Background As the number and type of cancer treatments available rises and patients live with the consequences of their disease and treatments for longer, understanding preferences for cancer care can help inform decisions about optimal treatment development, access, and care provision. Discrete choice experiments (DCEs) are commonly used as a tool to elicit stakeholder preferences; however, their implementation in oncology may be challenging if burdensome trade-offs (e.g. length of life versus quality of life) are involved and/or target populations are small. Objectives The aim of this review was to characterise DCEs relating to cancer treatments that were conducted between 1990 and March 2020. Data Sources EMBASE, MEDLINE, and the Cochrane Database of Systematic Reviews were searched for relevant studies. Study Eligibility Criteria Studies were included if they implemented a DCE and reported outcomes of interest (i.e. quantitative outputs on participants' preferences for cancer treatments), but were excluded if they were not focused on pharmacological, radiological or surgical treatments (e.g. cancer screening or counselling services), were non-English, or were a secondary analysis of an included study. Analysis Methods Analysis followed a narrative synthesis, and quantitative data were summarised using descriptive statistics, including rankings of attribute importance. Result Seventy-nine studies were included in the review. The number of published DCEs relating to oncology grew over the review period. Studies were conducted in a range of indications (n = 19), most commonly breast (n =10, 13%) and prostate (n = 9, 11%) cancer, and most studies elicited preferences of patients (n = 59, 75%). Across reviewed studies, survival attributes were commonly ranked as most important, with overall survival (OS) and progression-free survival (PFS) ranked most important in 58% and 28% of models, respectively. Preferences varied between stakeholder groups, with patients and clinicians placing greater importance on survival outcomes, and general population samples valuing health-related quality of life (HRQoL). Despite the emphasis of guidelines on the importance of using qualitative research to inform attribute selection and DCE designs, reporting on instrument development was mixed. Limitations No formal assessment of bias was conducted, with the scope of the paper instead providing a descriptive characterisation. The review only included DCEs relating to cancer treatments, and no insight is provided into other health technologies such as cancer screening. Only DCEs were included. Conclusions and Implications Although there was variation in attribute importance between responder types, survival attributes were consistently ranked as important by both patients and clinicians. Observed challenges included the risk of attribute dominance for survival outcomes, limited sample sizes in some indications, and a lack of reporting about instrument development processes. Protocol Registration PROSPERO 2020 CRD42020184232.
BACKGROUND AND AIMS Anemia is an important and common complication of chronic kidney disease (CKD). As the treatment landscape evolves, improving our limited understanding of patient and physician preferences for the management of anemia of CKD may help to better address patients’ treatment needs. Qualitative interviews were conducted to identify key treatment aspects that affect patients’ and physicians’ treatment preferences. METHOD A targeted literature informed the design and content of semi-structured qualitative interviews. All interviews were conducted (by telephone, in local language) with CKD patients (non-dialysis dependent and peritoneal dialysis dependent) and physicians from the USA, Germany and Japan. Interviews comprised of three parts. Part 1 discussed patients’ symptoms and quality of life, while physicians were asked about their clinical experience. Part 2 covered treatment experience and concerns, and included semi-structured discussions about benefits, adverse events and convenience. In part 3, patients and physicians were presented with a hypothetical treatment choice that required benefit–risk trade-offs. All data were analyzed using mixed deductive and inductive analysis, and results were visualized using a conceptual map. Subsequently, an attribute selection workshop was held with nephrologists from the USA and Germany, in which findings from the literature review and qualitative interviews were reviewed at length to identify drivers for patient and physician preferences for anemia treatments. RESULTS A total of 18 patients (n = 6 from each country) and 12 physicians (n = 4 from each country) participated in the qualitative interviews. Patients were at least in CKD stage 3 with 50% in stage 5. Most patients (72%) were receiving treatment with a recombinant human erythropoietin. Most frequently reported comorbidities were hypertension (78%), type 2 diabetes (46%) and hyperlipidemia (22%). All physicians had been in clinical practice for 40–50 years and 75% were in private practice. Figure 1 depicts the attribute conceptual map. Control of hemoglobin within target range was important to both patients and physicians. Physicians linked hemoglobin control to fewer symptoms and better quality of life. Nine out of 12 physicians (75%) spontaneously stated that they were concerned about the cardiovascular (CV) risk associated with use of erythropoiesis-stimulating agents. Patients reported experiencing several symptoms associated with anemia of CKD, with fatigue/tiredness (lack of energy) and dizziness being the most common. Physicians also highlighted these as important, and patients linked improvements in lack of energy to treatment success. Patients raised concerns about the convenience of intravenous (time commitment) and subcutaneous (storage requirements, self-injection) administration, but considered oral pills to be convenient and familiar. Once-daily administration of oral pills was considered easier to remember than thrice weekly. CONCLUSION This study demonstrated that patient and physician treatment preferences are multi-factorial, driven by clinically important attributes such as keeping within hemoglobin target ranges, reducing fatigue and weakness and the risk of CV side effects. Drug regimen attributes such as dosing frequency and dosing requirements affected perceived convenience. While all aspects contribute jointly to perceived value, they appear to have different relative importance. These findings are suitable for designing a subsequent preference elicitation survey that will aim to elicit trade-offs between the relevant treatment aspects and better understand patient and physician preferences. Sponsorship: GlaxoSmithKline (Study number: 213 496).
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.