Hollin Ilene L, Dimmock Anne Ef, Bridges John Fp, Danoff Sonye K, Bascom Rebecca
Department of Health Services Administration and Policy, Temple University College of Public Health, Philadelphia, PA, USA.
Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Penn State University College of Medicine, Hershey, PA, USA.
Patient Prefer Adherence. 2019 May 16;13:795-804. doi: 10.2147/PPA.S201632. eCollection 2019.
Rare diseases present challenges for accessing patient populations to conduct surveys. Clinical Data Research Networks (CDRNs) offer an opportunity to overcome those challenges by providing infrastructure for accessing patients and sharing data. This study aims to demonstrate the feasibility of collecting patient preference information for a rare disease in a CDRN, using idiopathic pulmonary fibrosis as proof of concept. Utilizing a cohort of idiopathic pulmonary fibrosis (IPF) patients across a CDRN, a discrete choice experiment was administered via electronic and paper methods to collect patient preference information about benefits and risks of two therapeutic options. Survey data were augmented with data from electronic health records and patient-reported outcome surveys. Thirty-three patients completed the preference experiment. The amount of choice attributable to a benefit of slowing of decline in lung function was 36%. Improving efficacy in terms of lung function was 2.16 times as important as improving efficacy in terms of shortness of breath. In terms of side effects, decreasing risk of gastrointestinal problems was 2.6 times as important as decreasing risk of sun sensitivity and 2.4 times as important as decreasing risk of liver injury. In terms of benefit-risk trade-offs, improving efficacy in terms of lung function was 1.6 times as important as decreasing risk of gastrointestinal problems. This study used IPF as a proof of concept to demonstrate the feasibility of collecting patient preference information in a CDRN. The network was advantageous to the study of patient preferences. Future research should continue to explore pathways for the collection and use of patient preference information across networks. The power of consolidated collection efforts may lead to the ability to use preference data to inform decision-making at the regional, specialty, or individual encounter level.
罕见病在接触患者群体以开展调查方面存在挑战。临床数据研究网络(CDRN)通过提供接触患者和共享数据的基础设施,为克服这些挑战提供了契机。本研究旨在以特发性肺纤维化作为概念验证,证明在CDRN中收集罕见病患者偏好信息的可行性。利用CDRN中的一组特发性肺纤维化(IPF)患者,通过电子和纸质方式进行了一项离散选择实验,以收集患者对两种治疗方案的益处和风险的偏好信息。调查数据通过电子健康记录和患者报告结局调查的数据进行了补充。33名患者完成了偏好实验。因肺功能下降减缓这一益处而产生的选择占比为36%。在改善肺功能疗效方面比改善呼吸急促疗效重要2.16倍。在副作用方面,降低胃肠道问题风险比降低阳光敏感风险重要2.6倍,比降低肝损伤风险重要2.4倍。在效益-风险权衡方面,改善肺功能疗效比降低胃肠道问题风险重要1.6倍。本研究以IPF作为概念验证,证明了在CDRN中收集患者偏好信息的可行性。该网络对患者偏好研究具有优势。未来研究应继续探索跨网络收集和使用患者偏好信息的途径。集中收集工作的力量可能会带来利用偏好数据为区域、专科或个体诊疗层面的决策提供信息的能力。