患者对骶骨固定术或改良曼彻斯特手术的偏好：一项离散选择实验。
Patient's preference for sacrospinous hysteropexy or modified Manchester operation: A discrete choice experiment.
机构信息
Department of Obstetrics and Gynaecology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.
Department of Obstetrics and Gynaecology, Rijnstate Hospital, Arnhem, The Netherlands.
出版信息
BJOG. 2023 Jan;130(1):99-106. doi: 10.1111/1471-0528.17280. Epub 2022 Aug 31.
OBJECTIVE
To investigate women's preference for modified Manchester (MM) or sacrospinous hysteropexy (SH) as surgery for uterine prolapse.
DESIGN
Labelled discrete choice experiment (DCE).
SETTING
Eight Dutch hospitals.
POPULATION
Women with uterine prolapse, eligible for primary surgery and preference for uterus preservation.
METHODS
DCEs are attribute-based surveys. The two treatment options were labelled as MM and SH. Attributes in this survey were treatment success ( levels SH: 84%, 89%, 94%; levels MM: 89%, 93%, 96%), dyspareunia (levels: 0%, 5%, 10%), cervical stenosis (levels: 1%, 6%, 11%) and severe buttock pain (levels: 0%, 1%). A different combination of attribute levels was used in each choice set. Women completed nine choice sets, making a choice based on attribute levels. Data were analysed in multinomial logit models.
MAIN OUTCOME MEASURES
Women's preference for MM or SH.
RESULTS
137 DCEs were completed (1233 choice sets). SH was chosen in 49% of the choice sets, MM in 51%. Of all women, 39 (28%) always chose the same surgery. After exclusion of this group, 882 choice sets were analysed, in which women preferred MM, likely associated with a labelling effect, i.e. description of the procedure, rather than the tested attributes. In that group, MM was chosen in 53% of the choice sets and SH in 47%. When choosing MM, next to the label, dyspareunia was relevant for decision-making. For SH, all attributes were relevant for decision-making.
CONCLUSIONS
The preference of women for MM or SH seems almost equally divided. The variety in preference supports the importance of individualised healthcare.
目的
调查女性对改良式曼彻斯特（MM）或骶骨固定术（SH）作为子宫脱垂手术的偏好。
设计
标记离散选择实验（DCE）。
设置
八家荷兰医院。
人群
患有子宫脱垂、适合初次手术且保留子宫偏好的女性。
方法
DCE 是基于属性的调查。两种治疗方法分别标记为 MM 和 SH。该调查中的属性包括治疗成功率（SH 水平：84%、89%、94%；MM 水平：89%、93%、96%）、性交困难（水平：0%、5%、10%）、宫颈狭窄（水平：1%、6%、11%）和严重臀部疼痛（水平：0%、1%）。在每个选择集中使用了不同的属性水平组合。女性完成了九个选择集，根据属性水平做出选择。数据在多项逻辑回归模型中进行分析。
主要观察指标
女性对 MM 或 SH 的偏好。
结果
完成了 137 项 DCE（1233 个选择集）。在 49%的选择集中选择了 SH，在 51%的选择集中选择了 MM。所有女性中，有 39 人（28%）始终选择相同的手术。排除该组后，分析了 882 个选择集，在这些选择集中，女性更喜欢 MM，这可能与标签效应相关，即手术过程的描述，而不是测试的属性。在该组中，在 53%的选择集中选择了 MM，在 47%的选择集中选择了 SH。当选择 MM 时，除了标签外，性交困难也是决策的相关因素。对于 SH，所有属性都是决策的相关因素。
结论
女性对 MM 或 SH 的偏好似乎几乎平分秋色。这种偏好的多样性支持了个性化医疗的重要性。
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