Bansback Nick, Harrison Mark, Marra Carlo
Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, BC, Canada (NB)
School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada (NB)
Med Decis Making. 2016 May;36(4):490-502. doi: 10.1177/0272989X15600708. Epub 2015 Aug 24.
Imprecision in estimates of benefits and harms around treatment choices is rarely described to patients. Variation in sampling error between treatment alternatives (e.g., treatments have similar average risks, but one treatment has a larger confidence interval) can result in patients failing to choose the option that is best for them. The aim of this study is to use a discrete choice experiment to describe how 2 methods for conveying imprecision in risk influence people's treatment decisions.
We randomized a representative sample of the Canadian general population to 1 of 3 surveys that sought choices between hypothetical treatments for rheumatoid arthritis based on different levels of 7 attributes: route and frequency of administration, chance of benefit, serious and minor side effects and life expectancy, and imprecision in benefit and side-effect estimates. The surveys differed in the way imprecision was described: 1) no imprecision, 2) quantitative description based on a range with a visual graphic, and 3) qualitative description simply describing the confidence in the evidence.
The analyzed data were from 2663 respondents. Results suggested that more people understood imprecision when it was described qualitatively (88%) versus quantitatively (68%). Respondents who appeared to understand imprecision descriptions placed high value on increased precision regarding the actual benefits and harms of treatment, equivalent to the value placed on the information about the probability of serious side effects. Both qualitative and quantitative methods led to small but significant increases in decision uncertainty for choosing any treatment. Limitations included some issues in defining understanding of imprecision and the use of an internet survey of panel members.
These findings provide insight into how conveying imprecision information influences patient treatment choices.
治疗选择的获益和危害评估中的不精确性很少向患者说明。治疗方案之间抽样误差的差异（例如，治疗具有相似的平均风险，但一种治疗的置信区间更大）可能导致患者无法选择最适合自己的方案。本研究的目的是使用离散选择实验来描述传达风险不精确性的两种方法如何影响人们的治疗决策。
我们将加拿大普通人群的代表性样本随机分为3项调查中的1项，这些调查要求基于7个属性的不同水平，在类风湿性关节炎的假设治疗方案之间进行选择：给药途径和频率、获益机会、严重和轻微副作用以及预期寿命，以及获益和副作用估计的不精确性。各项调查在描述不精确性的方式上有所不同：1）无不精确性，2）基于范围并带有视觉图形的定量描述，3）仅描述对证据信心的定性描述。
分析的数据来自2663名受访者。结果表明，与定量描述（68%）相比，定性描述不精确性时，更多人能够理解（88%）。似乎理解不精确性描述的受访者高度重视提高治疗实际获益和危害方面的精确性，这与对严重副作用概率信息的重视程度相当。定性和定量方法都导致选择任何治疗方案时决策不确定性有小幅但显著的增加。局限性包括在定义对不精确性的理解方面存在一些问题，以及使用了对小组成员的网络调查。
这些发现为传达不精确性信息如何影响患者治疗选择提供了见解。
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