Choice-based Conjoint Survey Research Articles

Perfusion Recruitment Strategies Using Choice-Based Conjoint Analysis

Perfusionists are leaving the workforce in higher rates as baby-boomers retire, yet the volume of cases involving perfusion continues to increase. This change has resulted in a high-demand market with organizations competing for the same candidates. The purpose of this study was to use a choice-based conjoint (CBC) analysis to determine what attributes of employment opportunities are most important to perfusionists so hiring organizations are better equipped to produce employment offers specific to each candidate. The Sawtooth Software Discover program was used to create a CBC survey that was distributed to perfusionists. After a series of demographic questions, respondents chose between three employment offers that comprised eight attributes, each with three varying options. Completed surveys were analyzed using the Discover software, producing importance scores. Two hundred forty surveys were completed, 154 (64%) male and 86 (36%) female. Extracorporeal membrane oxygenation (ECMO) impact to the perfusionist and hours worked per week ranked most important, at 19.4% and 17.5%, respectively. A significant difference exists between ECMO impact to perfusionists and all other attributes. The least important attributes were annual continuing education funds and sign-on bonus/relocation, at 6.8% and 4.7%, respectively. Respondents in their 20s and 30s find the importance of ECMO impact to be significantly less important than those in their 50s. Perfusionists with a master’s degree believe salary to be significantly more important than perfusionists with other types of perfusion education. Based on the respondents who completed this survey, the impact ECMO has on the perfusionist was the most significant job attribute. Offering large sign-on bonuses and relocation packages to entice new employees is not indicated as a viable way to satisfy perfusionists. Appropriate management of hours worked, days on call, and how ECMO impacts the perfusionists will be most impactful in recruitment of new employees.

Vietnamese Consumers’ Preferences for Functional Milk Powder Attributes: A Segmentation-Based Conjoint Study with Educated Consumers

This paper investigated Vietnamese consumers’ preferences for functional milk powder products to determine if there were differences in market segments. A Qualtrics survey and a 1000minds choice-based conjoint survey were completed by 272 participants, predominantly 18-30-year-old males with high education levels and above average incomes. Firstly, general perceptions of the use of functional foods to maintain health were determined, with results revealing that participants believed in the benefits the foods claim to provide. Secondly, participants’ tradeoffs for specific extrinsic functional milk powder attributes were determined by examining the relative importance they placed on a range of attributes. Participants prioritized a quality stamp attribute and preferred that this was obtained from an international certification body. Finally, a two-step cluster analysis and multinomial logistic regression was used to profile the participants and analyze relationships between socio-demographic data and the four resulting segments (i.e., Food Safety Concerned, Price Sensitive, Premium Product Focused, and Nutrition Focused). The largest of these segments was Food Safety Concerned (46.3%) with males significantly less likely than females to be in this segment. Given the limited literature on Vietnamese consumers’ decision-making processes, this study is an important contribution to this topic, as well as providing information about market opportunities.

Attitudes of urban residents towards environmental migration in Kenya and Vietnam

The displacement of people is an important consequence of climate change, as people may choose or be forced to migrate in response to adverse climate conditions or sudden-onset extreme climate events. Existing studies show that there is a consistently higher social acceptance of migrants fleeing political persecution or war than of economic migrants. Here we examine whether individuals in Vietnam and Kenya also extend the notion of deservingness to environmental migrants in the context of internal rural-to-urban migration, using original data from a choice-based conjoint survey experiment. We find that although residents in receiving areas view short-term climate events and long-term climate conditions as legitimate reasons to migrate, they do not see environmental migrants as more deserving than economic migrants. These findings have implications for how practitioners address population movements due to climatic changes, and how scholars study people’s attitudes towards environmental migrants. People may choose or be forced to relocate due to climate change. Here the authors show that urban residents in Vietnam and Kenya view climate conditions as a legitimate reason for migration from rural to urban areas, but environmental migrants are not seen as more deserving than economic migrants.

Determining How Chinese Consumers that Purchase Western Food Products Prioritize Food Safety Cues: A Conjoint Study on Adult Milk Powder

ABSTRACT This study investigated how Chinese consumers prioritize cues when assessing the safety of imported milk powder. A choice-based conjoint survey was completed by 307 participants in Beijing, Shanghai, Tianjin, and Nanjing, using the internet-based software 1000minds. Important cues for consumers were “government certification logo shown on the product label/Website”; “ingredients and materials, free from preservatives and additives”; “having traceability techniques such as QR code included” and “realistic photos.” Distinct consumer segments reflecting differing trade-offs between safety cues were not detected suggesting that a single food safety communication strategy for this market may be sufficient. These findings add to extant literature by highlighting what cues give consumers the most confidence a product is safe and they provide a raft of actionable insights for government and the food industry in terms of designing and implementing effective risk or market communication strategies for Chinese consumers.

Organizational Attributes and Their Effect on Donor Intentions: Examining How the Descriptors Used in Marketing Communications Can Affect Donor Support

ABSTRACT Utilizing a choice-based conjoint survey of donors from four nonprofit organizations, this study investigated individual donation intentions and their organizational and venture attribute preferences. A sample of 191 participants indicated that a nonprofit organization’s administrative efficiency was the most important attribute when choosing between donation options. Attribute choices of 8% and 10% of the budget spent on administrative expenses seem to be strongly preferred over the attributes of 12% and 16%. The attributes concerning the venture itself (the profitability of the venture, the venture’s location, the entrepreneurial competence of those starting the venture, and terms used to describe the venture) were all significantly more important to donors than the age of the nonprofit organization launching the venture. Interestingly, respondents appear to favor a venture described as “social enterprise” over a venture described as a for-profit social enterprise. This study may help determine which organizational and enterprise attributes are most effective in eliciting donor support. These findings extend previous research studies.

Identifying most typical and most ideal attribute levels in small populations of expert decision makers: Studying the Go/No Go decision of disaster relief organizations

This paper proposes the use of Most Typical (MT) and Most Ideal (MI) levels when an adaptive choice-based conjoint (ACBC) survey can only obtain a small sample size n from a small population size N. This situation arises when expert decision makers are surveyed from among important small populations such as executives of large companies or political leaders, for which the expert decision maker assumption is reasonable. The paper compares respondents' MT levels obtained using the Build Your Own (BYO) question with MI levels obtained using part-worth utilities. The MI levels are validated using the Potentially All Pairwise RanKings of all possible Alternatives (PAPRIKA) method. It then explores differences in MT/MI levels for two related populations using an application concerning disaster relief. For effective disaster relief coordination, humanitarian organizations must understand each other's response decisions. An ACBC survey on the “Go/No-Go” decision by 49 faith-based (FBOs) and 12 non faith-based (NFBOs) disaster relief organizations considered four attributes: Funding, Disaster Response Type, Need Assessment, and Community Access. There was disparity between MT/MI Funding levels: 18 of 19 respondents reported MT levels of 50% or less, but 12 of 19 estimated to have MI levels of at least 75%. Greatest similarity between FBOs and NFBOs was observed for MI Need Assessment. Greatest disagreement of MI levels determined by part-worths and PAPRIKA was for Need Assessment and Disaster Response Type. To handle zero counts in the sample frequency distributions, we include a mathematical appendix explaining our use of a Bayesian rather than maximum likelihood estimation of MT/MI population frequency distributions.

PMD46 UNDERSTANDING DISCRETE CHOICE PREFERENCES FOR A NOVEL PROSTHETIC DEVICE IN PERSONS WITH LOWER LIMB LOSS

Understand patient’s preferences for an osseointegration device for attachment of their lower limb prosthetic to assist in decision making for FDA device approval. Sixty five adults with lower limb loss completed a choice-based conjoint survey. Patient and clinical expert interviews were conducted for selection and definition of attributes of risk: treatable infection, complete device failure, chance of daily pain, time without prosthetic, activity limitations and of benefit: improved motion and fatigue, limb perception, and avoiding socket problems. The survey consisted of 20 pairs of prosthetic choices created using a random, full profile, balanced overlap design via Sawtooth Software. Beta coefficients were calculated using a mixed effects regression model to determine most and least important attributes to inform our survey attribute choice for a larger follow-up study. Respondents showed the strongest negative preferences were for risks of treatable infection (β = -1.69, p<0.001) and complete device failure (β = -1.49, p<0.001) (the biggest risks associated with osseointegration) and also chance of daily pain (β = -1.54, p<0.001) (which osseointegration can decrease). There was no significant preference for improved motion and fatigue allowed with osseointegration. Also important was avoiding time spent without use of their device (β = -0.989, p<0.001). In preliminary sub-group analysis, men favored avoiding socket problems much more than women who valued a greater sense of limb perception. Patients showed strong negative preferences for the major risks of the osseointegration procedure. The importance shown avoiding time without their prosthetic will be important as approval decisions are made for the riskier one stage instead of two stage surgical procedure, allowing faster time to weight bearing. A larger study will explore more differences across gender and other patient characteristics.

A Product Feature Prioritization-Based Segmentation Model of Consumer Market for Health Drinks

This study sets out to identify the various factors of a health drink product that affects the consumer decision-making process. It aims to determine the relative importance connected to multiple aspects of health drink beverages, such as brand, nutrition content, taste, muscle building, brain boosting, price, ingredients, and country of origin. The paper also aims to identify consumer segments by the relative importance consumers give to various attributes of health drinks. Through examining the literature, the researchers identified various attributes of health drinks, which they analyzed empirically using a choice-based conjoint survey conducted with the help of the internet-based software 1000minds. Cluster analysis was also done to identify different consumer segments. The study identified two consumer segments: brand conscious and value conscious. As the name indicates, the brand-conscious segment gives more importance to a trusted brand, followed by nutrition content and price.

Identification and characterization of fluid milk consumer groups

Consumption of fluid milk has steadily declined over the last few decades. Understanding the attributes of fluid milk products that are attractive to specific consumer groups may provide a sound basis for education and marketing to encourage increased dairy consumption and reverse the downward trend. The objective of this study was to identify the attributes of fluid milk that specific consumer groups find attractive and attributes that suggest a higher purchase likelihood. An adaptive choice-based conjoint (ACBC) survey was designed to assess attributes of fluid milk. The ACBC survey included Kano, importance, labeling identification, and beliefs questions to determine the key attributes that dictated consumer purchase and consumption. Self-reported purchase habits and attitudes for organic food products were also collected. Attributes in the ACBC exercise included fat content, package type, shelf life, and label claims. Maximum difference scaling was used to rank the importance of attributes in fluid milk that affected purchase. Maximum difference scaling was also used to rank qualities and issues associated with organic milk that were most motivating for those who identified as organic milk consumers. Results were analyzed by univariate and multivariate statistics. A total of 1,163 fluid milk consumers completed the survey, and of those, 434 were regular purchasers of organic milk. The ideal fluid milk from conjoint analysis was 2% milkfat, organic, packaged in a plastic jug, conventionally pasteurized, and contained no additives or label claims. The belief that "organic milk is healthier" was the most important motivator for purchases of organic milk, followed by the beliefs that "organic milk production encourages ethical treatment of animals" and "organic milk production supports local farms and farmers." Conjoint importance scores of all fluid milk consumers showed that milkfat content was the most important attribute, followed by flavor, package size, and price. For all milk consumers, designation as organic was ranked as the 8th most important of 14 attributes. Evaluation of these results on both aggregate and individual levels suggest that fluid milk consumers are not a homogeneous consumer group and that underlying consumer groups are led to purchase decisions by specific product features or expectations.

Guest preferences for service recovery procedures: conjoint analysis

PurposeThe ongoing challenge for hospitality firms is not to avoid service failures completely but rather to find effective ways of recovering from them. The purpose of this paper is to adopt conjoint analysis to examine guest preferences for service recovery actions that are taken simultaneously and the effect of such actions in the context of hotels in order to seek answers to the following research questions: what type of compensation bundle is most preferred by guests? and How effective are compensations in terms of recovery satisfaction, especially with regard to subsequent behavioral intentions?Design/methodology/approachIn order to study guest preferences for compensation, choice-based conjoint (CBC) experiments were used. The CBC survey method involves presenting respondents with several hypothetical scenarios that include numerous combinations of compensation attributes. The survey sample was recruited through web-based panels run by a marketing firm. The online survey was designed and built in the Sawtooth Software platform. Conjoint analysis was carried out.FindingsThe conjoint analysis results show that among the different compensation attributes, consumers preferred discounts the most, followed by corrective actions and loyalty points. Among the discount levels, consumers favored “free one night certificate for a future stay” over “100 percent off one night’s room bill.” Regarding loyalty points, consumers desire more points than fewer points. In terms of correction levels, consumers appear to desire an “upgrade to a suite” over just moving to another room or having the original room cleaned. Moreover, consumers prefer that service recovery be handled by upper-level management.Research limitations/implicationsSeveral limitations should be discussed. For example, the type of service failure studied was limited to a booked room not being clean upon check-in. Different types and magnitudes of service failures may result in a different set of preferences for compensation bundles. In addition, the compensation attributes and levels were limited in scope even though they were obtained from interviews with managers at midsize hotels. Other attributes and attribute levels can be included in future studies.Originality/valueAlthough an abundant number of studies have been done regarding service failure and recovery, the extent to which service recovery needs to be carried out before it translates into actual recovery remains unanswered. Using conjoint analysis, the study identified exactly which bundle of compensation items was most preferred by guests.

P026 DEVELOPMENT OF A PREFERENCE-WEIGHTED SYMPTOM SCALE FOR INFLAMMATORY BOWEL DISEASE

Practicing patient-centric care by incorporating patient preferences in IBD care is increasingly recognized to be important. However, existing IBD disease activity measures do not incorporate patient perspective. Here, we describe the development of a preference-weighted symptom score to evaluate treatment efficacy in IBD. We conducted three focus groups to understand which symptoms are most important for patients and why. Based on the results of the focus groups, we developed a choice-based conjoint (CBC) analysis survey to quantify the relative importance of identified symptoms. A preference-weighted score will be developed based on the results. To validate the results, the concordance between self-reported preferences and preferences obtained from the CBC analysis will be assessed. We performed focus groups with 8 IBD patients in total. Three key-themes were identified that elucidate what makes symptoms important to patients: 1) symptoms that interfere with daily life; 2) symptoms that generate anxiety; or 3) symptoms that patients have no control over. Based on the results of the focus group, urgency, blood in the stool, abdominal pain and stool frequency were selected for inclusion in the CBC analysis. To date, 11 patients have filled out the CBC survey. An interim analysis of the survey found that – consistent with the focus group results – urgency is perceived to be the most important symptom, followed by abdominal pain, rectal bleeding, then stool frequency. As expected, more severe symptoms were perceived as more important. Self-reported preferences revealed that indeed, urgency was the most important symptom for 55% of patients. To fully quantify outcomes of IBD care based on the patient experience, we are developing a patient preference-weighted symptom score. This score will allow IBD researchers and practitioners to evaluate treatment efficacy while taking into account which symptoms matter to patients.

When Is Teleconsultation Acceptable to School Psychologists?

ABSTRACTSchool psychologists report a desire to increase consultation with teachers but are limited by competing job demands. Consultation via videoconference (i.e., teleconsultation) offers one possible means of increasing consultant availability to teachers, but little is known about the acceptability of this technology in actual practice. In this exploratory study, we conducted an online survey to assess the conditions under which school consultants would use teleconsultation to assist teachers remotely. Sixty-two school psychology practitioners, trainers, and trainees completed a choice-based conjoint survey designed to assess teleconsultation acceptability in the context of varying commute times, consultee comfort levels, and student problem severities. Findings suggest important differences in teleconsultation acceptability in the context of real-world tradeoffs. Implications of these results are discussed, as well as the potential for using conjoint analysis to better understand technology decisions among school consultants.

Strategies to Implement Pre-exposure Prophylaxis with Men Who Have Sex with Men in Ukraine.

Ukrainian men who have sex with men (MSM) remain highly stigmatized group with HIV prevalence as high as 23%. Despite documented effectiveness of pre-exposure prophylaxis (PrEP), PrEP remains unavailable in Ukraine. The aim of this study was to elicit MSM preferences in order to inform program development to facilitate successful delivery of PrEP to Ukrainian MSM. 1184 MSM were recruited through social networking applications to complete a stated preference (choice-based conjoint) survey. Respondents completed 14 choice tasks presenting experimentally-varied combinations of five attributes related to PrEP administration (dosing frequency, dispensing venue, prescription practices, adherence support, and costs). Latent class analysis was used to estimate the relative importance of each attribute and preferences across nine possible PrEP delivery programs. Preferences clustered into five groups. PrEP affordability was the most influential attribute across groups, followed by dosing strategy. Only one group preferred injectable PrEP (n=216), while the other four groups disliked daily PrEP and strongly preferred the 'on demand' option. One group (n=258) almost exclusively considered cost in their decision making. One group (n=151) had very low level of interest in PrEP initiation correlated with low self-perceived risk for HIV. The two most at-risk groups (n=415) were also more sensitive to changes in program delivery. PrEP uptake among MSM is most likely to be successful when PrEP is affordable, its implementation is targeted, provided as "on-demand" with associated education, and when more thorough medical care and related testing is provided to at-risk populations. Its introduction will need affirmation by the Ukrainian government, and guidelines that reflect safety, efficacy, and patient preferences.

Optimizing Selection of Biologics in Inflammatory Bowel Disease: Development of an Online Patient Decision Aid Using Conjoint Analysis.

Recent drug approvals have increased the availability of biologic therapies for inflammatory bowel disease (IBD), making it difficult for patients with ulcerative colitis (UC) and Crohn's disease (CD) to navigate treatment options. Here we developed a conjoint analysis to examine patient decision-making surrounding biologic medicines for IBD. We used the results to create an online patient decision aid that generates a unique "preferences report" for each patient to assist with shared decision-making with their provider. We administered an adaptive choice-based conjoint survey to IBD patients that quantifies the relative importance of biologic attributes (e.g., efficacy, side effect profile, mode of administration, and mechanism of action) in decision making. The conjoint software determined individual patient preferences by calculating part-worth utilities for each attribute. We conducted regression analyses to determine if demographic and disease characteristics (e.g., type of IBD and severity) predicted how patients made decisions. 640 patients completed the survey (UC=304; CD=336). In regression analyses, demographics and IBD characteristics did not predict individual patient preferences; the main exception was IBD type. When compared to UC, CD patients were more likely to report side effect profile as most important (odds ratio (OR) 1.63, 95% confidence interval (CI) 1.16-2.30). Conversely, those with UC were more likely to value therapeutic efficacy (OR 1.41, 95% CI 1.01-2.00). Biologic decision-making is highly personalized; demographic and disease characteristics poorly predict individual preferences, indicating that IBD patients are unique and difficult to statistically categorize. The online decision tool resulting from this study (www.ibdandme.org) may be used by patients to support shared decision-making and optimize personalized biologic selection with their provider.

Preferences of Patients and Pharmacists with Regard to the Management of Drug-Drug Interactions: A Choice-Based Conjoint Analysis.

IntroductionThe management of drug–drug interactions (DDIs) is a complex process in which risk–benefit assessments should be combined with the patient’s perspective.ObjectiveThe aim of this study was to determine patients’ and pharmacists’ preferences regarding DDI management.MethodsWe conducted a choice-based conjoint survey about a fictitious DDI concerning the combination of a cardiovascular drug and an antibiotic for pneumonia. Patients and pharmacists had to choose 12 times between two management options. The options were described by five attributes, including risk, benefit and practical consequences. Each attribute could have two different levels, which were varied over the choice tasks. Latent class analysis was used to identify potential classes of respondents with distinct patterns of similar preferences.Results In total, 298 patients and 178 pharmacists completed the questionnaire. The latent class model for both patients and pharmacists resulted in three classes. For patients, in one class the most importance was attached to avoiding switch of medication (class probability 20%), in a second class to fewer adverse events (41%), and in a third class to blood sampling (39%). For pharmacists, again one class attached the highest importance to avoiding switch of medication (31%). The other classes gave priority to curing pneumonia (31%) and avoiding blood sampling (38%).ConclusionThe results showed diverging preferences regarding DDI management among both patients and pharmacists. Different groups attached different value to risk and benefit versus practical considerations. Awareness of existing variability in preferences among and between pharmacists and patients is a step towards shared decision making in DDI management.Electronic supplementary materialThe online version of this article (doi:10.1007/s40264-017-0601-7) contains supplementary material, which is available to authorized users.

A Demand-Side Perspective on Developing a Future Electricity Generation Mix: Identifying Heterogeneity in Social Preferences

Public support is an important factor in failure or success of the government decisions with respect to the electricity generation mix, which highlights the necessity of developing an electricity mix that reflects social preferences and acceptance. This study explores heterogeneity in social preferences for power sources and develops an electricity mix from a demand-side perspective. The study utilizes the choice-based conjoint survey and latent class model, and bases its empirical analysis on South Korea’s electric power sector. Results demonstrate that preferences for power sources in Korean society consist of two classes: one that is sensitive to the environment and one that is sensitive to risk. An electricity mix for Korea that reflects social preferences is 16.5–19.8% coal-fired, 13.3–24.9% liquefied natural gas (LNG), 9.0–11.2% oil, 22.3–32.9% nuclear, and 18.5–38.9% renewables, depending on the scenario. The study confirms that renewables are the power source with the least potential to cause social conflict, compared to nuclear and coal-fired sources. Moreover, increasing the proportion of renewables (currently only 3.9%) while decreasing the proportion of coal-fired power sources (currently 39.9%) to less than half its current level will result in an electricity mix that is accordance with social preferences in the long run.

Discerning the clinical relevance of biomarkers in early stage breast cancer.

Prior data suggest that breast cancer patients accept significant toxicity for small benefit. It is unclear whether personalized estimations of risk or benefit likelihood that could be provided by biomarkers alter treatment decisions in the curative setting. A choice-based conjoint (CBC) survey was conducted in 417 HER2-negative breast cancer patients who received chemotherapy in the curative setting. The survey presented pairs of treatment choices derived from common taxane- and anthracycline-based regimens, varying in degree of benefit by risk of recurrence and in toxicity profile, including peripheral neuropathy (PN) and congestive heart failure (CHF). Hypothetical biomarkers shifting benefit and toxicity risk were modeled to determine whether this knowledge alters choice. Previously identified biomarkers were evaluated using this model. Based on CBC analysis, a non-anthracycline regimen was the most preferred. Patients with prior PN had a similar preference for a taxane regimen as those who were PN naïve, but more dramatically shifted preference away from taxanes when PN was described as severe/irreversible. When modeled after hypothetical biomarkers, as the likelihood of PN increased, the preference for taxane-containing regimens decreased; similarly, as the likelihood of CHF increased, the preference for anthracycline regimens decreased. When evaluating validated biomarkers for PN and CHF, this knowledge did alter regimen preference. Patients faced with multi-faceted decisions consider personal experience and perceived risk of recurrent disease. Biomarkers providing information on likelihood of toxicity risk do influence treatment choices, and patients may accept reduced benefit when faced with higher risk of toxicity in the curative setting.

Chronic anemia due to gastrointestinal bleeding: when do gastroenterologists transfuse?

BackgroundThe hypothesis is that decision-making for transfusion varies considerably among gastroenterologists. The aim is to identify preferences and predictors of transfusion decision-making in chronic anemia.Study design and methodsBetween February and April of 2015, a computerized adaptive choice-based conjoint survey was administered to gastroenterologists in the Netherlands. The survey included seven patient attributes: hemoglobin levels, hemoglobin stability, age, iron indices, the presence of anemia-related symptoms, cardiovascular comorbidities, and the number of transfusions in the past half year. Predictors of transfusion preferences were assessed by multivariable regression.Results113 gastroenterologists completed the survey (response rate = 29%; mean age = 47 years; 24% women). Absolute hemoglobin level was the most important incentive of transfusion, accounting for 42% of decision-making, followed by age (15%), hemoglobin stability (12%), anemia-related symptoms (10%), and cardiovascular comorbidities (10%). A hemoglobin level >9.6 g/dL is an inflection point, where gastroenterologists would not prescribe transfusions. Age of the patient is more important in the decision-making process to younger gastroenterologists (OR −2.9, 95% CI −5.3 to −0.5).ConclusionAbsolute hemoglobin level is the most important factor to transfusion decision-making. This is contradictory to transfusion guidelines for chronic anemia which address the importance of symptoms.

Patient preferences for palliative treatment of locally advanced or metastatic gastric cancer and adenocarcinoma of the gastroesophageal junction: a choice-based conjoint analysis study from Germany.

BackgroundDecisions on palliative chemotherapy (CT) for locally advanced or metastatic gastric cancer (mGC) require trade-offs between potential benefits and risks for patients. Healthcare providers and payers agree that patient-preferences should be considered. We conducted a choice-based conjoint (CBC) analysis study in pre-treated patients from Germany with mGC or locally advanced or metastatic adenocarcinoma of the gastroesophageal junction (mGEJ-Ca), to evaluate their preferences when hypothetically selecting a CT regimen.MethodsGerman oncologists and gastroenterologists were contacted to identify patients with mGC or mGEJ-Ca who had completed ≥2 cycles of palliative CT in first or later lines of therapy (CT ongoing or complete). The primary objective was to quantify patient preferences for palliative CT by CBC analysis. Six in-depth qualitative interviews identified 3 attributes: treatment tolerability, quality of life in terms of ability of self-care, and additional survival benefit. The CBC matrix was constructed with 4 factor levels per attribute and each participant was presented with 15 different iterations of these levels. A minimum of 50 participants was needed. Consenting patients completed the CBC survey, choosing systematically among profiles. CBC models were estimated by multinomial logistic regression (MLR) and hierarchical Bayesian (HB) analysis. Estimates of importance for each attribute and factor-level were calculated.ResultsFifty-five patients participated in the CBC survey (78.2% male, median age 63 years, 81.8% currently receiving CT). Across this sample, low treatment toxicity was ranked highest (44.6% relative importance, MLR analysis), followed by ability to self-care (32.3%), and an additional survival benefit of up to 3 months (3 months 23.1%, 2 months 18.3%, 1 month 11.2%). The MLR analysis showed high validity (certainty 37.9%, chi square p < 0.01, root-likelihood 0.505). The HB analysis yielded similar results.ConclusionsPatients’ preferences related to a new hypothetical palliative CT of mGC or mGEJ-Ca can be assessed by CBCanalysis. Although in real-life, patients initially need to decide on CT before they have any experience, and patients’ varied experiences with CT will have impacted specific responses, low toxicity and self-care ability were considered as most important by this group of patients with mGC or mGEJ-Ca.

The Influence of Varying Cost Formats on Preferences.

Numerous studies have found that cost strongly influences patients' decision making. The objective of this study was to explore the impact of varying cost formats on patients' preferences. Mechanical Turk workers completed a choice-based conjoint (CBC) survey. The CBC survey was designed to examine stated preferences for the use of second-line agents to treat diabetes across 5 attributes: route of administration, efficacy, risk of low blood sugar, frequency of checking blood sugar levels, and cost. We developed 7 versions of the CBC survey that were identical except for the cost attribute. We described cost in terms of: Affordability, Monthly Co-pay, Dollar Sign Rating, How Expensive, or How Cheap compared with other medications, Working Hours Equivalent (per mo) and Percent of Monthly Income. The resulting part-worth utilities were used to calculate the relative importance of cost and to estimate treatment preferences for exenatide, a sulfonylurea, and insulin. The relative impact of cost varied significantly across the 7 formats. Cost had the greatest influence on participants' decisions when framed in terms of Affordability [mean (SD) relative importance, 37.3 (0.9)] and the lowest influence when framed in terms of How Cheap (compared with other drugs) [12.1 (0.9)]. A sulfonylurea was strongly preferred across 4 of the 7 formats. Preference for insulin, the most effective, albeit riskiest, option was low across all cost formats. The format used to describe cost affects how the attribute impacts patients' preferences. Individuals are most cost-sensitive when cost is framed in terms of affordability and least cost-sensitive when cost is described in terms of how cheap the medication is compared with others.