Patient Preferences for Outcomes After Kidney Transplantation: A Best-Worst Scaling Survey
Patient Preferences for Outcomes After Kidney Transplantation: A Best-Worst Scaling Survey
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DOI：
10.1097/tp.0000000000001793
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发表时间：
2017-11-01
期刊：
影响因子：
6.2
通讯作者：
Howard, Kirsten
中科院分区：
文献类型：
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作者：
Howell, Martin;Wong, Germaine;Howard, Kirsten
背景肾移植受者的护理涉及最大限度地提高移植物存活率和严重不良后果之间的平衡。本研究旨在量化患者对移植后重要结局的偏好和权衡。方法.通过多项logit模型分析的最佳-最差比例调查用于计算标准化偏好评分（0，最佳; 1，最差），针对不同的移植持续时间和移植失败前死亡、癌症、心血管疾病、糖尿病、感染、焦虑/抑郁、腹泻/恶心和体重增加的风险。计算了移植物存活年数的交易意愿，以最大限度地减少不良结局的风险。结果来自2个澳大利亚移植单位和一个在线小组的93名移植受者（年龄18-69岁（自移植以来的平均时间，7年）完成了调查。1年时移植物丢失是最不理想的结局（平均偏好值，0.0：95%置信区间，-0.05至0.05），并且比移植物丢失前100%死亡风险更差（0.17：0.12-0.23）。移植持续时间为5年的患者的偏好评分（即，同样差）与所有不良结局的最大风险相同，包括移植失败前死亡的风险为100%。为了实现癌症、死亡和心血管疾病的零风险，参与者只愿意分别交易3.1（2.1至4.7）、1.7（1.1至2.5）和1.2（0.8至1.8）年的移植物存活期，而所有其他结局的交易时间均少于1年。结论.移植受者认为移植物丢失比死亡更糟糕，并表现出最小的意愿，以改善任何其他结果来交换这一结果的减少。
Background. The care of kidney transplant recipients involves a balance between maximizing graft survival and serious adverse outcomes. This study aimed to quantify patients' preferences and trade-offs for important outcomes after transplantation. Methods. A best-worst scaling survey, analyzed by multinomial-logit models, was used to calculate normalized preference scores (0, best; 1, worst), for varying years of graft duration and risk of dying before graft failure, cancer, cardiovascular disease, diabetes, infection, anxiety/depression, diarrhoea/nausea, and weight gain. Willingness to trade years of graft survival to minimize the risk of adverse outcomes was calculated. Results. Ninety-three transplant recipients from 2 Australian transplant units and an on-line panel (aged 18-69 years (mean time since transplantation, 7 years) completed the survey. Graft loss at 1 year was the least desirable outcome (mean preference value, 0.0: 95% confidence intervals, -0.05 to 0.05) and worse than a 100% risk of dying before graft loss (0.17: 0.12-0.23). Graft duration of 5 years had the same preference scores (ie, as bad) as the maximum risk of all adverse outcomes including a 100% risk of dying before graft failure. To achieve zero risk of cancer, dying, and cardiovascular disease participants were only willing to trade 3.1(2.1 to 4.7), 1.7(1.1 to 2.5), and 1.2(0.8 to 1.8) years of graft survival, respectively, and less than 1 year for all other outcomes. Conclusions. Transplant recipients regarded graft loss as worse than death and showed minimal willingness to trade a reduction in this outcome with an improvement in any other outcome.