Eliciting preferences for alternative drug therapies in oncology: Influence of treatment outcome description, elicitation technique and treatment experience on preferences

doi:10.1016/0021-9681(87)90133-0

Journal of Chronic Diseases

Volume 40, Issue 8, 1987, Pages 811-818

Journal of Chronic D...

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Abstract

Several methodologic issues arise in eliciting preferences for therapy. Examples are the selection of appropriate descriptions of treatment outcomes and of elicitation techniques. Of particular importance is the correspondence of patients' anticipated preferences for treatment to actual preferences once they have experienced treatment. Treatment outcome descriptions and elicitation techniques were compared for a hypothetical drug decision problem involving trade-offs between quality and quantity of life. Preferences of 54 cancer patients were elicited before, and 6 weeks following initiation of chemotherapy treatment. Patients' preferences were not influenced by the way information about side effects was presented, nor the stated probability of survival at high and moderate levels. A riskless rating technique produced different preferences from those of a risky treatment choice method. Although patients experienced significant toxicity following initiation of treatment, their preferences remained stable on retest. The results raise questions about the extent to which patients are willing, at the time of decision making, to trade off survival rate for improved quality of life.

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Citation Excerpt :
The questionnaires are available in the Supplementary material. Validated scoring systems were used, namely, the Decisional Conflict Scale (DCS), Decision Making Preference Questionnaire (DMPQ), and State-Trait Anxiety Inventory (STAI) [15–17]. The importance of various factors in patient decision-making, such as survival, bowel function, and sexual dysfunction, were assessed using the methodology published previously [18].
Predict Prostate is a freely available online personalised risk communication tool for men with nonmetastatic prostate cancer. Its accuracy has been assessed in multiple validation studies, but its clinical impact among patients has not hitherto been assessed.
To assess the impact of the tool on patient decision-making and disease perception.
A multicentre randomised controlled trial was performed across eight UK centres among newly diagnosed men considering either active surveillance or radical treatment. A total of 145 patients were included between 2018 and 2020, with median age 67 yr (interquartile range [IQR] 61–72) and prostate-specific antigen 6.8 ng/ml (IQR 5.1–8.8).
Participants were randomised to either standard of care (SOC) information or SOC and a structured presentation of the Predict Prostate tool.
Validated questionnaires were completed by assessing the impact of the tool on decisional conflict, uncertainty, anxiety, and perception of survival.
Mean Decisional Conflict Scale scores were 26% lower in the Predict Prostate group (mean = 16.1) than in the SOC group (mean = 21.7; p = 0.027). Scores on the “support”, “uncertainty”, and “value clarity” subscales all favoured Predict Prostate (all p < 0.05). There was no significant difference in anxiety scores or final treatment selection between the two groups. Patient perception of 15-yr prostate cancer–specific mortality (PCSM) and overall survival benefit from radical treatment were considerably lower and more accurate among men in the Predict Prostate group (p < 0.001). In total, 57% of men reported that the Predict Prostate estimates for PCSM were lower than expected, and 36% reported being less likely to select radical treatment. Over 90% of patients in the intervention group found it useful and 94% would recommend it to others.
Predict Prostate reduces decisional conflict and uncertainty, and shifts patient perception around prognosis to be more realistic. This randomised trial demonstrates that Predict Prostate can directly inform the complex decision-making process in prostate cancer and is felt to be useful by patients. Future larger trials are warranted to test its impact upon final treatment decisions.
In this national study, we assessed the impact of an individualised risk communication tool, called Predict Prostate, on patient decision-making after a diagnosis of localised prostate cancer. Men were randomly assigned to two groups, which received either standard counselling and information, or this in addition to a structured presentation of the Predict Prostate tool. Men who saw the tool were less conflicted and uncertain in their decision-making, and recommended the tool highly. Those who saw the tool had more realistic perception about their long-term survival and the potential impact of treatment upon this.
The use of an individualised risk communication tool, such as Predict Prostate, reduces patient decisional conflict and uncertainty when deciding about treatment for nonmetastatic prostate cancer. The tool leads to more realistic perceptions about survival outcomes and prognosis.
Explorations of the effect of experience on preferences for a health-care service
2010, Journal of Socio-Economics
The standard assumption in economic theory is that preferences do not change as a result of experience with the commodity/service/event. Behavioral scientists have challenged this assumption, claiming that preferences constantly do change as experience is accumulated. This paper tests the effect of experience with a health-care service on preferences for maternity-ward attributes. In order to explore the effect of experience on preferences, the research sample was decomposed into three sub-samples: women pregnant with their first child (no experience); women after one delivery (single experience); and women after more than one delivery (multiple experiences). The preference patterns of the three sub-groups were estimated and compared. A Discrete Choice Experiment (DCE) was employed for establishing the relative importance of five attributes. Socio-economic background variables were also considered. The basic findings are that preferences change significantly as a result of experience with the health event; that the effect of experience is attribute-specific; that the extent of past experience (number of deliveries) is irrelevant; and that the effect of experience differs by socio-economic status.
A typology of preferences for participation in healthcare decision making
2006, Social Science and Medicine
Classifying patients as “active” or “passive” with regard to healthcare decision making is misleading, since patients have different desires for different components of the decision-making process. Distinguishing patients’ desired roles is an essential step towards promoting care that respects and responds to individual patients’ preferences. We included items on the 2004 Wisconsin Longitudinal Study mail survey measuring preferences for four components of the decision-making process: physician knowledge of patient medical history, physician disclosure of treatment choices, discussion of treatment choices, and selection of treatment choice. We characterized preference types for 5199 older adults using cluster analysis. Ninety-six percent of respondents are represented by four preference types, all of which prefer maximal information exchange with physicians. Fifty-seven percent of respondents wanted to retain personal control over important medical decisions (“autonomists”). Among the autonomists, 81% preferred to discuss treatment choices with their physician. Thirty-nine percent of respondents wanted their physician to make important medical decisions (“delegators”). Among the delegators, 41% preferred to discuss treatment choices. Female gender, higher educational attainment, better self-rated health, fewer prescription medications, and having a shorter duration at a usual place of care predicted a significantly higher probability of the most active involvement in discussing and selecting treatment choices. The overwhelming majority of older adults want to be given treatment options and have their physician know everything about their medical history; however, there are substantial differences in how they want to be involved in discussing and selecting treatments.
Valuing the health state 'tinnitus': Differences between patients and the general public
2005, Hearing Research
Citation Excerpt :
That is, the general public is not able to anticipate the specific burden of a health condition, and/or the description of the health state scenario cannot meet the real experience. Studies finding stable utilities (Llewellyn-Thomas et al., 1993; O’Connor et al., 1987) are usually based on health state scenarios rather than first hand experience of the health condition as the reference case (Bombardier et al., 1986; Christensen-Szalanski, 1984; Llewellyn-Thomas et al., 1992). Also, larger variability in the data could be expected as a result of the induced uncertainty due to inexperience.
In recent years, prioritisation in health care has gained increasing attention. However, rankings of interventions might depend on whom valuations of health states are elicited from. This paper’s objective is to compare tinnitus valuations by patients and the general public.
Groups of 210 patients and 210 adults not (currently) affected were interviewed to elicit valuations using visual analogue scale (VAS), time trade-off (TTO) and standard gamble (SG). MANOVA is used to test for group differences, controlling for sex and age.
For all elicitation methods, valuations significantly differ in that patients report higher values than the general public respondents. Most notably, on the visual analogue scale which varies between 0 (‘worst imaginable health’) and 1 (‘best imaginable health’), patients elicit a mean score of 0.54, and the general public 0.34 (those with former tinnitus experience) and 0.35 (without experience), respectively (F(2,377) = 55.67, p < 0.001). That is, patients valuate tinnitus as less severe than unaffected people.
As for other health states, tinnitus valuations differ depending on whether values of patients or the general public are elicited. These differences should be taken into account in health care evaluation and planning.
Assessing patients' preferences for treatments for angina using a modified repertory grid method
2005, Social Science and Medicine
A current popular theme in medicine concerns whether and how patients should be involved in treatment choice. Assuming patient involvement is desirable, how should one go about eliciting preferences? A variety of quantitative and qualitative methods exist that may be used for this purpose, one of which is the repertory grid method. This method involves eliciting constructs (reasons) for preferences through comparing sets of three options. This method allows the structured elicitation of the reasons behind individual preferences, but also, when used with generalised procrustes analysis (GPA), allows aggregation of individual data to reveal general preference patterns. In this study the repertory grid method was used to examine patient preferences for angina treatments with the goal of, first, gaining some understanding of general patterns of patient preference, and second, examining the likely utility of the technique in this setting. A sample of 21 patients with mild and stable angina from two general practices in Norfolk, UK was interviewed using the repertory grid method to elicit the constructs underlying their preferences amongst seven angina treatments (including ‘no treatment’). Individualised questionnaires were then produced and sent to the patients for self-completion, which required rating the extent to which each construct was relevant for each treatment (scored on visual analogue rating scales). Analysis of the ratings, using GPA, showed that the constructs clustered around two dimensions: ‘some treatment’ versus ‘no treatment’, and drug treatment versus surgical treatment. While some treatment was generally preferred to no treatment, individuals varied in preference for drug treatments or surgical treatments. Although the latter were generally perceived as ‘effective’ they were also perceived, for example, as ‘invasive’, ‘frightening’, related to ‘negative experiences’, and being more appropriate for when symptoms are severe (‘proportionate’). We consider the implications of these results for involving patients in choosing amongst treatments.
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Original articleEliciting preferences for alternative drug therapies in oncology: Influence of treatment outcome description, elicitation technique and treatment experience on preferences

Abstract

Socio-econ Plan Sci

J Chron Dis

J Chron Dis

Methodological problems in assessing preferences for alternative therapies in oncology: the influence of preference elicitation technique, position order, and the test-retest error on preferences for alternative cancer drug therapies

Describing health states: Methodologica issues in obtaining values for health states

Med Care

Prospect theory: An analysis of decision under risk

Econometrica

Sources of bias in assessment procedures for utility functions

Management Sci

Discount functions and the measurement of patients' values: Women's decisions during childbirth

Med Decis Making

The selection of primary therapy for patients with cancer of the rectum

Med Decis Making

Knowing what you want: Measuring labile values

Original article
Eliciting preferences for alternative drug therapies in oncology: Influence of treatment outcome description, elicitation technique and treatment experience on preferences