Patient Preferences for Treatment of Low Back Pain-A Discrete Choice Experiment
Patient Preferences for Treatment of Low Back Pain-A Discrete Choice Experiment
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DOI：
10.1016/j.jval.2014.01.005
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发表时间：
2014-06-01
期刊：
影响因子：
4.5
通讯作者：
Sogaard, Rikke
中科院分区：
文献类型：
--
作者：
Klojgaard, Mirja Elisabeth;Manniche, Claus;Sogaard, Rikke
背景：背痛造成了巨大的经济和社会负担，并且相互矛盾的证据扭曲了治疗决策。因此，在决策和政策制定中纳入患者偏好非常重要。目的：有助于了解患者对腰痛治疗选择的偏好。方法：对转诊至区域脊柱中心的连续患者进行离散选择实验。受访者 (n = 348) 被邀请回答两种假设的治疗方案和一个选择退出的选择。治疗属性包括治疗方式、复发风险、疼痛减轻以及日常生活活动能力的预期提高。此外，达到治疗效果的等待时间也被用作支付手段。创建混合 Logit 模型来执行分析。亚组分析将受访者分为社会人口统计学和疾病相关类别，进一步探讨了等待的意愿。 结果：受访者将积极的效用分配给积极的治疗结果，将负效用分配给更高的风险以及更长的等待治疗效果和手术干预的时间。该模型捕获了样本中疼痛减轻结果、进行日常生活活动的能力以及治疗方式的显着异质性。亚组分析揭示了等待意愿的差异，特别是在治疗方式、数据收集时经历的疼痛程度以及受访者对手术的偏好方面。结论：大多数受访者更喜欢非手术干预，但患者愿意等待更理想的结果和首选干预措施。结果表明，医疗保健专业人员的一项非常重要的任务是清楚地传达治疗的预期结果及其治疗决策的基础，因为患者的偏好具有很大的个体性。
Background: Back pain imposes a substantial economic and social burden, and treatment decisions are distorted by conflicting evidence. Thus, it is important to include patient preferences in decision making and policy making. Objective: To contribute to the understanding of patient preferences in relation to the choice of treatment for low back pain. Methods: A discrete choice experiment was conducted with consecutive patients referred to a regional spine center. The respondents (n = 348) were invited to respond to a choice of two hypothetical treatment options and an opt out option. The treatment attributes included the treatment modality, the risk of relapse, the reduction in pain, and the expected increase in the ability to perform activities of daily living. In addition, the wait time to achieve the treatment effect was used as a payment vehicle. Mixed logit models were created to perform analysis. Subgroup analysis, dividing respondents into sociodemographic and disease-related categories, further explored the willingness to wait Results: Respondents assigned positive utilities to positive treatment outcomes and disutility to higher risks and longer waits for effects of treatment and to surgical interventions. The model captured significant heterogeneity within the sample for the outcomes of pain reduction and the ability to pursue activities of daily living and for the treatment modality. The subgroup analysis revealed differences in the willingness to wait, especially with regard to treatment modality, the level of pain experienced at the time of data collection, and the respondents' preferences for surgery. Conclusions: The majority of the respondents prefer nonsurgical interventions, but patients are willing to wait for more ideal outcomes and preferred interventions. The results show that health care professionals have a very important task in communicating clearly about the expected results of treatment and the basis of their treatment decisions, as patients' preferences are highly individual.