Tan Chia Jie, Tan Melinda Si Yun, Nagarajan Chandramouli, Chng Wee Joo, Chee Yen-Lin, Ooi Melissa, Ng Lawrence Cheng Kiat, Chen Yunxin, Yoong Joanne Su Yin, Wong Xin Yi, Jen Wei-Ying
Department of Pharmacy, National University of Singapore, Singapore, Singapore.
Department of Haematology, Singapore General Hospital, Singapore, Singapore.
JCO Oncol Pract. 2023 Dec;19(12):1168-1178. doi: 10.1200/OP.23.00336. Epub 2023 Oct 16.
Treatment options for myeloma and indolent lymphoma are increasing exponentially, with distinct efficacy, side effects, and cost. We aim to determine the factors influencing patient and caregiver treatment preferences.
Patients and caregivers of patients with myeloma and indolent lymphoma were recruited from two cancer centers in Singapore. Preferences were elicited using a discrete choice experiment. Attributes and levels were selected based on a previous qualitative study. The relative preference for levels within each attribute (part worth utility values) and the extent to which an attribute would influence decision making (relative importance) were calculated. Patient and caregiver participation in the treatment plan selection process were assessed using the Control Preference Scale.
One hundred ninety-nine patients and 169 caregivers were recruited. Patients placed the highest importance on out-of-pocket costs (relative importance = 35%), followed by efficacy (25%), persistent side effects (19%), administration route (8%), treatment duration (7%), and short-term side effects (5%). Caregivers ranked efficacy (27%) as the most important attribute, over out-of-pocket costs (24%). Most patients preferred a collaborative role in the shared decision-making process, while similar proportions of caregivers favored active and collaborative roles.
Our study demonstrates that both patients and caregivers consider cost seriously when making treatment decisions. Furthermore, as patient and caregiver preferences may differ, there are implications for treatment selection and counseling, especially in cultures where caregivers have more prominent roles in treatment planning.
骨髓瘤和惰性淋巴瘤的治疗选择呈指数级增长，疗效、副作用和成本各不相同。我们旨在确定影响患者和护理人员治疗偏好的因素。
从新加坡的两个癌症中心招募骨髓瘤和惰性淋巴瘤患者及其护理人员。使用离散选择实验来引出偏好。根据先前的定性研究选择属性和水平。计算每个属性内各水平的相对偏好（部分价值效用值）以及属性影响决策的程度（相对重要性）。使用控制偏好量表评估患者和护理人员参与治疗计划选择过程的情况。
招募了199名患者和169名护理人员。患者最看重自付费用（相对重要性 = 35%），其次是疗效（25%）、持续副作用（19%）、给药途径（8%）、治疗持续时间（7%）和短期副作用（5%）。护理人员将疗效（27%）列为最重要的属性，高于自付费用（24%）。大多数患者在共同决策过程中倾向于合作角色，而类似比例的护理人员则倾向于积极和合作角色。
我们的研究表明，患者和护理人员在做出治疗决策时都认真考虑成本。此外，由于患者和护理人员的偏好可能不同，这对治疗选择和咨询有影响，特别是在护理人员在治疗计划中发挥更突出作用的文化中。
