National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, New South Wales, Australia
National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, New South Wales, Australia.
BMJ Open. 2019 Aug 2;9(8):e027153. doi: 10.1136/bmjopen-2018-027153.
High rates of chronic non-cancer pain (CNCP), concerns about adverse effects including dependence among those prescribed potent pain medicines, the recent evidence supporting active rather than passive management strategies and a lack of funding for holistic programme have resulted in challenges around decision making for treatment among clinicians and their patients. Discrete choice experiments (DCEs) are one way of assessing and valuing treatment preferences. Here, we outline a protocol for a study that assesses patient preferences for CNCP treatment.
A final list of attributes (and their levels) for the DCE was generated using a detailed iterative process. This included a literature review, a focus group and individual interviews with those with CNCP and clinicians who treat people with CNCP. From this process a list of attributes was obtained. Following a review by study investigators including pain and addiction specialists, pharmacists and epidemiologists, the final list of attributes was selected (number of medications, risk of addiction, side effects, pain interference, activity goals, source of information on pain, provider of pain care and out-of-pocket costs). Specialised software was used to construct an experimental design for the survey. The survey will be administered to two groups of participants, those from a longitudinal cohort of patients receiving opioids for CNCP and a convenience sample of patients recruited through Australia's leading pain advocacy body (Painaustralia) and their social media and website. The data from the two participant groups will be initially analysed separately, as their demographic and clinical characteristics may differ substantially (in terms of age, duration of pain and current treatment modality). Mixed logit and latent class analysis will be used to explore heterogeneity of responses.
Ethics approval was obtained from the University of New South Wales Sydney Human Ethics committee HC16511 (for the focus group discussions, the one-on-one interviews and online survey) and HC16916 (for the cohort). A lay summary will be made available on the National Drug and Alcohol Research Centre website and Painaustralia's website. Peer review papers will be submitted, and it is expected the results will be presented at relevant pain management conferences nationally and internationally. These results will also be used to improve understanding of treatment goals between clinicians and those with CNCP.
慢性非癌性疼痛（CNCP）发生率高，人们对包括依赖在内的不良影响感到担忧，近期有证据支持积极而非被动的管理策略，以及缺乏全面计划的资金，这些都导致临床医生及其患者在治疗决策方面面临挑战。离散选择实验（DCE）是评估和衡量治疗偏好的一种方法。在这里，我们概述了一项评估 CNCP 治疗患者偏好的研究方案。
使用详细的迭代过程生成 DCE 的最终属性（及其水平）列表。这包括文献综述、与 CNCP 患者和治疗此类患者的临床医生进行的焦点小组和个人访谈。从这个过程中获得了属性列表。经过包括疼痛和成瘾专家、药剂师和流行病学家在内的研究调查人员的审查后，选择了最终的属性列表（药物数量、成瘾风险、副作用、疼痛干扰、活动目标、疼痛信息来源、疼痛护理提供者和自付费用）。专门的软件用于构建调查的实验设计。该调查将分两个组进行，一组来自接受阿片类药物治疗 CNCP 的纵向队列患者，另一组来自通过澳大利亚领先的疼痛倡导组织（Painaustralia）及其社交媒体和网站招募的便利样本患者。这两个组的参与者的数据将单独进行初步分析，因为他们的人口统计学和临床特征可能有很大差异（在年龄、疼痛持续时间和当前治疗方式方面）。混合对数和潜在类别分析将用于探索反应的异质性。
新南威尔士大学悉尼人类伦理委员会已批准该研究（用于焦点小组讨论、一对一访谈和在线调查）和 HC16916（用于队列）。国家药物和酒精研究中心网站和 Painaustralia 网站上将提供通俗易懂的摘要。将提交同行评审论文，并预计将在全国和国际相关疼痛管理会议上介绍研究结果。这些结果还将用于改善临床医生和 CNCP 患者之间对治疗目标的理解。
