Wong Shu Fen, Norman Richard, Dunning Trisha L, Ashley David M, Lorgelly Paula K
Department of Medicine, Barwon Health, Deakin University, Geelong, Victoria, Australia.
Andrew Love Cancer Centre, Barwon Health, Geelong, Victoria, Australia.
BMJ Open. 2014 Oct 24;4(10):e006661. doi: 10.1136/bmjopen-2014-006661.
Medical decision-making in oncology is a complicated process and to date there are few studies examining how patients with cancer make choices with respect to different features of their care. It is also unknown whether patient choices vary by geographical location and how location could account for observed rural and metropolitan cancer differences. This paper describes an ongoing study that aims to (1) examine patient and healthcare-related factors that influence choices of patients with cancer; (2) measure and quantify preferences of patients with cancer towards cancer care using a discrete choice experiment (DCE) and (3) explore preference heterogeneity between metropolitan and rural locations.
A DCE is being conducted to understand how patients with cancer choose between two clinical scenarios accounting for different patient and healthcare-related factors (and levels). Preliminary qualitative research was undertaken to guide the development of an appropriate DCE design including characteristics that are important and relevant to patients with cancer. A fractional factorial design using the D-efficiency criteria was used to estimate interactions among attributes. Multinomial logistic regression will be used for the primary DCE analysis and to control for sociodemographic and clinical characteristics.
The Barwon Health Human Research Ethics Committee approved the study. Findings from the study will be presented in national/international conferences and peer-reviewed journals. Our results will form the basis of a feasibility study to inform the development of a larger scale study into preferences of patients with cancer and their association with cancer outcomes.
肿瘤学中的医疗决策是一个复杂的过程，迄今为止，很少有研究探讨癌症患者如何就其治疗的不同特征做出选择。患者的选择是否因地理位置而异，以及地理位置如何解释观察到的农村和大都市地区的癌症差异，目前也尚不清楚。本文描述了一项正在进行的研究，其目的是：（1）研究影响癌症患者选择的患者及医疗相关因素；（2）使用离散选择实验（DCE）测量和量化癌症患者对癌症治疗的偏好；（3）探索大都市和农村地区之间的偏好异质性。
正在进行一项DCE，以了解癌症患者如何在两种临床情景之间进行选择，这两种情景考虑了不同的患者及医疗相关因素（和水平）。已开展初步定性研究，以指导制定合适的DCE设计，包括对癌症患者重要且相关的特征。使用D效率标准的分数析因设计来估计属性之间的相互作用。多项逻辑回归将用于主要的DCE分析，并控制社会人口统计学和临床特征。
巴旺健康人类研究伦理委员会批准了该研究。该研究的结果将在国内/国际会议和同行评审期刊上发表。我们的结果将构成一项可行性研究的基础，为开展一项关于癌症患者偏好及其与癌症结局关联的更大规模研究提供信息。
