusion criteria and performed data extraction. Data was analysed and summarized in tabular and narrative form. RESULTS Two thousand seven-hundred and sixty-four titles and abstracts were screened. One hundred and sixty-seven papers underwent full-text analysis. No studies used health literacy as an outcome measure; therefore, the outcome measure was broadened to include its constructs, and the full-text analysis was repeated. Thirteen studies were included. No study following a structured design for their DHI. Eleven studies demonstrated participant improvement in constructs of health literacy, including knowledge, decision-making and self-management. CONCLUSION Current evidence suggests digital technology may provide new means of educating patients and improving aspects of their health literacy. More research digital technology with a structured approach, framework and standardized measures is required. Well-designed digital technology may become a useful adjunct to future patient care.
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Affiliation(s)
- Myles T Davaris
- Department of Surgery, St Vincent's Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Samantha Bunzli
- Department of Surgery, St Vincent's Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Jason Trieu
- Department of Surgery, St Vincent's Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Michelle M Dowsey
- Department of Surgery, St Vincent's Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Peter F Choong
- Department of Surgery, St Vincent's Hospital, University of Melbourne, Melbourne, Victoria, Australia
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Connor MJ, Genie MG, Burns D, Bass EJ, Gonzalez M, Sarwar N, Falconer A, Mangar S, Dudderidge T, Khoo V, Winkler M, Ahmed HU, Watson V. A Systematic Review of Patients' Values, Preferences, and Expectations for the Treatment of Metastatic Prostate Cancer. EUR UROL SUPPL 2021; 36:9-18. [PMID: 34977691 PMCID: PMC8703228 DOI: 10.1016/j.euros.2021.10.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2021] [Indexed: 12/01/2022] Open
Abstract
CONTEXT Advances in systemic agents have increased overall survival for men diagnosed with metastatic prostate cancer. Additional cytoreductive prostate treatments and metastasis-directed therapies are under evaluation. These confer toxicity but may offer incremental survival benefits. Thus, an understanding of patients' values and treatment preferences is important for counselling, decision-making, and guideline development. OBJECTIVE To perform a systematic review of patients' values, preferences, and expectations regarding treatment of metastatic prostate cancer. EVIDENCE ACQUISITION The MEDLINE, Embase, and CINAHL databases were systematically searched for qualitative and preference elucidation studies reporting on patients' preferences for treatment of metastatic prostate cancer. Certainty of evidence was assessed using Grading of Recommendation, Assessment, Development and Evaluation (GRADE) or GRADE Confidence in the Evidence from Reviews of Qualitative Research (CERQual). The protocol was registered on PROSPERO as CRD42020201420. EVIDENCE SYNTHESIS A total of 1491 participants from 15 studies met the prespecified eligibility for inclusion. The study designs included were discrete choice experiments (n = 5), mixed methods (n = 3), and qualitative methods (n = 7). Disease states reported per study were: metastatic castration-resistant prostate cancer in nine studies (60.0%), metastatic hormone-sensitive prostate cancer in two studies (13.3%), and a mixed cohort in four studies (26.6%). In quantitative preference elicitation studies, patients consistently valued treatment effectiveness and delay in time to symptoms as the two top-ranked treatment attributes (low or very low certainty). Patients were willing to trade off treatment-related toxicity for potential oncological benefits (low certainty). In qualitative studies, thematic analysis revealed cancer progression and/or survival, pain, and fatigue as key components in treatment decisions (low or very low certainty). Patients continue to value oncological benefits in making decisions on treatments under qualitative assessment. CONCLUSIONS There is limited understanding of how patients make treatment and trade-off decisions following a diagnosis of metastatic prostate cancer. For appropriate investment in emerging cytoreductive local tumour and metastasis-directed therapies, we should seek to better understand how this cohort weighs the oncological benefits against the risks. PATIENT SUMMARY We looked at how men with advanced (metastatic) prostate cancer make treatment decisions. We found that little is known about patients' preferences for current and proposed new treatments. Further studies are required to understand how patients make decisions to help guide the integration of new treatments into the standard of care.
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Affiliation(s)
- Martin J. Connor
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK,Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK,Corresponding author at: Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Imperial College London, Charing Cross Campus, Fulham Palace Road, London W6 8RF, UK.
| | - Mesfin G. Genie
- Health Economic Research Unit (HERU), Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - David Burns
- Health Economic Research Unit (HERU), Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Edward J. Bass
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK,Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Michael Gonzalez
- Department of Oncology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Naveed Sarwar
- Department of Oncology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Alison Falconer
- Department of Oncology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Stephen Mangar
- Department of Oncology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Tim Dudderidge
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Vincent Khoo
- Department of Clinical Oncology, The Royal Marsden Hospital & Institute of Cancer Research, London, UK
| | - Mathias Winkler
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK,Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Hashim U. Ahmed
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK,Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Verity Watson
- Health Economic Research Unit (HERU), Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
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Connor MJ, Genie MG, Gonzalez M, Sarwar N, Thippu Jayaprakash K, Horan G, Hosking-Jervis F, Klimowska-Nassar N, Sukumar J, Pokrovska T, Basak D, Robinson A, Beresford M, Rai B, Mangar S, Khoo V, Dudderidge T, Falconer A, Winkler M, Watson V, Ahmed HU. Metastatic prostate cancer men's attitudes towards treatment of the local tumour and metastasis evaluative research (IP5-MATTER): protocol for a prospective, multicentre discrete choice experiment study. BMJ Open 2021; 11:e048996. [PMID: 34794989 PMCID: PMC8603288 DOI: 10.1136/bmjopen-2021-048996] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Systemic therapy with androgen deprivation therapy (ADT) and intensification with agents such as docetaxel, abiraterone acetate and enzalutamide has resulted in improved overall survival in men with de novo synchronous metastatic hormone-sensitive prostate cancer (mHSPC). Novel local cytoreductive treatments and metastasis-directed therapy are now being evaluated. Such interventions may provide added survival benefit or delay the requirement for further systemic agents and associated toxicity but can confer additional harm. Understanding men's preferences for treatment options in this disease state is crucial for patients, clinicians, carers and future healthcare service providers. METHODS Using a prospective, multicentre discrete choice experiment (DCE), we aim to determine the attributes associated with treatment that are most important to men with mHSPC. Furthermore, we plan to determine men's preferences for, and trade-offs between, the attributes (survival and side effects) of different treatment options including systemic therapy, local cytoreductive approaches (external beam radiotherapy, cytoreductive radical prostatectomy or minimally invasive ablative therapy) and metastases-directed therapies (metastasectomy or stereotactic ablative body radiotherapy). All men with newly diagnosed mHSPC within 4 months of commencing ADT and WHO performance status 0-2 are eligible. Men who have previously consented to a cytoreductive treatment or have developed castrate-resistant disease will be excluded. This study includes a qualitative analysis component, with patients (n=15) and healthcare professionals (n=5), to identify and define the key attributes associated with treatment options that would warrant trade-off evaluation in a DCE. The main phase component planned recruitment is 300 patients over 1 year, commencing in January 2021, with planned study completion in March 2022. ETHICS AND DISSEMINATION Ethical approval was obtained from the Health Research Authority East of England, Cambridgeshire and Hertfordshire Research Ethics Committee (Reference: 20/EE/0194). Project information will be reported on the publicly available Imperial College London website and the Heath Economics Research Unit (HERU website including the HERU Blog). We will use the social media accounts of IP5-MATTER, Imperial Prostate London, HERU and the individual researchers to disseminate key findings following publication. Findings from the study will be presented at national/international conferences and peer-reviewed journals. Authorship policy will follow the recommendations of the International Committee of Medical Journal Editors. TRIAL REGISTRATION NUMBER NCT04590976.
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Affiliation(s)
- Martin John Connor
- Imperial Prostate, Divison of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
- Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Mesfin G Genie
- Health Economics Research Unit (HERU), Faculty of Medicine, University of Aberdeen, Aberdeen, UK
- Economics, Ca' Foscari University of Venice, Venezia, Italy
| | - Michael Gonzalez
- Department of Oncology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Naveed Sarwar
- Department of Oncology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Kamalram Thippu Jayaprakash
- Department of Oncology, Addenbrooke's Hospital, Cambridge, UK
- Department of Oncology, Queen Elizabeth Hospital King's Lynn NHS Foundation Trust, King's Lynn, UK
| | - Gail Horan
- Department of Oncology, Addenbrooke's Hospital, Cambridge, UK
| | - Feargus Hosking-Jervis
- Imperial Prostate, Divison of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Natalia Klimowska-Nassar
- Imperial Prostate, Divison of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
- Imperial College Clinical Trials Unit (ICTU), Imperial College London, London, UK
| | - Johanna Sukumar
- Imperial Prostate, Divison of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
- Imperial College Clinical Trials Unit (ICTU), Imperial College London, London, UK
| | - Tzveta Pokrovska
- Department of Oncology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Dolan Basak
- Department of Oncology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Angus Robinson
- Department of Oncology, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Mark Beresford
- Department of Oncology, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - Bhavan Rai
- Department of Urology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Stephen Mangar
- Department of Oncology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Vincent Khoo
- Department of Oncology, The Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, UK
| | - Tim Dudderidge
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Alison Falconer
- Department of Oncology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Mathias Winkler
- Imperial Prostate, Divison of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
- Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Verity Watson
- Health Economics Research Unit (HERU), Faculty of Medicine, University of Aberdeen, Aberdeen, UK
| | - Hashim Uddin Ahmed
- Imperial Prostate, Divison of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
- Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
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Abstract
BACKGROUND Common donor nerve options in smile reanimation include ipsilateral trigeminal motor or contralateral facial nerve branches. Neurotization preference may be influenced by multiple factors, whose relative importance remains poorly understood. In this article, decision-making in smile reanimation is assessed using a stated preference model. METHODS Qualitative interviews with facial palsy patients identified five relevant attributes for study: smile type ("smile when biting" versus "smile spontaneously" as proxies for trigeminal versus cross-facial neurotization), number of operations, success rates, complication rates, and side effects. Community volunteers (n = 250) completed a discrete-choice experiment relevant to free muscle transfer for smile reanimation. Preoperative and postoperative states were demonstrated through video vignettes, together with explanation of surgical risks, consequences, and benefits. Attribute importance was modeled using hierarchical Bayes estimation. RESULTS Two hundred forty-one responses met quality controls. Attribute importance ranked as follows: chance of success, 37.3 percent; smile type, 21.4 percent; side effects, 13.9 percent; complication rates, 13.8; and number of operations, 13.6 percent. All attributes significantly correlated with decision making (p < 0.0001). An aggregate response model revealed most participants (67.6 percent; standard error, 3.0 percent) preferred smile reanimation by cross-facial (assuming a success rate of 80 percent) as opposed to ipsilateral trigeminal motor branch neurotization. When the success rate for cross-facial neurotization was reduced below 67 percent, trigeminal neurotization was preferred. CONCLUSIONS Despite a higher risk of failure, most respondents preferred a cross-facial as opposed to trigeminal neurotization strategy for smile reanimation. These findings highlight the complexity of decision-making and need for individualized risk tolerance assessment in the field of facial reanimation.
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9
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Davaris MT, Bunzli S, Dowsey MM, Choong PF. Gamifying health literacy: how can digital technology optimize patient outcomes in surgery? ANZ J Surg 2021; 91:2008-2013. [PMID: 33825300 DOI: 10.1111/ans.16753] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 02/22/2021] [Accepted: 03/07/2021] [Indexed: 01/22/2023]
Abstract
The digital age is entrenched in our society, with constant innovation driving change in the way clinicians and patients manage their health concerns. Health literacy is emerging as an important modifiable factor that can affect clinical and patient outcomes, yet traditional forms of patient education have shown mixed results. Digital media and technologies, the concept of gamification as a means to improve patient health literacy, and its potential for misuse will be explored in this review, in the context of a digital, gamified tool that could support patients along their surgical journey.
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Affiliation(s)
- Myles T Davaris
- Department of Surgery, University of Melbourne, St Vincent's Hospital, Fitzroy, Victoria, Australia
| | - Samantha Bunzli
- Department of Surgery, University of Melbourne, St Vincent's Hospital, Fitzroy, Victoria, Australia
| | - Michelle M Dowsey
- Department of Surgery, University of Melbourne, St Vincent's Hospital, Fitzroy, Victoria, Australia
| | - Peter F Choong
- Department of Surgery, University of Melbourne, St Vincent's Hospital, Fitzroy, Victoria, Australia
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10
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Meng B, Ma J, Liu Z, Du C, Zhang G. Efficacy and Safety of Tranexamic Acid Combined with Rivaroxaban in Primary Total Knee Arthroplasty: A Meta-Analysis of Randomized Controlled Trials. J INVEST SURG 2019; 34:728-737. [PMID: 31766898 DOI: 10.1080/08941939.2019.1690602] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Tranexamic acid (TXA) combined with rivaroxaban (RA) has been widely used in total knee replacement (TKA). This meta-analysis explored the clinical effects of TXA combined with RA on reducing bleeding and preventing venous thrombosis in patients with unilateral TKA. METHODS Five controlled clinical studies that met the inclusion criteria were collected from PubMed, Embase and Cochrane libraries. Fixed effect model and random effect model were used to compare the TXA + RA group with the RA group in 731 patients. RESULTS Decrease of hemoglobin (Hb), total blood loss, transfusion rate and wound complications of the TXA + RA group is lower than the RA group, the difference was statistically significant (p < 0.05). Deep venous thrombosis (DVT) occurs in the TXA + RA group and the RA group showed no statistically significant difference (p > 0.05). There was no obvious difference of two ways of drug given that intra-articular (IA) and intravenous (IV) effect on Hb decrease, total blood loss, transfusion rate, wound complications, DVT (p > 0.05). CONCLUSION The application of TXA combined with RA in the TKA can effectively reduce blood loss without increasing the risk of DVT. However, it should be noted that TXA combined with RA after TKA has a potential increased risk of wound complications.
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Affiliation(s)
- Baoyuan Meng
- Graduate School of Qinghai University, Qinghai University, Xining, China
| | - Juan Ma
- Graduate School of Qinghai University, Qinghai University, Xining, China
| | - Zhou Liu
- Graduate School of Qinghai University, Qinghai University, Xining, China
| | - Changhong Du
- Graduate School of Qinghai University, Qinghai University, Xining, China
| | - Guoqiu Zhang
- Graduate School of Qinghai University, Qinghai University, Xining, China
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11
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Szawlowski S, Choong PFM, Li J, Nelson E, Nikpour M, Scott A, Sundararajan V, Dowsey MM. How do surgeons' trade-off between patient outcomes and risk of complications in total knee arthroplasty? a discrete choice experiment in Australia. BMJ Open 2019; 9:e029406. [PMID: 31272981 PMCID: PMC6615832 DOI: 10.1136/bmjopen-2019-029406] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To measure the trade-off between risk of complications versus patient improvement in pain and function in orthopaedic surgeons' decisions about whether to undertake total knee arthroplasty (TKA). METHODS A discrete choice experiment asking surgeons to make choices between experimentally-designed scenarios describing different levels of operative risk and dimensions of pain and physical function. Variation in preferences and trade-offs according to surgeon-specific characteristics were also examined. RESULTS The experiment was completed by a representative sample of 333 orthopaedic surgeons (n=333): median age 52 years, 94% male, 91% fully qualified. Orthopaedic surgeons were willing to accept substantial increases in absolute risk associated with TKA surgery for greater improvements in a patient's pain and function. The maximum risk surgeons were willing to accept was 40% for reoperation and 102% for the need to seek further treatment from a general practitioner or specialist in return for a change from postoperative severe night-time pain at baseline to no night-time pain at 12 months. With a few exceptions, surgeon-specific characteristics were not associated with how much risk a surgeon is willing to accept in a patient undergoing TKA. CONCLUSION This is the first study to quantify risk-benefit trade-offs among orthopaedic surgeons performing TKA, using a discrete choice experiment. This study provides insight into the risk tolerance of surgeons.
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Affiliation(s)
- Sandie Szawlowski
- Melbourne Institute of Applied Economic and Social Research, The University of Melbourne, Parkville, Victoria, Australia
| | - Peter F M Choong
- Department of Surgery, St Vincent's Hospital, The University of Melbourne, Fitzroy, Victoria, Australia
- Department of Orthopaedics, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Jinhu Li
- Department of Economics, Deakin University, Burwood, Victoria, Australia
| | - Elizabeth Nelson
- Department of Surgery, St Vincent's Hospital, The University of Melbourne, Fitzroy, Victoria, Australia
| | - Mandana Nikpour
- Department of Medicine, St Vincent's Hospital, The University of Melbourne, Fitzroy, Victoria, Australia
| | - Anthony Scott
- Melbourne Institute of Applied Economic and Social Research, The University of Melbourne, Parkville, Victoria, Australia
| | - Vijaya Sundararajan
- Department of Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Michelle M Dowsey
- Department of Surgery, St Vincent's Hospital, The University of Melbourne, Fitzroy, Victoria, Australia
- Department of Orthopaedics, St Vincent's Hospital, Melbourne, Victoria, Australia
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12
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Hiligsmann M, Pinto D, Dennison E, Al-Daghri N, Beaudart C, Branco J, Bruyère O, Conaghan PG, Cooper C, Herrero-Beaumont G, Jiwa F, Lems W, Rizzoli R, Thomas T, Veronese N, Reginster JY. Patients' preferences for osteoarthritis treatment: the value of stated-preference studies. Aging Clin Exp Res 2019; 31:1-3. [PMID: 30607878 PMCID: PMC6390947 DOI: 10.1007/s40520-018-1098-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 12/12/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Mickael Hiligsmann
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
| | - Daniel Pinto
- Department of Physical Therapy, Marquette University, Milwaukee, USA
| | - Elaine Dennison
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, England, UK
| | - Nasser Al-Daghri
- Prince Mutaib Chair for Biomarkers of Osteoporosis, Biochemistry Department, College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Charlotte Beaudart
- Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | - Jaime Branco
- Rheumatology Department, CEDOC-NOVA Medical School, Faculdade de Ciências Médicas da Universidade Nova de Lisboa, CHLO, Hospital Egas Moniz, Lisbon, Portugal
| | - Olivier Bruyère
- Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | - Philip G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds, UK
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, England, UK
- NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK
| | | | - Famida Jiwa
- Chair of the Committee of Patients Societies at the International Osteoporosis Foundation, Osteoporosis Canada, Toronto, Canada
| | - Willem Lems
- VU University Medical Center, Amsterdam, The Netherlands
| | - Rene Rizzoli
- Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Thierry Thomas
- Department of Rheumatology, Nord Hospital, University Hospital of St-Etienne, INSERM 1059, University of Lyon, Saint-Étienne, France
| | - Nicola Veronese
- Neuroscience Institute, Aging Branch, National Research Council, Padua, Italy
| | - Jean-Yves Reginster
- Prince Mutaib Chair for Biomarkers of Osteoporosis, Biochemistry Department, College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia
- Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
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13
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Mahdi A, Nyman MH, Wretenberg P. How do orthopaedic surgeons inform their patients before knee arthroplasty surgery? A cross-sectional study. BMC Musculoskelet Disord 2018; 19:414. [PMID: 30474569 PMCID: PMC6260647 DOI: 10.1186/s12891-018-2345-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Accepted: 11/15/2018] [Indexed: 11/11/2022] Open
Abstract
Background Total knee arthroplasty (TKA) is a successful and common procedure. However, 6–28% of patients are dissatisfied postoperatively. The provision of preoperative patient information, inquiring about patients’ expectations, and taking a psychiatric history are essential parts of both preoperative evaluation and postoperative outcome. The aim of this study was to investigate how orthopaedic knee surgeons in Sweden inform their patients before surgery. Methods A questionnaire was distributed to all knee surgeons performing TKA in Sweden. Responses were received from 60 of the 65 orthopaedic departments performing TKA in Sweden (92%), covering 219 of the approximately 311 knee surgeons at the 65 departments (70%). The answers were analysed with descriptive statistics. A content analysis of the surgeons’ opinions was also performed using a thematic method. Results In terms of information provision, 58% of the surgeons always gave written information while 92% informed orally. Only 44% always asked about the patient’s expectations, and only 42% always informed patients about the 20% dissatisfaction rate after TKA. Additionally, 24% never operated on mild indication of arthrosis, 20% always took a psychiatric history, and half never or seldom consulted a psychiatrist. However, all the knee surgeons believed in a psychiatric impact on TKA outcome. Qualitative analysis revealed five common causes of patient dissatisfaction, which in descending frequency were: patients’ expectations, choice of patients to operate on, surgical factors, combinations of factors, and insufficient information provision to patients. Conclusions Knee surgeons in Sweden have considerable awareness of the importance of preoperative patient information, the impact of patient expectations, and psychiatric illness. However, they need to improve their preoperative routines when it comes to providing written information, asking about the patient’s expectations, and psychiatric assessment.
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Affiliation(s)
- Aamir Mahdi
- Department of Orthopaedics, Örebro County, Sweden. .,Faculty of Medicine and Health, School of Medical Sciences, Örebro University, Örebro, Sweden.
| | - Maria Hälleberg Nyman
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Per Wretenberg
- Department of Orthopaedics, Örebro County, Sweden.,Faculty of Medicine and Health, School of Medical Sciences, Örebro University, Örebro, Sweden
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14
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Weernink MG, van Til JA, Witteman HO, Fraenkel L, IJzerman MJ. Individual Value Clarification Methods Based on Conjoint Analysis: A Systematic Review of Common Practice in Task Design, Statistical Analysis, and Presentation of Results. Med Decis Making 2018; 38:746-755. [PMID: 29592585 PMCID: PMC6587358 DOI: 10.1177/0272989x18765185] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 02/09/2018] [Indexed: 01/29/2023]
Abstract
BACKGROUND There is an increased practice of using value clarification exercises in decision aids that aim to improve shared decision making. Our objective was to systematically review to which extent conjoint analysis (CA) is used to elicit individual preferences for clinical decision support. We aimed to identify the common practices in the selection of attributes and levels, the design of choice tasks, and the instrument used to clarify values. METHODS We searched Scopus, PubMed, PsycINFO, and Web of Science to identify studies that developed a CA exercise to elicit individual patients' preferences related to medical decisions. We extracted data on the above-mentioned items. RESULTS Eight studies were identified. Studies included a fixed set of 4-8 attributes, which were predetermined by interviews, focus groups, or literature review. All studies used adaptive conjoint analysis (ACA) for their choice task design. Furthermore, all studies provided patients with their preference results in real time, although the type of outcome that was presented to patients differed (attribute importance or treatment scores). Among studies, patients were positive about the ACA exercise, whereas time and effort needed from clinicians to facilitate the ACA exercise were identified as the main barriers to implementation. DISCUSSION There is only limited published use of CA exercises in shared decision making. Most studies resembled each other in design choices made, but patients received different feedback among studies. Further research should focus on the feedback patients want to receive and how the CA results fit within the patient-physician dialogue.
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Affiliation(s)
- Marieke G.M. Weernink
- Department of Health Technology and Services Research, MIRA—Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, the Netherlands
| | - Janine A. van Til
- Department of Health Technology and Services Research, MIRA—Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, the Netherlands
| | - Holly O. Witteman
- />Department of Family and Emergency Medicine, Office of Education and Professional Development, Laval University, Quebec City, QC, Canada
- />Population Health and Optimal Health Practices Research Unit, CHU de Québec, Quebec City, QC, Canada
| | | | - Maarten J. IJzerman
- Department of Health Technology and Services Research, MIRA—Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, the Netherlands
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15
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Antonio ALM, Weiss RE, Saigal CS, Dahan E, Crespi CM. A Bayesian hierarchical model for discrete choice data in health care. Stat Methods Med Res 2017; 27:3544-3559. [PMID: 28417689 DOI: 10.1177/0962280217704226] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In discrete choice experiments, patients are presented with sets of health states described by various attributes and asked to make choices from among them. Discrete choice experiments allow health care researchers to study the preferences of individual patients by eliciting trade-offs between different aspects of health-related quality of life. However, many discrete choice experiments yield data with incomplete ranking information and sparsity due to the limited number of choice sets presented to each patient, making it challenging to estimate patient preferences. Moreover, methods to identify outliers in discrete choice data are lacking. We develop a Bayesian hierarchical random effects rank-ordered multinomial logit model for discrete choice data. Missing ranks are accounted for by marginalizing over all possible permutations of unranked alternatives to estimate individual patient preferences, which are modeled as a function of patient covariates. We provide a Bayesian version of relative attribute importance, and adapt the use of the conditional predictive ordinate to identify outlying choice sets and outlying individuals with unusual preferences compared to the population. The model is applied to data from a study using a discrete choice experiment to estimate individual patient preferences for health states related to prostate cancer treatment.
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Affiliation(s)
- Anna Liza M Antonio
- 1 Department of Biostatistics, Fielding School of Public Health, UCLA, Los Angeles, CA, USA
| | - Robert E Weiss
- 1 Department of Biostatistics, Fielding School of Public Health, UCLA, Los Angeles, CA, USA
| | | | - Ely Dahan
- 3 Anderson School of Management, UCLA, Los Angeles, CA, USA
| | - Catherine M Crespi
- 1 Department of Biostatistics, Fielding School of Public Health, UCLA, Los Angeles, CA, USA
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