Examining Treatment Decision‐Making Among Patients With Axial Spondyloarthritis: Insights From a Conjoint Analysis Survey

Abstract

Objective The number of therapies for axial spondyloarthritis (axSpA) is increasing. Thus, it has become more challenging for patients and physicians to navigate the risk‐benefit profiles of the various treatment options. In this study, we used conjoint analysis—a form of trade‐off analysis that elucidates how people make complex decisions by balancing competing factors—to examine patient decision‐making surrounding medication options for axSpA. Methods We conducted an adaptive choice‐based conjoint analysis survey for patients with axSpA to assess the relative importance of medication attributes (eg, chance of symptom improvement, risk of side effects, route of administration, etc) in their decision‐making. We also performed logistic regression to explore whether patient demographics and disease characteristics predicted decision‐making. Results Overall, 397 patients with axSpA completed the conjoint analysis survey. Patients prioritized medication efficacy (importance score 26.8%), cost (26.3%), and route of administration (13.9%) as most important in their decision‐making. These were followed by risk of lymphoma (9.5%), dosing frequency (7.2%), risk of serious infection (6.0%), tolerability of side effects (5.3%), and clinic visit and laboratory test frequency (4.8%). In regression analyses, there were few significant associations between patients’ treatment preferences and sociodemographic and axSpA characteristics. Conclusions Treatment decision‐making in axSpA is highly individualized, and demographics and baseline disease characteristics are poor predictors of individual preferences. This calls for the development of online shared decision‐making tools for patients and providers, with the goal of selecting a treatment that is consistent with patients’ preferences.

Determining patient treatment preferences for management of acute pain episodes in irritable bowel syndrome

“…While conjoint analysis has been used to examine clinical decision-making in other areas of healthcare, [16][17][18][19][20][21][22] it has not been commonly employed to assess IBS therapy decision-making. While prior studies have examined IBS patients' decision-making and willingness to take risks with hypothetical medications, [13][14][15] our study is…”

“…To accomplish this, we used conjoint analysis-a technique that determines how people make complex decisions by balancing competing factors that has been widely used in gastroenterology and beyond. [16][17][18][19][20][21][22] Furthermore, as a separate aim, we evaluated patients' willingness to use and minimum efficacy needed for them to consider SQ therapies for treating their breakthrough pain.…”

Conjoint Analysis: A Research Method to Study Patients’ Preferences and Personalize Care

“…In the hospital setting, implementation of CA constituted a feasible and useful tool in several clinical areas such as investigating hospital stakeholders' decision-making in the adoption of evidence-based interventions [68], eliciting patients preferences regarding diagnostics and screening [69,70], improving decision-making regarding patients' treatment [71,72], understanding patients' perceived needs and expectations [73], and determining the clinical factors that physicians prioritize regarding patients' treatment [74]. Furthermore, the CA method was very useful during the recent pandemic, as it has been used to understand how people prioritize when deciding whether to present to the emergency department during the coronavirus disease (COVID-19) pandemic for care unrelated to COVID-19 [75].…”

Australian Consensus Statements for the Assessment and Management of Non-radiographic Axial Spondyloarthritis

“…We found no directly relevant literature for these recommendations, only evidence detailing diverse preferences and frequent discordance between patient and physician global assessment. A survey of axSpA reported a wide variety of medication administration route preferences where only 50% preferred tablets [ 16 ]. A single study comparing patient global assessment and physician global assessment found these metrics to be significantly discordant at 48% of encounters [ 17 ].…”