Influence Treatment Preferences Research Articles

Abstract PO1-18-01: Patient Preferences for HR+/HER2- Metastatic Breast Cancer Treatments in Italy: A Qualitative Assessment

Abstract Objectives: Factors that influence treatment preferences of patients with hormone receptor-positive/HER2-negative (HR+/HER2-) metastatic breast cancer (mBC) are being investigated using discrete choice experiment (DCE) methodology. Appropriate attributes for the ongoing quantitative online survey phase were identified by this initial qualitative pilot study. Methods: To generate hypotheses and inform variables of the quantitative survey, the pilot phase consisted in online telephone interviews with patients with a diagnosis of Stage IV HR+/HER2- breast cancer at various stages of treatment. Interviews focused on exploring patients' perspectives on their interaction with physicians, preferences, and treatment experiences. Transcripts were coded using NVivo software to identify key themes. The ongoing DCE online survey aims to recruit patients meeting the same selection criteria as in the qualitative phase, also at various stages of treatment. Results: Fifteen mBC patients (median age, 43 years [range, 29-64]), including nine chemotherapy-treated and six without chemotherapy exposure, were enrolled in the pilot qualitative study. Eight and four patients reported receiving little information about their treatment plan and their risk status beyond the risk of relapse, respectively. Most participants did not know what to expect from their therapy but expressed trust in their physician’s decision in terms of treatment goals. Few patients (n=3) looked for a second opinion before starting treatment. Four out of fifteen patients declared that they were actively involved in their treatment plan decision, although all relied on their physician’s knowledge and decision. Reduced symptoms and improved quality of life (QoL) were patients’ main treatment goals, and side-effects and efficacy of treatment were their main concerns. When asked about the degree of acceptability of certain side effects, some participants considered hair loss and vomiting as unacceptable side effects, regardless of severity, while others considered them to be the most acceptable. This discrepancy is to be interpreted in the light of participants’ own treatment journey. Severity and duration of side-effects were mentioned by three patients as acceptability factors. In a choice task, patients were asked to express preferences between two hypothetical treatments. Efficacy (n=9) and administration mode (n=6) were spontaneously deemed important for treatment selection. While assessing the difference in risk between the two hypothetical treatments, ten patients explained that the main choice feature was extended progression-free survival (PFS) rate. Risk of infection and neutropenia (n=12) were concerns expressed by most patients in the post-COVID-19 period. Considering their substantial impact on QoL, alopecia (n=9) and vomiting (n=9) were presented by patients as particularly important, regardless of their degree of severity; whereas almost all patients reported that only severe fatigue (n=12), diarrhea (n=13) or nausea (n=13) would be an issue. These results allowed selection of the following attributes for further quantification of their preference weights in a DCE: PFS, risk of neutropenia, risk of alopecia, risk of vomiting, risk of diarrhea, risk of grade 3/4 side effects and mode of administration. Conclusions: This qualitative pilot study allowed for identification of what matters most to patients when selecting a treatment for mBC, which will be further assessed in the DCE. It also highlighted the need of patients with HR+/HER2- mBC for information about their treatment, potential side-effects, and health management. This research suggests that there is a need for patients to be more involved in treatment plans, and that taking patient preferences into account may help improve the treatment selection experiences. Citation Format: Grazia Arpino, Carmine De Angelis, Lorenzo Gerratana, Matteo Lambertini, Sarah Igidbashian, Martina Bellini, Serena Giuntoli, Xavier Guillaume, Julie Behillil, Claire Graziani-Taugeron. Patient Preferences for HR+/HER2- Metastatic Breast Cancer Treatments in Italy: A Qualitative Assessment [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-18-01.

Cross-cultural perspectives on patient expectations in cosmetic dermatology: A comparative analysis across countries and ethnicities.

Patient expectations in cosmetic dermatology exhibit significant variations across countries, cultures, and ethnicities, thereby reflecting individual desires, concerns, and goals. While some individuals seek aesthetic enhancements, others prioritize addressing specific skin conditions within the context of beauty norms in their respective countries. The provision of personalized and culturally sensitive care plays a crucial role in meeting these diverse expectations. Skin characteristics and concerns differ among ethnicities, influencing treatment preferences. For instance, individuals with darker skin tones may prioritize the treatment of pigmentation disorders, whereas those with lighter skin tones may focus on achieving a fair complexion. Furthermore, differences in facial anatomy among various ethnicities necessitate tailored treatment approaches. This commentary aims to contribute to the effective understanding and management of patient expectations, ultimately leading to satisfactory outcomes. Additional research and regional studies are required to further deepen our understanding of patient expectations in cosmetic dermatology and enable the delivery of improved and culturally appropriate care on a global scale.

Current Health State Affected Patient Preferences More Than Disease Status: A Discrete Choice Experiment in Multiple Myeloma

ObjectivesTo examine how disease status and current health state influence treatment preferences of patients with multiple myeloma (MM). MethodsParticipants with MM from France, Germany, and the United Kingdom completed a web-based survey that included a discrete choice experiment (DCE) and EQ-5D assessment. The DCE elicited preferences for 8 attributes: increased life expectancy, increased time to relapse, pain, fatigue, risk of infection, administration (route and duration), frequency of administration, and monitoring. Multinomial logit models were used to analyze DCE preference data and to calculate life expectancy trade-offs. ResultsThree hundred participants with MM (newly diagnosed, transplant eligible, n = 108; newly diagnosed, transplant ineligible, n = 105; relapsed-refractory, n = 87) completed the survey. The most valued attributes were pain, fatigue, and increased life expectancy. Participants would want an additional 2.7 years of life expectancy (95% confidence interval [CI] 2.4-3.1 years) to tolerate extreme pain and an additional 2.0 years of life expectancy (95% CI 1.6-2.3 years) to tolerate constant fatigue. Participants in a better health state (third EQ-5D score quartile [0.897]) required less additional life expectancy than participants with a worse health state (first EQ-5D score quartile [0.662]) to tolerate extreme pain (2.3 years [95% CI 1.9-2.6 years] vs 3.0 years [95% CI 2.6-3.4 years]; P = .007). There was little difference in treatment preferences between newly diagnosed and relapsed-refractory patients for pain, fatigue, and increased life expectancy. ConclusionsCurrent health state influenced treatment preferences of patients with MM more than disease status and should be considered when making treatment decisions.

Out-of-pocket payment and patients’ treatment choice for assisted reproductive technology by household income: a conjoint analysis using an online social research panel in Japan

BackgroundEconomic disparities affect access to assisted reproductive technology (ART) treatment in many countries. At the time of this survey, Japan provided partial reimbursement for ART treatment only for those in low- or middle-income classes due to limited governmental budgets. However, the optimal level of financial support by income class remains unclear.MethodsWe conducted a conjoint analysis of ART in Japan in January 2020. We recruited 824 women with fertility problems aged 25 to 44 years via an online social research panel. They completed a questionnaire of 16 hypothetical scenarios measuring six relevant ART attributes (i.e., out-of-pocket payment, pregnancy rate, risk of adverse effects, number of visits to outpatient clinics, consultation hours and kindness of staff) and their relations to treatment choice.ResultsMixed-effect logistic regression models showed that all six attributes significantly influenced treatment preferences, with participants valuing out-of-pocket payment the most, followed by pregnancy rates and kindness of staff. Significant interactions occurred between high household income (≥ 8 million JPY) and high out-of-pocket payment (≥ 500,000 JPY). However, the average marginal probability of the highest-income patients (i.e., ≥ 10 million JPY, ineligible for the subsidy) receiving ART treatment at the average cost of 400,000 JPY was 47%, compared to 56 − 61% of other income participants, who opted to receive ART at an average cost of 100,000 JPY after a 300,000 JPY subsidy.ConclusionOur results suggest that out-of-pocket payment is the primary determinant in patients’ decision to opt for ART treatment. High-income patients were more likely to choose treatment, even at a high cost, but their income-based ineligibility for government financial support might discourage some from receiving treatment.

Patient preferences for topical psoriasis treatments: a discrete choice experiment

Background Topical medication continues to be the most frequently prescribed therapy for psoriasis. However, patients are often dissatisfied with their topical medication, and adherence to this type of therapy is particularly poor. Objective To investigate the preferences of patients with psoriasis regarding the process and outcome attributes associated with topical treatments and to assess influencing factors. Methods A discrete choice experiment was conducted to analyze patient preferences for topical psoriasis treatments based on outcome attributes (probabilities of 90% improvement, 50% improvement, skin atrophy and skin irritation) and process attributes (treatment cost not covered by health insurance, treatment duration, location, frequency and formulation). Results The study cohort (N = 184) considered probabilities of 50% (Relative Importance Score (RIS)=41.0) and 90% (RIS = 33.9) improvement most important, followed by risk of skin atrophy (RIS = 26.4) and treatment cost (RIS = 22.2). Treatment location (RIS = 18.9), risk of skin irritation (RIS = 16.2), treatment frequency (RIS = 13.3) and formulation (RIS = 11.0) were considered less relevant. Income, cardiovascular disease, number of visits and current topical therapy influenced treatment preferences. Conclusions Averaged across the cohort, participants preferred an efficient topical treatment associated with a low risk of skin atrophy and reasonable personal expenses. Individual preferences should be integrated into a shared decision-making process about psoriasis treatment.

Different patients, different preferences: A multicenter assessment of patients' personality traits and anxiety in shared decision making.

ObjectivePatient‐centered care and shared decision making (SDM) are generally recognized as the gold standard for medical consultations, especially for preference‐sensitive decisions. However, little is known about psychological patient characteristics that influence patient‐reported preferences. We set out to explore the role of personality and anxiety for a preference‐sensitive decision in bladder cancer patients (choice of urinary diversion, UD) and to determine if anxiety predicts patients' participation preferences.MethodsWe recruited a sample of bladder cancer patients (N = 180, primarily male, retired) who awaited a medical consultation on radical cystectomy and their choice of UD. We asked patients to fill in a set of self‐report questionnaires before this consultation, including measures of treatment preference, personality (BFI‐10), anxiety (STAI), and participation preference (API and API‐Uro), as well as sociodemographic characteristics.ResultsMost patients (79%) indicated a clear preference for one of the treatment options (44% continent UD, 34% incontinent UD). Patients who reported more conscientiousness were more likely to prefer more complex methods (continent UD). The majority (62%) preferred to delegate decision making to healthcare professionals. A substantial number of patients reported elevated anxiety (32%), and more anxiety was predictive of higher participation preference, specifically for uro‐oncological decisions (β = 0.207, p < 0.01).ConclusionsOur findings provide insight into the role of psychological patient characteristics for SDM. Aspects of personality such as conscientiousness influence treatment preferences. Anxiety contributes to patients' motivation to be involved in pertinent decisions. Thus, personality and negative affect should be considered to improve SDM.

A systematic review of the effects of positive versus negative framing on cancer treatment decision making

Objective Presenting treatment outcomes positively or negatively may differently influence treatment preferences and lead to sub-optimal decision in a medical context. This review systematically organised how positive versus negative framing of treatment outcomes influenced cancer treatment decisions of cancer patients and individuals without a cancer diagnosis. Design Three databases (PubMed, PsycInfo and Scopus) were searched for studies reporting the effects of positive versus negative framing on cancer treatment decision-making from 1981 to December 2020. Main Outcome Measure The effects of positive versus negative framing on cancer treatment preferences and the elimination of framing effect were evaluated. Results A total of 12 studies that met inclusion criteria were reviewed. Framing effect was consistently observed in individuals without a cancer diagnosis. There was not enough evidence to suggest a robust framing effect in cancer patients. Surgery was preferred in positive framing, whereas adjuvant therapy was preferred in negative framing. Justification intervention significantly eliminated framing effect. Mixed framing failed to eliminate framing effect. Conclusion Current recommendations for presenting treatment options are based on research in cancer-screening decision-making. Knowledge of how positive versus negative framing affect cancer patients’ treatment decisions is still limited. Our review highlighted the need for continued research in this area.

Patient and caregiver preferences on treatment attributes for atopic dermatitis

Background The expanding number of potential treatment options for atopic dermatitis (AD) highlights the need to better understand the treatment preferences of individuals with AD. Objective This study identified attributes that most greatly influenced treatment preferences of adults/adolescents/caregivers of children with mild/moderate/severe AD. Methods Adults (≥18 years), adolescents (12–17 years), and caregivers of children (2–11 years) with mild, moderate, or severe AD in the United States (US) and United Kingdom (UK) participated in semistructured interviews. Thematic analysis was used to identify and generate themes across the interview results describing the treatment attributes of greatest importance to participants. Results Qualitative interviews were conducted with 35 adults, 35 caregivers, and 33 adolescent participants across both countries (n = 103; US = 51; UK = 52) and all severity groups (mild = 43; moderate = 47; severe = 13). The most important treatment attributes included efficacy (96.1%; speed and duration of symptom relief), mode of administration (66.0%; route of administration, frequency, and convenience), and side effects (55.3%, short-term, long-term, and general). Conclusions Efficacy, mode of administration, and side effects were the most important attributes that influenced AD treatment preferences for patients and caregivers across different countries, ages, and disease severity. These results may assist patients/caregivers/clinicians in shared decision-making discussions to improve treatment adherence and outcomes.

177 The Relationship between Language Preference and Sleep Aid Utilization among Spanish and English-speaking Latinx Adults

Abstract Introduction Studies have found positive associations between acculturation and self-reported sleep disturbances among Latinx adults, however whether acculturation-related factors influence treatment preferences for sleep disturbances remain underexplored. This study examines the relationship between language preference, an indicator of acculturation, and various types of sleep aid use among Latinx adults. Methods Using cross-sectional screener survey data from the LAtino Sleep and Health Study (N=739) of Latinx adults living in NYC, we conducted logistic regression analyses to examine the relationship between language preference and 3 types of sleep aid use (prescription, over-the-counter, and natural/herbal). Language preference was determined by whether the survey was completed in English or Spanish. Participants responded “Yes/No” to each type of sleep aid use. Primary regression models included adjustments for gender and age. Sensitivity analyses were conducted accounting for self-reported, physician-diagnosed sleep disorders. Results In unadjusted models, participants with Spanish-language preference were 2.38 (OR=2.38, 95%CI:1.30-4.36) and 1.80 (OR=1.80,95%CI:1.27-2.55) times more likely to report prescription and natural/herbal sleep aid use, respectively, compared to those with English-language preference. In primary models, language preference was not significantly associated with any type of sleep aid use. However, being below age 50 was associated with 68% and 44% decreased odds of reporting prescription and natural/herbal sleep aid use, respectively, when compared to those above age 50-79 (OR=0.32, 95%CI:0.16-0.64; OR=0.56,95%CI:0.38-0.84).Those who reported a sleep disorder were 6.35, 2.65, and 2.83 times more likely to report prescription, over-the-counter, and natural/herbal sleep aid use (OR=6.35, 95%CI:3.45-11.69; OR=2.65,95%CI:1.61-4.36; OR=2.83, 95%CI:1.85-4.37) compared to those without sleep disorder. Conclusion To our knowledge, this is the first study to examine language preference and sleep aid use in a Latinx sample. After adjusting for demographics, language was no longer significantly associated with prescription or over-the-counter sleep aid use. This change in significance may be due to differences in the age composition of the sample by language preference. Future studies in more balanced age samples should replicate these findings, and further unpack the determinants of prescription sleep aid use in Latinx adults with sleep disorders given the adverse side effects associated with prescription sleep aids. Support (if any):

Association of Factors Influencing Selection of Upfront Hematopoietic Cell Transplantation versus Nontransplantation Therapies in Myelofibrosis

Despite the curative potential of allogeneic hematopoietic cell transplantation (HCT) for myelofibrosis (MF), a significant number of patients with MF do not undergo HCT. Factors influencing treatment preferences in these patients have not been well studied. This study was conducted to identify patient-, disease-, and donor-related factors influencing the decision regarding HCT in patients with MF. A secondary objective was to compare survival between patients who elected upfront HCT and those who opted for nontransplantation therapy. We conducted a retrospective chart review amongst patients meeting criteria for transplant indication, evaluating clinical characteristics, treatment preferences, and outcomes. Of the 183 study eligible patients age <70 years, 129 (70%) developed an HCT indication. Age >60 years was significantly associated with higher rates of HLA-typing refusal (13 of 72 versus 1 of 44; P=.02). Caucasian ethnicity was significantly associated with an increased rate of identifying well-matched donors compared with non-Caucasian ethnicity (75% versus 48%; P=.02). Of the 69 patients with well-matched donors, 34 (49%) preferred to not pursue upfront HCT despite an indication for transplantation. Patient preference for nontransplantation therapies was the most common reason for declining HCT. We did not find any difference in survival between patients pursuing upfront HCT and those opting for nontransplantation therapies, although more patients in the HCT arm were in remission at the last follow-up. Patients of Caucasian ethnicity were significantly more likely than non-Caucasian patients to identify a well-matched donor. Despite availability of a well-matched donor, a significant proportion of MF patients with an indication for transplantation do not pursue HCT. Patient age, donor type, and patient preference play major roles in the selection of upfront HCT. Although a survival difference was not observed between upfront HCT versus non-transplant therapy, more patients in the HCT arm were in remission at the last follow-up.

Evaluation of a decision aid for the treatment of depression among college students

Objective Depression, and its treatment, is a concern among college students. Research indicates decision aids (DA) improve patients’ treatment knowledge, decision making, and decisional conflict; however, it is unknown whether they are helpful for disseminating depression treatment information to college students. This study evaluated a DA for depression and its impact on college students’ knowledge and treatment decision making. Methods: College students (N = 144) completed questionnaires pre-, post-, and at 1-month follow-up after reviewing an evidence-based DA for depression. Results: Participants rated the DA as highly acceptable and useful, and their knowledge increased at post-treatment and follow-up. However, treatment option presentation order influenced decision making. Conclusions: This DA is a useful and acceptable decision-making tool, and increased knowledge of depression and its treatment among college students. This study proposes a novel tool for educating college students about depression treatment, furthering our understanding of factors influencing treatment preferences.

Understanding Clinician and Patient Preferences about Novel Agents in Chronic Lymphocytic Leukemia

Understanding Clinician and Patient Preferences about Novel Agents in Chronic Lymphocytic Leukemia

Understanding patients\u2019 preferences for osteoporosis treatment: the impact of patients\u2019 characteristics on subgroups and latent classes

SummaryThis study revealed patterns in osteoporosis patients’ treatment preferences, which cannot be related to socio-demographic or clinical characteristics, implicating unknown underlying reasons. Therefore, to improve quality of care and treatment, patients should have an active role in treatment choice, irrespective of their characteristics.IntroductionPatient centeredness is important to improve the quality of care. Accounting for patient preferences is a key element of patient centeredness, and understanding preferences are important for successful and adherent treatment. This study was designed to identify different preferences profiles and to investigate how patient characteristics influence treatment preferences of patients for anti-osteoporosis drugs.MethodsData from a discrete choice experiment among 188 osteoporotic patients were used. The hypothetical treatment options were characterized by three attributes: treatment efficacy, side effects, and mode/frequency of administration. A mixed logit model was used to measure heterogeneity across the sample. Subgroup analyses were conducted to identify potential effect of patient characteristics. Latent class modeling (LCM) was applied. Associations between patients’ characteristics and the identified latent classes were explored with chi-square.ResultsAll treatment options were important for patients’ decision regarding osteoporotic treatment. Significant heterogeneity was observed for most attributes. Subgroup analyses revealed that patients with a previous fracture valued efficacy most, and patients with a fear of needles or aged > 65 years preferred oral tablets. Elderly patients disliked intravenous medication. Three latent classes were identified, in which 6-month subcutaneous injection was preferred in two classes (86%), while oral tablets were preferred in the third class (14%). No statistically significant associations between the profiles regarding socio-demographic or clinical characteristics could be found.ConclusionsThis study revealed patterns in patients’ preferences for osteoporosis treatment, which cannot be related to specific socio-demographic or clinical characteristics. Therefore, patients should be involved in clinical decision-making to reveal their preferences.

P030 Patient and physician preferences for ulcerative colitis treatments in the United States

BACKGROUND: Ulcerative colitis (UC) is a chronic and debilitating inflammatory bowel disease. While there is no cure, patients and physicians can choose from a variety of treatments characterized by different attributes such as efficacy, safety, and mode and frequency of administration. Hence, it is important to understand how (and to what degree) these attributes influence treatment preferences from both patient and prescriber perspectives. Therefore, the purpose of this study was to elicit patient and physician preferences for different attributes of UC treatments via a discrete choice experiment (DCE). METHODS: The study was conducted in the United States (US) in 2 phases: (1) a qualitative phase involving in-depth individual interviews with patients and physicians to explore the UC treatment attributes that patients and physicians consider most important when making treatment decisions, and (2) a quantitative phase to estimate the relative importance of those attributes. Screening criteria for patients (self-reported clinical diagnosis of UC, disease severity of moderate to severe based on self-reported medication history) and physicians (gastroenterologists with experience treating patients with moderate to severe UC) were consistent across phases. In the quantitative phase, 2 discrete choice experiment survey instruments (one for patients, one for physicians) with an identical set of UC treatment attributes were developed and administered. The resulting data were analyzed using a random-parameters logit model to estimate preference weights and conditional relative importance of UC treatment attributes. RESULTS: Two hundred patients with moderate to severe UC and 200 board-certified (or eligible) gastroenterologists completed the survey. The average age of patients was approximately 42 years, and the majority of patients (59%) were female. In the qualitative phase, both patients and physicians indicated that the most important UC treatment attributes were time to symptom improvement, chance of long-term symptom control, risk of serious infection, risk of malignancy, mode and frequency of administration, and need for use of steroids. For patients, symptom control was 2.5 times more important than the time to symptom improvement. Patients considered a 5-year risk of malignancy almost as important as long-term symptom control (relative importance of 0.79 compared with 0.96 for long-term symptom control) and preferred all suggested pill-dosing schedules to both subcutaneous injections and intravenous infusions (relative importance of 0.47 compared with 0.11 and 0.18, respectively). For physicians, symptom control was by far the most important attribute when prescribing a treatment, and it was 5 times as important as the 5-year risk of malignancy. CONCLUSION(S): We identified patient and physician preferences for UC treatments. The differences in results between patients and physicians suggest that patients are thinking about the treatment features differently from their physicians. Both patients and physicians identified long-term symptom control as the most important attribute relative to the others; however, the 5-year risk of malignancy was almost of equal importance to patients but not for physicians. This highlights the need for improved communication about the relevant benefits and risks of different UC treatments so that patients and physicians can engage in better decision making.

Patient preferences for rheumatoid arthritis treatment.

To provide an overview of recent articles discussing patient preferences for rheumatoid arthritis (RA) treatment. Recent studies examined patient preferences for RA treatment in several populations, finding that most participants were willing to accept certain risks of adverse effects to gain potential benefits. Perspectives regarding cannabis were studied, with patients describing medical marijuana as an alternative therapy to be used with prescription medications or as means of tapering off these medications. Treatment preferences for different RA therapies were explored using a conjoint analysis survey and five distinct preference phenotypes emerged, with members of the largest group most concerned with the cost of medications. Other discrete choice studies demonstrated route of administration as an important attribute influencing treatment preferences, with patients expressing preference for various modes in different studies. Patient preferences for route of administration have demonstrated preference for newer autoinjectors over prefilled syringes as well as currently marketed autoinjectors. Incorporating patient preferences in clinical practice recommendations was described in the development of the 2015 American College of Rheumatology (ACR) RA treatment guidelines as well as the 2017 ACR/American Association of Hip and Knee Surgeons guidelines for perioperative management of antirheumatic medications. In addition, other studies explored preferences with regard to predictive testing, medication intensification and tapering, treatment goals, and psychological support. Our review of recent studies show variability in patient preferences for RA treatment, highlighting the importance of incorporating patient input into the treatment approach.

PRM199 - STAKEHOLDER PERSPECTIVES ON CONDUCT AND USE OF PATIENT PREFERENCE STUDIES ALONG THE MEDICAL PRODUCT LIFECYCLE: RESULTS FROM FOCUS GROUPS

To investigate stakeholder perspectives on how patient preference studies (PPS) should be designed, conducted and used in assessments and decision making along the medical product lifecycle. Focus group guides were set up and informed by a literature review and semi-structured interviews (n=142). Focus groups were conducted with patients from the UK, Sweden, Italy and Romania; and with European industry representatives, European regulators, US regulators and European/Canadian HTA representatives. Focus groups were analysed thematically using NVivo. Characteristics of medical products that influence treatment preferences according to patients, and thus to consider in the design of PPS, included benefits, side effects, price, quality, administration, packaging and storage. Patients highlighted factors influencing their participation in preference studies such as encouragement of family and the relationship with the recruiter. Across all focus groups it was found important that the PPS sponsor collaborates with other stakeholders including patients, patient organizations, regulators and HTA bodies to limit occurrence of bias, ensure comprehensibility of questions and that results are useful for decision makers. Participants indicated that currently, mostly qualitative input is collected by industry, regulators and HTA bodies and that use of quantitative methods is limited but might be useful for late stages of medical product development. Regulatory, HTA and industry participants agreed that the value of PPS in decision making depends on the level of uncertainty of the clinical evidence and profile of the medical product presented to decision makers. Stakeholders believed that PPS should be designed in collaboration with multiple healthcare stakeholders including patients. The value of PPS for decision making might depend on the match of the method (qualitative versus quantitative) to the lifecycle phase and on uncertainties relating to the clinical evidence and profile of the medical product.

PSS63 - IDENTIFYING PATIENT PREFERENCES FOR GLAUCOMA TREATMENT: EVIDENCE FROM LITERATURE REVIEW

One of the main objectives of glaucoma treatment is to lower intraocular pressure through topical medication, laser, or more invasive procedures (surgery, or surgical implants). In addition, long-lasting drug depots may also soon be a treatment option. The aim of current review was to identify the patient preferences towards glaucoma treatment and relevant influencing factors. A comprehensive literature search was performed for studies published in English from inception through August 2017 in Embase, MEDLINE, MEDLINE-In Process, and Cochrane library. Studies reporting patient preferences for any glaucoma treatment were included. The review identified 32 studies (7 RCTs, 1 non-RCTs, 12 observational studies and 7 single-arm studies) including studies assessing treatment-switching (n=11) and factors influencing treatment preference (n=5). Patients receiving monotherapies had significantly higher treatment satisfaction compared to polytherapies (p=0.05). Topical agents (QD regimen) were more convenient compared to BID regimens (p=0.104). Among monotherapies, brimonidine was preferred over topical β-blockers (less efficacious) or dual therapies (less convenient); travoprost BAK-free over latanoprost; and bimatoprost over travoprost. Patients switching from PGA monotherapies or mono/adjunctive therapies were significantly more likely to accept fixed-dose combinations such as travoprost/timolol. Additionally, studies reported high patient willingness to accept a novel glaucoma treatment such as sustained drug delivery (via punctal plug, subconjunctival or intracameral route) and implant (p=0.011) based upon effectiveness and cost. Other factors influencing patient preference were clear center vision, outdoor mobility, travelling distance during follow-ups, and treatment-associated symptoms (vision blurring, drowsiness, or inhibition of sexual performance). No studies assessing surgical treatment options were identified. Evidence clearly indicates that glaucoma patients have preference towards more efficacious and less frequent medication regimens. In addition, patients are willing to accept novel treatment options such as surgical implants and sustained release medication depots. However, scarce evidence necessitates the need for more research focusing on patient preferences towards surgical treatment options.

Association of Preferences for Papillary Thyroid Cancer Treatment With Disease Terminology

ImportanceGiven recent evidence of overdiagnosis and overtreatment of small papillary thyroid cancers (PTCs) and other low-risk cancers, strategies are needed to help patients consider less invasive treatment options.ObjectivesTo determine which factors influence treatment preferences for patients with PTC, and the trade-offs in treatment factors people are willing to accept, and to understand how terminology influences preferences and benefit-harm trade-offs.Design, Setting, and ParticipantsPreferences in PTC treatment were evaluated using a discrete choice experiment (DCE) conducted as a web-based survey using an existing public online research panel. Participants were randomized to receive 1 of 2 frames of information based on the terminology used to describe the condition: “cancer” or “lesion.” Participants chose between 3 treatment options for PTC (thyroidectomy, hemithyroidectomy, and active surveillance). Analyses were conducted using a mixed logit model.Main Outcomes and MeasuresThe main outcome variable was treatment preference; attributes of treatment options and sociodemographic characteristics were explanatory variables.ResultsThe DCE was completed by 2054 participants (993 [48.3%] men and 1061 [51.7%] women; mean [SD] age, 46.0 [16.5] years) with no history of thyroid cancer. Participants preferred options with less frequent follow-up, lower out-of-pocket costs, lower chances of having voice and calcium level problems, and a lower risk of developing invasive thyroid cancer and of dying of thyroid cancer. When trading benefits against harms, participants were willing to accept a higher number of extra patients experiencing adverse effects to avoid a thyroid cancer death when the condition was described as a cancer compared with a lesion. Specifically, participants for whom the condition was described as a cancer were willing to accept more patients requiring lifelong medication (mean, 273; 95% CI, 207-339 vs mean, 98; 95% CI, 66-131), experiencing calcium problems (mean, 110; 95% CI, 77-144 vs mean, 56; 95% CI, 55-58), and fatigue (mean, 958; 95% CI, 691-1224 vs mean, 469; 95% CI, 375-564). For both the cancer and lesion terminology, health literacy consistently was associated with preferences for treatment options. Those with lower health literacy had a significantly lower preference for less invasive treatment options.Conclusions and RelevanceThis study makes an important contribution to understanding how attributes of treatment options, terminology, and patient characteristics, in particular health literacy, influence treatment decision making for PTC. As a result of increasing evidence of the indolent nature of PTC and other low-risk cancers, strategies to deal with potential overtreatment are critically needed.Trial RegistrationAustralian New Zealand Clinical Trials Registry: ACTRN12617000066381

Treatment preferences and treatment satisfaction among psoriasis patients: a systematic review

A critical gap exists in determining treatment preferences and treatment satisfaction from patient perspectives, which is paramount to achieving therapeutic success. The objective of this systematic review is to determine factors influencing treatment preferences and treatment satisfaction among psoriasis patients. PubMed, EMBASE, and Web of Science databases were searched between November 1, 2010, and December 1, 2017. Observational and interventional research studies published in the English language that discussed patient preferences and patient satisfaction in the treatment of psoriasis were reviewed and synthesized. We utilized data on treatment preferences and treatment satisfaction from 35,388 psoriasis patients based on 60 articles from the years 2010 to 2017. Treatment preferences were heterogeneous and changed over time among psoriasis patients. Across all treatment modalities, the most important treatment attributes were treatment location, probability of improvement, and delivery method. For biologics specifically, the most important attributes were risk of adverse events and probability of treatment benefit. Factors that influenced patients' preferences for certain treatments included age, sex, comorbidities, disease duration, and prior treatments. Notably, some psoriasis patients placed higher importance on a treatment's process attributes (e.g., access and delivery) over its outcome attributes (e.g., efficacy). Overall, patient satisfaction with existing therapies remains modest; however, those treated with biologic agents exhibited highest treatment satisfaction over oral therapy, phototherapy, and topical therapy.

Interest in dental implantology and preferences for implant therapy: a survey of Victorian dentists.

The purpose of this study was to gauge dentists' interest, knowledge and training in implantology, and to compare their treatment preferences with current literature. Subsequently, this information may be used to evaluate implantology education pathways. A cross-sectional postal survey of 600 randomly selected dentists registered with the Dental Practice Board of Victoria was conducted. Respondents were asked about background, interest and training in implantology, and implant treatment preferences. Results were analysed according to primary practice location, decade of graduation and attendance at continuing professional development (CPD) programmes. One hundred and seventy-six questionnaires were included for analysis. In general, dentists rate their implant knowledge, interest and enjoyment in restoring implants favourably. No differences were found between city and country practitioners, and different graduation decades. The level of CPD significantly influenced treatment preferences. Practitioners were generally unwilling to treat patients taking bisphosphonates, or to perform grafting procedures. Most dentists provide common services to treat peri-implant conditions. Direct-to-fixture is the most popular fixture-abutment connection. Overall, there is a high level of implant knowledge corresponding to current evidence in the literature. Level of CPD attendance is the most important factor in dentists' willingness to provide more implant therapy options.