PDB127 - APPLICATION OF BEST WORST SCALING TO IMPROVE PATIENT-CENTERED TREATMENT DECISIONS IN DIABETIC PERIPHERAL NEUROPATHY

Abstract

Treatment of diabetic peripheral neuropathy (DPN) symptoms is challenging due to variable treatment effectiveness and side effects. This study evaluated best-worst scaling as a strategy for patient-centered tailoring of treatment choice. We designed an object case best-worst scaling preference instrument to identify DPN treatment attributes of least and most importance to patients. An initial set of 9 attributes was identified through coding and analysis of transcripts from in-depth interviews with 42 patients with DPN symptoms in a large U.S. health system. We used Sawtooth Software to design a balanced incomplete block design of the survey instrument. We then conducted 2 rounds of iterative pilot testing with interviewers and patients (n=19), resulting in a refined instrument with 7 attributes with 2 levels each. The final survey instrument was limited to 4 choices per set and a total of 15 sets per patient. We fielded the survey among a random sample of 100 patients who were actively being treated for DPN symptoms. The importance score was then calculated for each patient. Preference assessments were conducted with 100 patients with an average age of 61. Most of the participants were female (52%) and were 34% White, 33% Black, 16% Asian, 14% Hispanic and 3% unknown race or ethnicity. The attribute identified by patients as being most important to decision-making was functioning “I can do the things that I usually do”. The second most important attribute was whether “my doctor and I discuss my concerns about this medication”. The attributes identified as least important were medication cost and whether they had to take more than one pill every day. This study provides real-world evidence regarding the treatment preferences of adults with DPN symptoms. Healthcare innovations in DPN are needed to foster patient-provider communication about treatment preferences, particularly related to functioning.