Managing neurogenic bowel dysfunction: what do patients prefer? A discrete choice experiment of patient preferences for transanal irrigation and standard bowel management.
Managing neurogenic bowel dysfunction: what do patients prefer? A discrete choice experiment of patient preferences for transanal irrigation and standard bowel management.
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DOI：
10.2147/ppa.s96082
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发表时间：
2016
影响因子：
2.2
通讯作者：
Emmanuel A
中科院分区：
文献类型：
--
作者：
Nafees B;Lloyd AJ;Ballinger RS;Emmanuel A
大多数继发于神经系统疾病的肠功能障碍患者通过一系列非手术方法进行治疗，包括饮食改变，泻药和栓剂用于经肛门冲洗（TAI）。本研究的目的是探讨个人的偏好TAI设备，并进一步调查支付意愿（WTP）的属性在英国的设备。采用离散选择实验调查方法评价患者对TAI器械的感知价值。根据文献综述和临床医生的输入选择属性。与三名临床医生进行了访谈，并根据患者和专业人员的意见制定和完成了调查。最后的属性是“尿路感染的风险”（UTIs），“大便失禁的风险”（FI），“使用频率”，“如厕时间”，“易用性”，“控制/独立水平”和“成本”。参与者由英国TAI器械用户的患者小组招募。使用条件logit模型分析数据，其中从模型获得的系数提供了属性偏好的（log）比值比（OR）估计值。还估计了每个属性的WTP。共有129名参与者被纳入最终分析。62%的参与者在前一年患有三次UTI，58%的患者报告目前使用当前器械时发生FI。所有属性都是选择的重要预测因素。参与者最重要的属性是“FI风险”，“使用频率”和“UTI风险”。肠功能障碍的参与者认为“FI风险”、“使用频率”和“避免UTI”是TAI器械的最重要特征。这些偏好在告知决策者和临床医生关于不同的肠道管理解决方案以及未来设备的开发方面是有价值的。
Most patients with bowel dysfunction secondary to neurological illness are managed by a range of nonsurgical methods, including dietary changes, laxatives, and suppository use to transanal irrigation (TAI). The aim of the present study was to explore individuals’ preferences regarding TAI devices and furthermore investigate willingness to pay (WTP) for attributes in devices in the UK. A discrete choice experiment survey was conducted to evaluate the patients’ perceived value of TAI devices. Attributes were selected based upon a literature review and input from clinicians. Interviews were conducted with three clinicians and the survey was developed and finalized with the input from both patients and professionals. The final attributes were “risk of urinary tract infections” (UTIs), “risk of fecal incontinence” (FI), “frequency of use”, “time spent on toilet”, “ease of use”, “level of control/independence”, and “cost”. Participants were recruited by a patient panel of TAI device users in the UK. Data were analyzed using the conditional logit model whereby the coefficients obtained from the model provided an estimate of the (log) odds ratios (ORs) of preference for attributes. WTP was also estimated for each attribute. A total of 129 participants were included in the final analyses. Sixty two percent of the participants had suffered from three UTIs in the preceding year and 58% of patients reported currently experiencing FI using their current device. All attributes were significant predictors of choice. The most important attributes for participants were the “risk of FI”, “frequency of use”, and “risk of UTIs”. Participants with bowel dysfunction regarded “risk of FI”, “frequency of use”, and “avoiding UTIs” as the most important features of a TAI device. These preferences are valuable in informing decision makers and clinicians regarding different bowel management solutions as well as for development of future devices.