Department of Pharmaceutical Sciences, University of Toronto, Toronto, Ontario, Canada.
Support Care Cancer. 2013 Jan;21(1):245-51. doi: 10.1007/s00520-012-1517-5. Epub 2012 Jun 9.
Studies have demonstrated that patients at low risk for febrile neutropenia (FN) complications can be treated safely and effectively at home. Information on patient preferences for outpatient treatment of this condition will help to optimize health care delivery to these patients. The purpose of this study was to elicit non-Hodgkin lymphoma patients' preferences on attributes related to outpatient treatment of FN.
We used a self-administered discrete choice experiment questionnaire based on the attributes of out-of-pocket costs, unpaid caregiver time required daily, and probability of return to the hospital. Ten paired scenarios in which levels of the attributes were varied were presented to study patients. For each pair, patients indicated the scenario they preferred. Adjusted odds ratios (ORs) of accepting a scenario that described outpatient care for FN were estimated.
Eighty-eight patients completed the questionnaire. Adjusted ORs [95 % confidence intervals] of accepting outpatient care for FN were 0.84 [0.75, 0.95] for each $10 increase in out-of-pocket cost; 0.82 [0.68, 0.99] for each 1 h increase in daily unpaid caregiver time; and 0.53 [0.50, 0.57] for each 5 % increase in probability of return to the hospital.
Probability of return to the hospital was the most important attribute to patients when considering home-based care for FN. Patients considered out-of-pocket costs and unpaid caregiver time to be less important than probability of return to the hospital. This study identifies factors that could be incorporated into outpatient delivery systems for FN care to ensure adequate patient uptake and satisfaction with such programs.
研究表明，患有发热性中性粒细胞减少症（FN）并发症低风险的患者可以安全有效地在家中接受治疗。了解患者对该疾病门诊治疗的偏好将有助于优化对这些患者的医疗服务。本研究旨在了解非霍奇金淋巴瘤患者对门诊治疗 FN 相关属性的偏好。
我们使用了基于自付费用、每日非付费护理时间和返院概率的离散选择实验问卷对患者进行调查。向研究患者展示了 10 对具有不同属性水平的配对场景。对于每对场景，患者会选择他们更倾向的场景。然后对接受门诊 FN 治疗的场景的调整后优势比（OR）进行了估计。
88 名患者完成了问卷。自付费用每增加 10 美元，接受 FN 门诊治疗的调整后 OR [95 %置信区间]为 0.84 [0.75, 0.95]；每日非付费护理时间每增加 1 小时，调整后 OR [95 %置信区间]为 0.82 [0.68, 0.99]；返院概率每增加 5 %，调整后 OR [95 %置信区间]为 0.53 [0.50, 0.57]。
当考虑 FN 的家庭护理时，返院概率是患者最看重的属性。患者认为自付费用和非付费护理时间不如返院概率重要。本研究确定了可纳入 FN 门诊治疗的交付系统的因素，以确保患者充分接受并对这些项目感到满意。
