Fraenkel Liana, Lim Joseph, Garcia-Tsao Guadalupe, Reyna Valerie, Monto Alexander
*VA Connecticut Health Care System, Yale University School of Medicine, New Haven, CT †Department of Human Development and Psychology, Cornell University, Ithaca, NY ‡San Francisco VAMC and the University of California, San Francisco, CA.
J Clin Gastroenterol. 2016 Mar;50(3):252-7. doi: 10.1097/MCG.0000000000000380.
To improve our understanding of patients' treatment preferences for chronic hepatitis C (HCV).
Subjects with HCV were recruited from 2 VA medical centers. Preferences were ascertained using conjoint analysis. We used segmentation analysis to examine whether there were groups of respondents with similar preferences that were systematically different from the preferences of others. We then measured the associations between treatment preference with subjects' characteristics and their gist principles related to living with HCV and the burden of therapy.
A total of 199 subjects participated in this study. The segmentation analysis demonstrated that subjects could be classified into 2 distinct groups. The larger group [group 1, n=118 (59%)] opted for current treatment and the other [group 2, n=81 (41%)] preferred to defer. Patients with cirrhosis were less likely to belong to group 2 (prefer to defer) compared with those without cirrhosis (40.5% vs. 21.3%), whereas subjects self-identifying as African American were more likely to belong to group 2 than white subjects (51.3% vs. 30.5%). Members of group 1 had a more positive overall gist principles related to HCV compared with members of group 2 [mean (SD) score=28.63 (3.06) vs. 26.46 (2.79), P<0.0001]. These gist principles mediated the relationship between race and treatment preference (Sobel test statistic=-2.68, 2-tailed P=0.007).
Our findings indicate that there are groups of HCV patients with similar preferences that are distinct from other groups' preferences. Patients' gist principles related to the significance of having a chronic viral infection and the burdens of therapy are strongly related to their current treatment decisions. These findings help inform how best to initiate and deliver treatment for patients with HCV.
加深我们对慢性丙型肝炎（HCV）患者治疗偏好的理解。
从2家退伍军人事务部医疗中心招募HCV患者。采用联合分析确定偏好。我们使用细分分析来检验是否存在偏好相似的受访者群体，这些群体与其他群体的偏好存在系统性差异。然后，我们测量了治疗偏好与受试者特征以及他们与HCV生活相关的要点原则和治疗负担之间的关联。
共有199名受试者参与了本研究。细分分析表明，受试者可分为2个不同的组。较大的组[第1组，n = 118（59%）]选择当前治疗，另一组[第2组，n = 81（41%）]则倾向于推迟治疗。与无肝硬化的患者相比，肝硬化患者属于第2组（倾向于推迟治疗）的可能性较小（40.5%对21.3%），而自我认定为非裔美国人的受试者比白人受试者更有可能属于第2组（51.3%对30.5%）。与第2组的成员相比，第1组的成员对HCV的总体要点原则更为积极[平均（标准差）得分 = 28.63（3.06）对26.46（2.79），P < 0.0001]。这些要点原则介导了种族与治疗偏好之间的关系（索贝尔检验统计量 = -2.68，双侧P = 0.007）。
我们的研究结果表明，存在偏好相似的HCV患者群体，这些群体与其他群体的偏好不同。患者与慢性病毒感染的重要性以及治疗负担相关的要点原则与他们当前的治疗决策密切相关。这些发现有助于指导如何为HCV患者启动和提供最佳治疗。
