Hamilton D W, Pedersen A, Blanchford H, Bins J E, McMeekin P, Thomson R, Paleri V, Wilson J A
Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.
Freeman Hospital, Newcastle upon Tyne, UK.
Clin Otolaryngol. 2018 Feb;43(1):117-123. doi: 10.1111/coa.12906. Epub 2017 Jul 11.
Time trade-off choice experiment.
Two large head and neck cancer centres.
Patients who have received treatment for head and neck cancer and members of the head and neck cancer multidisciplinary team.
Participants were asked to rank the outcome scenarios, assign utility values using time trade-off and rate the importance of survival on treatment choice.
A total of 49 patients with head and neck cancer and 73 staff members were recruited. Chemoradiotherapy (CRT) optimal outcome was the most preferred health state (34 of 49, 69% patients, and 50 of 73, 68% staff), and CRT with complications was least preferred (27 of 49, 55% patients, and 51 of 73, 70% staff). Using time trade-off, mean utility values were calculated for CRT optimal outcome (0.73 for patients, 0.77 for staff), total laryngectomy (TL) optimal outcome (0.67 for patients, 0.69 for staff), TL outcome with complications (0.46 for patients, 0.51 for staff) and CRT with complications (0.36 for patients, 0.49 for staff). The average survival advantage required for a participant to change their preferred choice was 2.6 years.
We have demonstrated that a significant proportion of patients with head and neck cancer and staff members would not choose CRT to manage locally advanced laryngeal cancer. Staff members rated the health states associated with laryngeal cancer treatment higher than patients who have experienced them, and this is particularly evident when considering the poorer outcomes. The head and neck cancer community should develop methods of practice and decision-making which incorporate elicitation and reporting of patient values as a central principle.
时间权衡选择实验。
两个大型头颈癌中心。
接受过头颈癌治疗的患者以及头颈癌多学科团队成员。
要求参与者对头颈癌治疗结局方案进行排序，使用时间权衡法赋予效用值，并评估生存对治疗选择的重要性。
共招募了49名头颈癌患者和73名工作人员。放化疗（CRT）最佳结局是最偏好的健康状态（49名患者中有34名，占69%；73名工作人员中有50名，占68%），而伴有并发症的CRT是最不被偏好的（49名患者中有27名，占55%；73名工作人员中有51名，占70%）。使用时间权衡法，计算出CRT最佳结局的平均效用值（患者为0.73，工作人员为0.77）、全喉切除术（TL）最佳结局的平均效用值（患者为0.67，工作人员为0.69）、伴有并发症的TL结局的平均效用值（患者为0.46，工作人员为0.51）以及伴有并发症的CRT结局的平均效用值（患者为0.36，工作人员为0.49）。参与者改变其偏好选择所需的平均生存优势为2.6年。
我们已经证明，相当一部分头颈癌患者和工作人员不会选择CRT来治疗局部晚期喉癌。工作人员对与喉癌治疗相关的健康状态的评分高于有过相关经历的患者，在考虑较差结局时尤其明显。头颈癌领域应制定实践和决策方法，将引出并报告患者价值观作为核心原则。
