Wilson Leslie, Lin Tracy Kuo, Hampson Lindsay A, Oh Anna, Ting Jie, Gaither Thomas, Allen Isabel, Breyer Benjamin N
University of California, San Francisco, 3333 California St, Suite 420, San Francisco, CA 94118.
University of California, San Francisco, 1001 Potrero Ave, SFGH 3, San Francisco CA 94110.
J Particip Med. 2017;9. Epub 2017 Jan 14.
Understanding patient preferences for characteristics of treatments facilitates patient participation and doctor-patient communication and enhances patient-centered care. Patient participation is especially important for urethral stricture disease, which has no definitive treatment guidelines favoring either endoscopic incision or open reconstruction, making patient preference an important factor in treatment choice. However, to date, there have been no studies assessing factors that patients value when choosing a treatment option.
We employ choice-based conjoint analysis to assess patient preferences in the trade-offs of treatment attributes for urethral stricture disease. Male patients undergoing treatment or follow-up examination for urethral stricture disease were recruited through a University Medical Practice. We included 169 patients in the analysis. Six attributes of both risk and benefit were examined: treatment type, success rate, number of future procedures, post-treatment catheter duration, recovery time, and copayment amount.
The treatment success rate was by far the most important attribute. Relative to a 25% success rate (OR = 1) an 85% success rate (OR = 26.72, p<.01) increased patient preference by approximately 27 times. Furthermore, patients are willing to pay a $10,000 copayment to double the success rate from 25% to 50%. Patients demonstrated a strong aversion to time with a urinary catheter. Catheter duration for 1 week or less (OR = .67, p<.01) reduced patient preference by about 1.5 times when compared to requiring no catheter. We also found that patients place low importance on both how invasive the treatment seems and low copayment amounts but are willing to pay $10,000 copayment for an open reconstruction surgery compared with an endoscopic incision procedure.
The findings highlight the importance of shared and detailed physician/patient discussions of all the risk and benefits of each treatment choice and suggest that conjoint analysis may be helpful as a decision aid to guide discussions with individual patients deciding on a treatment.
了解患者对治疗特征的偏好有助于患者参与及医患沟通，并加强以患者为中心的医疗服务。患者参与对于尿道狭窄疾病尤为重要，因为目前尚无明确的治疗指南支持内镜下切开或开放重建术，因此患者偏好成为治疗选择的一个重要因素。然而，迄今为止，尚无研究评估患者在选择治疗方案时所重视的因素。
我们采用基于选择的联合分析来评估患者在尿道狭窄疾病治疗属性权衡中的偏好。通过大学医学实践招募接受尿道狭窄疾病治疗或随访检查的男性患者。我们纳入了169例患者进行分析。研究了六个风险和益处属性：治疗类型、成功率、未来手术次数、治疗后留置导尿管时间、恢复时间和自付费用金额。
治疗成功率是迄今为止最重要的属性。相对于25%的成功率（OR = 1），85%的成功率（OR = 26.72，p <.01）使患者偏好增加了约27倍。此外，患者愿意支付10,000美元的自付费用，以使成功率从25%翻倍至50%。患者对留置导尿管的时间表现出强烈的厌恶。与无需留置导尿管相比，留置导尿管1周或更短时间（OR =.67，p <.01）使患者偏好降低了约1.5倍。我们还发现，患者对治疗的侵入性程度和低自付费用金额的重视程度较低，但与内镜下切开手术相比，他们愿意支付10,000美元的自付费用接受开放重建手术。
研究结果突出了医患共同详细讨论每种治疗选择的所有风险和益处的重要性，并表明联合分析作为一种决策辅助工具，可能有助于指导与决定治疗方案的个体患者进行讨论。
