Dionise Zachary R, Gonzalez Juan Marcos, Garcia-Roig Michael L, Kirsch Andrew J, Scales Charles D, Wiener John S, Purves J Todd, Routh Jonathan C
Division of Urology, Duke University Medical Center, Durham, NC, USA.
Duke Clinical Research Institute, Durham, NC, USA.
J Pediatr Urol. 2021 Feb;17(1):86.e1-86.e9. doi: 10.1016/j.jpurol.2020.11.020. Epub 2020 Nov 18.
Vesicoureteral reflux is a common pediatric urologic condition that often has several reasonable treatment options depending on condition severity. In order to choose the best treatment for their child, parents are expected to make judgements that weigh attributes such as treatment cost, effectiveness, and complication rate. Prior research has shown that factors such as treating hospital and surgeon also influence patient treatment choice.
This study evaluates parental preferences for reflux treatment using profile case best-worst scaling, an emerging technique in both urologic and health care preference estimation. The study also uses latent class analysis (LCA) to identify parental sub-classes with different preferences.
Data were collected from a community sample of parents via a multimedia best-worst scaling survey instrument published to Amazon's Mechanical Turk online community. After extensive review of the literature, reflux attributes and attribute levels were selected to correspond with available treatments. The profile case best-worst scaling exercise elicited preferences for granular attributes of reflux treatments. Data were analyzed using multinomial logistic regression and class analysis to distinguish preference heterogeneity. Probability scaled values (PSVs) reflected the order of desirability of the attributes. Attribute preference importance was rescaled into dollar units for comparison as well.
We analyzed data for 248 respondents. The highest treatment effectiveness was more desirable than all other leveled treatment attributes (PSV 17.8, all p < 0.01) (Table). Low complication rate and doctor recommendation were amongst the other most desirable treatment attributes (PSV 11.3 and 9.0, respectively). Latent class analysis identified a class with more extreme preferences, for whom doctor recommendation and avoiding hospitalization were particularly desirable.
In this community-based sample, high treatment effectiveness and low complication rate were the most desirable treatment attributes to parents, though parents likely have heterogenous treatment preference structures. Shared parent-physician decision-making that incorporates parental preferences will likely allow more effective, targeted decision-making in the future.
膀胱输尿管反流是一种常见的儿科泌尿系统疾病，根据病情严重程度通常有几种合理的治疗选择。为了为孩子选择最佳治疗方案，家长需要做出权衡治疗成本、有效性和并发症发生率等属性的判断。先前的研究表明，治疗医院和外科医生等因素也会影响患者的治疗选择。
本研究使用轮廓案例最佳-最差尺度法评估家长对反流治疗的偏好，这是一种在泌尿外科和医疗保健偏好评估中新兴的技术。该研究还使用潜在类别分析（LCA）来识别具有不同偏好的家长亚类。
通过发布到亚马逊的Mechanical Turk在线社区的多媒体最佳-最差尺度调查问卷，从家长社区样本中收集数据。在广泛查阅文献后，选择反流属性和属性水平以对应可用的治疗方法。轮廓案例最佳-最差尺度练习引出了对反流治疗颗粒属性的偏好。使用多项逻辑回归和类别分析对数据进行分析，以区分偏好异质性。概率尺度值（PSV）反映了属性的期望顺序。属性偏好重要性也重新缩放到美元单位进行比较。
我们分析了248名受访者的数据。最高的治疗有效性比所有其他分级治疗属性更受青睐（PSV 17.8，所有p < 0.01）（表）。低并发症发生率和医生推荐是其他最受青睐的治疗属性（分别为PSV 11.3和9.0）。潜在类别分析确定了一个偏好更为极端的类别，对他们来说医生推荐和避免住院特别重要。
在这个基于社区的样本中，高治疗有效性和低并发症发生率是家长最期望的治疗属性，尽管家长可能有不同的治疗偏好结构。纳入家长偏好的共同家长-医生决策可能会在未来实现更有效、有针对性的决策。
