Heterogeneity in physician and patient preferences for the treatment of renal cell carcinoma: Evidence from latent class analysis.

Abstract

661 Background: To inform shared decision-making, it is important to learn how patients or physicians trade off the features of adjuvant treatments and whether there is heterogeneity within preferences. Methods: An online discrete-choice experiment survey was administered to patients with physician-confirmed renal cell carcinoma (RCC) and physician-defined intermediate high/high risk of recurrence and physicians who treat such patients. Hypothetical treatment choices were defined by median disease-free survival (DFS); 5-year overall survival (OS) rate; mode and frequency of administration; need for concomitant daily pill; treatment duration; and the risks of severe diarrhea, fatigue, and dizziness. After making an adjuvant treatment choice, respondents were presented with the opportunity to opt out of treatment. Patient and physician choice data were analyzed separately using latent class (LC) models, which identify clusters within patients and physicians making similar choices. Each class’ preference weights were used to calculate the conditional relative attribute importance. Results: LC analysis identified three classes among the 250 patients (% respondents) that placed greater relative importance on: 1) 5-year OS and opting into treatment (37.5%), 2) median DFS and opting into treatment (26.9%), and 3) treatment duration and opting out of treatment (35.5%) (Table). Among the 250 physicians, the LC analysis identified three classes that placed greater relative importance on: 1) 5-year OS and recommending treatment (37.5%), 2) median DFS and recommending treatment (37.8%), and 3) not recommending treatment (24.7%). Additionally, each LC analysis showed that the other treatment attributes evaluated were less important, but the importance varied by LC (Table). Conclusions: Heterogeneity in physician and patient preferences for RCC adjuvant therapy was found, highlighting a need for shared decision-making. Discordance within patients and physicians in the propensity to opt out of adjuvant treatment suggests patient-physician dialogue is important. [Table: see text]