Symptoms and feelings valued by patients after a percutaneous coronary intervention: a discrete-choice experiment to inform development of a new patient-reported outcome

Abstract

ObjectiveTo inform the development of a patient-reported outcome measure, the aim of this study was to identify which symptoms and feelings following percutaneous coronary intervention (PCI) are most important to patients.DesignDiscrete-choice experiment consisting of two hypothetical scenarios of 10 symptoms and feelings (pain or discomfort; shortness of breath; concern/worry about heart problems; tiredness; confidence to do usual activities; ability to do usual activities; happiness; sleep disturbance; dizziness or light-headedness and bruising) experienced after PCI, described by three levels (never, some of the time, most of the time). Preference weights were estimated using a conditional logit model.SettingFour Australian public hospitals that contribute to the Victorian Cardiac Outcomes Registry (VCOR) and a private insurer’s claim database.Participants138 people aged >18 years who had undergone a PCI in the previous 6 months.Main outcome measuresPatient preferences via trade-offs between 10 feelings and symptoms.ResultsOf the 138 individuals recruited, 129 (93%) completed all 16 choice sets. Conditional logit parameter estimates were mostly monotonic (eg, moving to worse levels for each individual symptom and feeling made the option less attractive). When comparing the magnitude of the coefficients (based on the coefficient of the worst level relative to best level in each item), feeling unhappy was the symptom or feeling that most influenced perception of a least-preferred PCI outcome (OR 0.42, 95% CI 0.34 to 0.51, p<0.0001) and the least influential was bruising (OR 0.81, 95% CI 0.67 to 0.99, p=0.04).ConclusionThis study provides new insights into how patients value symptoms and feelings they experience following a PCI.

What matters most to patients following percutaneous coronary interventions? A new patient-reported outcome measure developed using Rasch analysis

“…This study was the final stage of a larger mixed-methods project (S1 Fig) that included a literature review, focus groups and interviews, and a discrete choice experiment (DCE) [20, 28, 29]. The methodology and results for these studies have been described in detail elsewhere and are briefly summarised below [20, 28, 29].…”

“…Eight focus groups and five interviews were conducted to explore patient perceptions of recovery with 32 patients who had undergone an elective or emergency PCI in the last six months [20]. Participants identified 10 symptoms and feelings to be important outcomes post-procedure (S1 Table) [20], which were subsequently confirmed by an expert panel consisting of cardiologists, nurses, health services researchers and allied health professionals[28].…”

“…In order to identify the physical, psychological and functional outcomes patients perceived as important following a PCI, a DCE was conducted with 138 people who had undergone the procedure in the last six months [28]. The DCE consisted of 240 choice sets of two health outcome scenarios of the 10 symptoms and feelings described in S1 Table (refer to Barker et al [28] for details). For each choice set, the participant was asked to select the scenario they would prefer to experience 30 days post-PCI (S2 Fig).…”

“…For each choice set, the participant was asked to select the scenario they would prefer to experience 30 days post-PCI (S2 Fig). The DCE analysis identified eight symptoms and feelings that were most valued by patients after having a PCI (S3 Fig)[28].…”

“…Recently, we conducted a mixed-methods project to identify outcomes most important to patients following PCI [20, 28, 29]. The primary aim of this study was to identify the final set of items that can be included in a PROM (the Monash University cardiac PROM [MC-PROM]) to assess recovery following PCI using the outcomes generated from previous studies.…”