Measuring patient preferences for treatment of colorectal cancer using discrete choice modelling

在世界各地，政府、医疗专业机构、个人临床医生和患者都在努力更理性地做出医疗保健决策。这些决定中有更多是由循证医学“知情的”，循证医学依赖于对所有可接受的科学严谨性的相关证据的系统审查。对于结直肠癌的治疗，已经进行了这种系统的回顾。对结直肠癌可能的治疗做出选择的患者将拥有最好的“循证”信息。但对于治疗方案的哪些方面对患者最重要，人们知之甚少。在不同的治疗方案之间进行选择，需要权衡或权衡与每种疗法相关的不同因素。根据癌症的临床阶段，患者可能需要在外科手术的类型和规模、是否进行化疗和/或放射治疗、治疗的副作用、疾病复发和过早死亡的机会以及他们的生活质量之间做出选择。这项研究项目将询问已经接受过结直肠癌治疗的患者，他们在无病生存率、治疗的毒性和长期生活质量等因素之间做出了什么样的权衡。这将使用假设的临床情景来完成，将一种类型的治疗与另一种类型的治疗进行比较。通过这种方式，假想的选择将由患者的治疗经验来告知，而不是要求他们反思或直接停留在他们自己的治疗选择上。假设性选择问题的答案可以用来评估治疗中哪些因素对患者最重要，以及影响程度有多大。这些信息随后可以被临床医生用于呈现新诊断的结直肠癌患者的治疗的循证信息。

Around the world, governments, medical professional bodies, individual clinicians and patients are trying to make decisions in health care more rationally. More of these decisions are 'informed' by evidence-based medicine, which depends on a systematic review of all relevant evidence of acceptable scientific rigour. This kind of systematic review has been conducted for the management of colorectal cancer. Patients making choices about possible treatment for colorectal cancer will then have the best 'evidence-based' information to hand. But not enough is known about what aspects of the treatment options matter most to patients. Choosing between different treatment options involves weighing up or trading-off different factors associated with each therapy. Depending on the clinical stage of their cancer, patients may have to choose between the type and size of surgical operation, whether or not to have chemotherapy and-or radiotherapy, the side effects of treatment, the chance of a recurrence of the disease and an early death as well as their quality of life. This research project will ask patients who have already been treated for their colorectal cancer what kind of tradeoffs they make between factors such as disease-free survival, toxicity of treatment and longer term quality of life. This will be done using hypothetical clinical scenarios comparing one type of treatment to another. In this way, the hypothetical choices will be informed by the patient's experience with treatment without asking them to reflect or dwell directly on their own treatment choices. The answers to the hypothetical choice questions can be used to assess what factors in treatment are most important to patients and by how much. This information can then be used by clinicians when presenting evidence-based information on treatment for patients newly diagnosed colorectal cancer.