Department of Urology, UCSF School of Medicine, 400 Parnassus Ave, A638, Box 0738, San Francisco, CA, 94143, USA.
Department of Clinical Pharmacy, UCSF School of Pharmacy, San Francisco, USA.
World J Urol. 2017 Nov;35(11):1799-1805. doi: 10.1007/s00345-017-2066-9. Epub 2017 Jun 29.
To understand how prioritization of treatment attributes and treatment choice varies by patient characteristics, we sought to specifically determine how demographic variables affect patient treatment preference.
Male patients with urethral stricture disease participated in a choice-based conjoint (CBC) analysis exercise evaluating six treatment attributes associated with internal urethrotomy and urethroplasty. Demographic and past symptom data were collected. Stratified analysis of demographic variables, including age, education, income, was conducted using a mixed effect logistic regression model to evaluate the coefficient size and confidence intervals between the treatments attribute preferences of each strata.
169 patients completed the CBC exercise and were included in our analysis. Overall success of the procedure is the most important treatment attribute to patients and this persists across strata. Older patients (≥65) express preferences for better success rates and fewer future procedures, whereas younger patients prefer a less invasive approach and are more willing to accept additional procedures if needed. Patients with lower levels of education preferred open reconstruction and had a stronger preference against multiple future procedures, whereas those with higher levels of education preferred endoscopic treatment and had a less strong preference against multiple future procedures. Low-income individuals express statistically significant stronger negative preferences against high copay costs compared to high-income individuals.
These results can help to inform physicians' counseling about surgical management of urethral stricture disease to better align patient preferences with treatment selection and encourage shared decision making.
为了了解治疗属性的优先级和治疗选择如何因患者特征而异，我们专门确定了人口统计学变量如何影响患者的治疗偏好。
患有尿道狭窄疾病的男性患者参与了一项基于选择的联合（CBC）分析，评估了与尿道内切开术和尿道成形术相关的六个治疗属性。收集了人口统计学和过去症状数据。使用混合效应逻辑回归模型对人口统计学变量（包括年龄、教育、收入）进行分层分析，以评估每个分层的治疗属性偏好之间的系数大小和置信区间。
169 名患者完成了 CBC 练习并被纳入我们的分析。手术的总体成功率是患者最重要的治疗属性，这在各层之间保持不变。年龄较大（≥65 岁）的患者表示更喜欢更高的成功率和更少的未来手术，而年轻患者则更喜欢侵入性较小的方法，如果需要，更愿意接受额外的手术。教育程度较低的患者更喜欢开放式重建，并强烈反对多次未来手术，而教育程度较高的患者则更喜欢内镜治疗，并强烈反对多次未来手术。与高收入者相比，低收入者对高自付费用表示出统计学上显著更强的负面偏好。
这些结果可以帮助医生就尿道狭窄疾病的手术管理提供咨询，更好地将患者的偏好与治疗选择相匹配，并鼓励共同决策。
