Abstract 18484: An App-based Discrete Choice Survey Tool for Assessing Patient Treatment Preferences in Critical Limb Ischemia

Abstract

Introduction: Patient centered care has potential to improve PAD treatment but providers need structured approaches to understand patients' values and apply them to individualized treatment. We used focus groups to identify factors patients with critical limb ischemia (CLI) consider important for treatment choices and developed an app to assess their treatment preferences during clinical encounters. Methods: Focus groups were used to identify factors patients with CLI consider important and relevant for treatment decisions. Treatment attributes and levels derived from qualitative data were then used to design an app for assessing treatment preferences through a discrete choice survey. Treatment options were presented pair-wise in patients' own terms using an orthogonal array design, and choice set order was individually randomized. The app also collected demographic and educational information, vascular specific health related quality of life, and user satisfaction. Aggregate responses were evaluated using conjoint analysis, and relative attribute importance was defined based on a ratio-based share of overall utility. Results: 26 patients with CLI participated in focus groups used to identify important attributes, levels, and terminology. A patient friendly app was developed and subsequently pilot tested in 20 additional patients. Mean participant age was 63.4 ± 11.2 years; 25% were women, 30% were African American, and 40% had a college education. Mean app completion time was 20.4 ± 6.6 minutes. Aggregate attribute importances in decreasing utility order were: type of treatment (45.9), chance of successful treatment outcome (22.9), treatment risk (15.8), symptomatic response (13.5), and treatment durability (1.9). 90% of participants indicated that they believed the app will help patients contribute to better treatment choices, and 90% believed it would help providers understand what patients consider most important. Conclusion: CLI treatment preference assessment is feasible during clinical encounters and may facilitate patient contributions to choices. Structured decision tools have potential to increase patient engagement and improve both satisfaction and outcomes.