Clinician preferences for neurotechnologies in pediatric drug‐resistant epilepsy: A discrete choice experiment

Abstract

Objective Novel and minimally invasive neurotechnologies offer the potential to reduce the burden of epilepsy while avoiding the risks of conventional resective surgery. Few neurotechnologies have been tested in randomized controlled trials with pediatric populations, leaving clinicians to face decisions about whether to recommend these treatments with insufficient evidence about the relevant risks and benefits. This study specifically explores the preferences of clinicians for treating pediatric drug‐resistant epilepsy (DRE) with novel neurotechnologies. Methods A discrete‐choice experiment (DCE) was designed to elicit the preferences of clinicians with experience in treating children with DRE using novel neurotechnological interventions. The preferences for six key attributes used when making treatment decisions (chances of clinically significant improvement in seizures, major and minor risks from intervention, availability of evidence, financial burden for the family, and access to the intervention) were estimated using a conditional logit model. The estimates from this model were then used to predict the adoption of existing novel neurotechnological interventions. Results Sixty‐eight clinicians completed the survey: 33 neurosurgeons, 28 neurologists, and 7 other clinicians. Most clinicians were working in the United States (74%), and the remainder (26%) in Canada. All attributes, apart from the nearest location with access to the intervention, influenced preferences significantly. The chance of clinically significant improvement in seizures was the most positive influence on clinician preferences, but low‐quality evidence and a higher risk of major complications could offset these preferences. Of the existing neurotechnological interventions, vagus nerve stimulation was predicted to have the highest likelihood of adoption; deep brain stimulation had the lowest likelihood of adoption. Significance The preferences of clinicians are drive primarily by the likelihood of achieving seizure freedom for their patients, but preferences for an intervention are largely eradicated if only low quality of evidence supporting the intervention is available. Until better evidence supporting the use of potentially effective, novel neurotechnologies becomes available, clinicians are likely to prefer more established treatments.

Add‐On Deep Brain Stimulation versus Continued Vagus Nerve Stimulation for Childhood Epilepsy (ADVANCE): A Partially Randomized Patient Preference Trial

“…The majority of the benefit of VNS is realized within the first year of optimization, 5 although some have argued that a longer optimization period is needed, especially for patients experiencing VNS‐induced side‐effects 15 . Given that VNS remains the favored choice upfront for most clinicians, 16 the current work supports earlier add‐on DBS therapy.…”

Role Preferences in Medical Decision Making: Relevance and Implications for Health Preference Research

“…When role preferences are directly discussed in qualitative research, it is often with regards to the patient’s preference for the clinician’s role [ 33 ]. Some researchers indicate that their qualitative data collection instrument inquired about role preferences, but there is little description of role preferences reported in the results [ 34 ]. In other cases, authors discuss findings regarding role preferences, but do not indicate whether this information was actionable or contributed to the HPR study design [ 35 – 37 ].…”