Integrating Patient Preferences Research Articles

Abstract PO5-26-08: Caveats behind the improved outcomes observed in recent clinical trials for women with breast cancer: Korean breast cancer consensus meeting 2023

Abstract Introduction Korean Breast Cancer Society has organized the biennial Korean Breast Cancer Consensus Conference to find solutions to clinical situations that cannot be answered by randomized clinical trials or other definitive treatment research data. Unlike guidelines which are designed to apply to the majority of patients with early or advanced breast cancer encountered in daily practice, consensus meetings yield answers from clinicians’ perspectives and experiences. Therefore, this meeting aimed to integrate patient preferences, treatment availability, or other individual circumstances upon recent medical advances and available evidence. Materials and methods. Panelists were invited from various filed, such as medical oncology, surgical oncology, radiation oncology, pathology, radiology, nuclear medicine, hereditary cancer specialist. Results. 1. caveats behind optimizing treatment There had been strong interests in refinening thresholes for treatment and it can be more or less than previous standard treatment. Some patients clearly required escalated treatment, such as ovarian function suppression, combined HER2-targeted treatment, and utilization of immunotherapy during neoadjuvant systemic treatment. However, even same agent which showed great success for high risk patients showed Disappointing results and even failure. Furthermore, we need more sophisticated decision even for successful stories which introduced above, because of their serious adverse events. AntiPd-1/PD-L1 showed different serious adverse events profiles and Trastuzumab-deruxtecan is related with life-threatening pulmonary complication. Therefore, there is a clinical equipoise for an appropriate therapeutic threshold not only for low-risk patients but also high-risk patients who can safely forgo recommend treatment escalation in the newly introduced clinical trials. 2. Completely new serious adverse events observed in new drugs. Unlike chemotherapy, most targeted therapies cause lethal damage that clinicians may not have experienced. Some, such as pulmonary complications from trastuzumab deruxtecan, can be fatal if not treated immediately. Even if patients survive, they may suffer catastrophic outcomes because these agents leave a fatal disability that is too great for the patient's quality of life. Moreover, in South Korea, where government-run health insurance is the only payer and at the same time policy maker, non-medical constraints such as passive reimbursement plans, value-based medicine, and intentional delay or denial of certain drugs, panelist delivered varing opinions on the extent to which new agents can be utilized and which treatment plan could offer equal clinical benefit with less toxicity, or provide for a measurable improvement in outcomes. 3. utilizing genomic signatures Panelist raised issues genetic assay which analyzed genes currently we do not have treatment options which can modify disease process. Many questions were addressed such as, appropriate sampling time, which sample, liquid or tumor, can yield meaningful information. Conclusion Korean Breast Cancer consensus meeting highlighted important caveats behinds new promising findings. Clinical unmet need and uncertainty should be disclosed before patients because what clinician and patients work with is their life. Shared decision making is essential and patients should become well aware of science and medicine. Proactive approach of clinician is critical for these movements. Citation Format: Airi Han, Young-Joon Kang, Sei Hyun Kim, Eui Su Chae, Han Cho Kim, Kyong Hwa Park. Caveats behind the improved outcomes observed in recent clinical trials for women with breast cancer: Korean breast cancer consensus meeting 2023 [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 PO5-26-08.

Assessment of management reasoning: Design considerations drawn from analysis of simulated outpatient encounters

Purpose Management reasoning is a distinct subset of clinical reasoning. We sought to explore features to be considered when designing assessments of management reasoning. Methods This is a hybrid empirical research study, narrative review, and expert perspective. In 2021, we reviewed and discussed 10 videos of simulated (staged) physician-patient encounters, actively seeking actions that offered insights into assessment of management reasoning. We analyzed our own observations in conjunction with literature on clinical reasoning assessment, using a constant comparative qualitative approach. Results Distinguishing features of management reasoning that will influence its assessment include management scripts, shared decision-making, process knowledge, illness-specific knowledge, and tailoring of the encounter and management plan. Performance domains that merit special consideration include communication, integration of patient preferences, adherence to the management script, and prognostication. Additional facets of encounter variation include the clinical problem, clinical and nonclinical patient characteristics (including preferences, values, and resources), team/system characteristics, and encounter features. We cataloged several relevant assessment approaches including written/computer-based, simulation-based, and workplace-based modalities, and a variety of novel response formats. Conclusions Assessment of management reasoning could be improved with attention to the performance domains, facets of variation, and variety of approaches herein identified.

Summary of evidence to facilitate the implementation of advance care planning among advanced cancer patients.

Advance care planning (ACP) is designed to ensure that patients lacking autonomous decision-making capacity receive medical services in accordance with their expectations and preferences. Individuals with advanced cancer are a crucial target for ACP implementation. However, the current practice of ACP in this group in China is suboptimal, demanding high-quality implementation evidence to strengthen ACP in the clinical practice of patients with advanced cancer. The existing literature can be summarized into 27 pieces of evidence across 7 dimensions, including initiation time, intervention content, intervention providers, intervention modalities, communication skills, outcome indicators, and environmental support. The aforementioned evidence could provide crucial support for improving ACP implementation for patients with advanced cancer. Subsequent research efforts should integrate patient preferences and explore the most suitable implementation strategies for ACP in the Chinese population with advanced cancer, considering diverse aspects such as traditional culture, ACP education and training, legislative support, and healthcare system refinement.

Being a woman or being a youth: what matters for young adults with chronic diseases?

Abstract Background as the prevalence of chronic diseases increases with age, most interventions focus on ‘adults’ and neglect the growing proportion of chronically ill young people aged 15-24. Although they are no longer children, they are still in a period of transition towards autonomy and independence, particularly in industrialised countries. Moreover, health care for chronic patients is criticised for neglecting gender-specific needs. This exploratory collaborative study identified needs and preferences of youths living with a chronic disease with a gender lens. Methods we conducted 24 semi-directive interviews: 12 university students living with rare or chronic diseases; 12 health care professionals (doctors, nurses and allied health professionals). We conducted a group interview with an interdisciplinary staff in hospital and a group interview in an integrated primary care centre in 2022 in Brussels, Belgium. Alongside thematic analysis of the content of the interviews, we used the group analysis method with youths and professionals to co-construct recommendations: data were analysed and discussed in several collaborative meetings. Results youths insisted that professionals should listen more to youths and be more flexible. Youths stressed the need for psychological support currently absent, support regarding educational trajectory and warm environment of care similar to paediatric settings. Professionals expressed their concerns about being more gender-friendly and their lack of training regarding gender issues and other non-medical aspects of chronic diseases. Both youths and professionals consider gender-specific needs in a larger frame of patient-centred care focusing on the integration of patient preferences in a co-constructed dialogue. Conclusions to be youth-friendly, health services should better embrace the personalised health care planning, allowing for a better inclusion of what really matters for youths, be their age or their gender. Key messages • Personnalised health care planning supports gender-friendly health services. • Personnalised health care planning supports youth-friendly health services.

Patient preferences and shared decision making for the traditional Chinese medicine treatment of lung cancer: A discrete choice experiment study

BackgroundTraditional Chinese Medicine (TCM), integrating patient preferences into decision-making process, has been widely used in the multimodality therapy of lung cancer. This study aimed to estimate patient preferences for treatment and shared decision-making (SDM) modes concerning inpatient TCM treatment of lung cancer in Shanghai in order to provide a basis for clinical decision-making process on TCM therapy for lung cancer. MethodsThis study was conducted among patients (n = 347) from nine tertiary hospitals in Shanghai by discrete-choice experiment (DCE) survey and Shared Decision-Making Questionnaire-patient version (SDM-Q-9) survey. The DCE was developed with the inclusion of the most relevant attributes at appropriate levels for the TCM treatment of lung cancer. The empirical data analyses of patients were performed using mixed logit models. Additionally, subgroup analysis was conducted. ResultsIn total, 347 respondents completed the questionnaire. All attributes’ coefficients were statistically significant for patients’ preferences. Patients showed strong preferences for increasing disease control rate, relieving nausea and vomiting, reducing the risk of side effects, and were concerned about monthly out-of-pocket costs. Subgroup analysis indicated that patients with a lower SDM-Q-9 score and those who were satisfied with medical services emphasized more importance of higher disease control rate. Furthermore, most of the patients (90.20%) self-reported a high willingness to use SDM during the decision-making process. ConclusionIn Shanghai, patients mainly preferred SDM and considered disease control rate as the most essential attribute in the TCM treatment of lung cancer. The study findings could underscore the importance of considering patients’ preferences and promote SDM.

Decision Analysis in SHared decision making for Thromboprophylaxis during Pregnancy (DASH-TOP): a sequential explanatory mixed-methods pilot study

ObjectivesTo gain insight into formal methods of integrating patient preferences and clinical evidence to inform treatment decisions, we explored patients’ experience with a personalised decision analysis intervention, for prophylactic low-molecular-weight...

Older adult preferences regarding benefits and harms of statin and aspirin therapy for cardiovascular primary prevention

ObjectivePersonalizing preventive therapies for atherosclerotic cardiovascular disease (ASCVD) is particularly important for older adults, as they tend to have multiple chronic conditions, increased risk for medication adverse effects, and may have heterogenous preferences when weighing health outcomes. However, little is known about outcome preferences related to ASCVD preventive therapies in older adults. MethodsIn May 2021, using an established online panel, KnowledgePanel, we surveyed older US adults aged 65-84 years without history of ASCVD on outcome preferences related to statin therapy (benefit outcomes to be reduced by the therapy: heart attack, stroke; adverse effects: diabetes, abnormal liver test, muscle pain) or aspirin therapy (benefit outcomes: heart attack, stroke; adverse effects: brain bleed, bowel bleed, stomach ulcer). We used standardized best-worst scores (range of -1 for “least worrisome” to +1 for “most worrisome”) and conditional logistic regression to examine the relative importance of the outcomes. ResultsIn this study, 607 ASCVD-free participants (median age 74, 46% male, 81% White) were included; 304 and 303 completed the statin and aspirin versions of the survey, respectively. For statin-related outcomes, stroke and heart attack were most worrisome (score 0.55; 95% CI 0.51, 0.60) and (0.53; 0.48, 0.58), followed by potential harms of diabetes (-0.07; -0.10, -0.03), abnormal liver test (-0.25; -0.29, -0.20), and muscle pain (-0.77; -0.82, -0.73). For aspirin-related outcomes, stroke and heart attack were similarly most worrisome (0.48; 0.43, 0.52) and (0.43; 0.38, 0.48), followed by brain bleed (0.30; 0.25, 0.34), bowel bleed (-0.31; -0.33, -0.28), and stomach ulcer (-0.90; -0.92, -0.87). Conditional logistic regression and subgroup analyses by age, sex, and race yielded similar results. ConclusionsOlder adults generally consider outcomes related to benefits of ASCVD primary preventive therapies—stroke and heart attack—more important than their adverse effects. Integrating patient preferences with risk assessment is an important next step for personalizing ASCVD preventive therapies for older adults.

Patient perspectives on intraoperative blood transfusion: A qualitative interview study with perioperative patients.

While red blood cell (RBC) transfusions are frequently administered during surgery, little is known about patient perspectives regarding intraoperative transfusion. The aim of this study was to understand patient perspectives about intraoperative RBC transfusion and explore their willingness to engage in transfusion prevention strategies. This descriptive qualitative study used semi-structured patient interviews before and after surgery. Purposive sampling was used to select adult patients with varying perioperative courses, including having perioperative transfusion or postoperative anemia. Inductive and deductive thematic analyses were conducted to identify themes. Twenty patients (nine preoperative and 11 postoperative patients) were interviewed. The following themes were identified: Risk-benefit perception of transfusion, transfusion acceptance, trust, patient involvement in transfusion decisions, acceptance of transfusion prevention interventions, and communication. Patients perceived transfusions as low-risk compared to the surgery itself. Factors influencing transfusion acceptance included trust in the healthcare system and the perception of the treatability of transfusion-related complications. Some patients preferred to defer transfusion decision making to the perioperative team, citing trust in professional judgment and building a positive relationship with their surgeon. Others wished for their preferences to be incorporated into transfusion decisions. Some desired detailed blood consent conversations and most were willing to participate in strategies to reduce intraoperative transfusion. In our sample, patients consider intraoperative transfusions as low-risk high-reward interventions and trust the healthcare system and perioperative team to guide intraoperative transfusion decision making. However, preoperative transfusion consent discussions were recalled as being superficial and lacking nuance. Targeted strategies are required to improve blood consent discussions to better integrate patient preferences.

ASSESSING PREFERENCES FOR COMMUNICATING WITH TECHNOLOGY: A PERSON-CENTERED APPROACH TO CARE MANAGEMENT

Abstract Technological advances, such as telehealth, have been used to manage the multiple chronic conditions that impact over 25% of the US adult population. Technology-assisted communication (TAC) can help to bridge the gap in effective management of health conditions in the community by patients, informal caregivers, and healthcare providers, while emphasizing person-centered care. The purpose of this project was to develop a new theoretically-derived and evidence based subscale for the Preferences for Everyday Living Inventory (PELI) that addresses preferred TAC approaches for community-dwelling adults over the age of 50 years in the context of multiple chronic conditions (N=297). Results indicated that over 60% of older adults are satisfied with technology-based healthcare communications. In general, older adults in the sample are satisfied with all domains of technology-assisted communication that are asked within P-TAC, including timing, sending and receiving of information, and content of communications. Almost 80% (N=234) indicate that they are satisfied with the content of TAC. This research has lead to the development of assessment items that will allow providers to better assess and then integrate patient preferences for technology communication strategies into plans of care. Potential benefits of understanding preferences for TAC include alignment of chronic care management with preferred strategies which may lead to improvement care congruence and improved healthcare outcomes for the older adult.

PCR63 Using Patient Preference to Inform Ritlecitinib Dose Selection for Alopecia Areata Treatment

To evaluate benefit-risk profiles of two doses of ritlecitinib (50 mg vs. 30 mg daily) integrating patient preferences and clinical efficacy estimates for ritlecitinib, an investigational treatment for alopecia areata (AA).

The impact of patient preference in the treatment algorithm for recurrent/metastatic head and neck squamous cell carcinoma

The advent of immune checkpoint inhibitors for recurrent/metastatic head and neck squamous cell carcinoma (RM-HNSCC) has revolutionized the standard of care approach in first-line treatment. The heterogeneity of disease presentation and treatment-related toxicities can be associated with suboptimal patient compliance to oncologic care. Hence, prioritizing quality of life and well-being are crucial aspects to be considered in tailoring the best treatment choice. The aim of our work is to present a short report on the topic of the patient’s preference in regard to treatment and its consequences on quality of life in the recurrent/metastatic setting. According to the literature, there’s an unmet need on how to assess patient attitude in respect to the choice of treatment. In view of the availability of different therapeutic strategies in first-line management of RM-HNSCC, increasing emphasis should be put on integrating patient preferences into the medical decision-making.

An Efficient Nomogram for Discriminating Intrahepatic Cholangiocarcinoma From Hepatocellular Carcinoma: A Retrospective Study.

ObjectiveThis study aims to establish a nomogram and provide an effective method to distinguish between intrahepatic cholangiocarcinoma (ICC) and hepatocellular carcinoma (HCC).MethodsA total of 1,591 patients with HCC or ICC hospitalized at Shandong Provincial Hospital between January 2016 and August 2021 were included and randomly divided into development and validation groups in a ratio of 3:1. Univariate and multivariate analyses were performed to determine the independent differential factors between HCC and ICC patients in the development cohort. By combining these independent differential factors, the nomogram was established for discriminating ICC from HCC. The accuracy of the nomogram was estimated by using receiver operating characteristic (ROC) curve and decision curve analysis (DCA). Furthermore, the predictive nomogram was assessed in the internal testing set.ResultsThrough multivariate analysis, independent differential factors between HCC and ICC involved hepatitis B virus (HBV), logarithm of alpha-fetoprotein (Log AFP), logarithm of protein induced by vitamin K absence or antagonist-II (Log PIVKA-II), logarithm of carbohydrate antigen 199 (Log CA199), and logarithm of carbohydrate antigen 125 (Log CA125). A nomogram was finally established by incorporating these five independent differential factors. Comparing a model of conventional tumor biomarkers including AFP and CA199, the nomogram showed a better distinction between ICC and HCC. The area under the ROC curve (AUC) of ICC diagnosis was 0.951 (95% CI, 0.938–0.964) for the nomogram. The results were consistent in the validation cohort with an AUC of 0.958 (95% CI, 0.938–0.978). After integrating patient preferences into the analysis, the DCA showed that using this nomogram to distinguish ICC and HCC increased more benefit compared with the conventional model.ConclusionAn efficient nomogram has been established for the differential diagnosis between ICC and HCC, which may facilitate the detection and diagnosis of ICC. Further use of the nomogram in multicenter investigations will confirm the practicality of the tool for future clinical application.

Prospective development of a standardized assessment algorithm for advanced oncoplastic breast conservation. A report from the OncoPRO Value trial

Background: Oncoplastic breast conserving therapy (OPBCT) reduces mastectomy rates while achieving low re-excision rates and good cosmetic outcomes. Several clinical algorithms have been proposed to facilitate decision-making, but there is no consensus and classifications based on excision cut-offs are arbitrary at large. The OncoPRO Value trial aims to develop a standardized oncoplastic assessment for tailored OPBCT, integrating patient preferences and patient reported outcomes in the shared decision-making process.

Participate Brussels, a collaborative research on healthcare personalisation for chronic patients

Abstract Background Integrating patients ‘preferences in the management of chronic diseases improves patient compliance and quality of care: this assumption is at the core of the healthcare personalisation. However, it is unclear how healthcare personalisation is negotiated and put into practice by patients and healthcare professionals. The collaborative research Participate Brussels aimed at co-constructing interventions promoting healthcare personalisation for persons living with a chronic disease in the context of the Brussels region, Belgium. Methods In a first step (2018-2019), 46 professionals (nurses, physicians, social workers, alternative practitioners…) and 26 adult patients living with a chronic disease participated in comprehensive interviews. Data were analysed using the ground theory approach. Results of these interviews were discussed between patients and professionals during 6 analysis seminaries in 2019-2020 where researchers acted as facilitators of the dialogue by using participative methods. Finally, solutions to improve healthcare personalisation were prioritized and co-created by patients and professionals in 2020-2021. Results Eleven interventions to improve healthcare personalisation for persons living with a chronic disease were co-constructed by patients, healthcare professionals, and researchers. Five interventions targeted the patient level, 3 addressed the organisational level and 3 the macro level. All these interventions were adapted to the regional context and 2 were tested into practice by professionals and patients. Conclusions The collaborative approach used in this project allowed for the development of interventions tailored to both the needs of patients and professionals. These interventions potentialize each other and contribute to the healthcare personalisation in a health promotion perspective. Despite the challenges of the collaborative approach, this project succeeded in making both patients and professionals actors of the research. Key messages Healthcare personalisation helps to integrate patient preferences into healthcare, but it remains unclear how to put it into practice. Co-created interventions have a better potential to improve quality of care for both patients and healthcare professionals.

Universal screening and trauma informed care: Current concerns and future directions.

There is a growing awareness of the prevalence and negative health effects associated with traumatic events, including childhood abuse and adversity, intimate partner violence, adult sexual assault, and exposure to combat and community violence. Health care systems have attempted to address this link by becoming trauma informed through universal trauma precautions and screening protocols. We review several clinical and methodological concerns associated with universal trauma screening in adult health care settings including: deciding which traumas to assess in which populations, integrating retrospective recall with current functioning to facilitate referrals, and guarding against adverse patient reactions and insurance discrimination. We outline potential implications for program development and future research including: adapting and refining screening tools, integrating patient preferences and privacy concerns into screening protocols, assessing resource limitations, and integrating public health advocacy into screening programs. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Mixed Methods Study of Nurse Assessment of Patient Preferences for Engagement During Hospitalization.

Global healthcare initiatives emphasize the importance of engaging patients in their healthcare to improve patients' experience and outcomes. Assessing patient preferences for engagement is critical, as there are many ways patients can engage in their care and preferences vary across individuals. The primary purpose of this study was to evaluate the effect of implementation of the Patient Preferences for Engagement Tool 13-Item Short Form (PPET13) during hospitalization on patient and nurse experience of engagement. Readmissions and emergency department (ED) usage within 30 days postdischarge were also examined. The mixed methods study was conducted within two medical units in the United States between December 2018 and May 2019. Preimplementation group patients completed a demographic survey and the Patient Experience of Engagement Survey (PEES) on discharge. Implementation group patients completed the PPET13 within 24 hours of admission with their nurse and the demographic survey and PEES on discharge. A focus group with nurses who implemented the PPET13 was conducted following the implementation period. Data analysis included confirmatory factor analysis, multiple and logistic regression, and qualitative content analysis. There was significant improvement in PEES scores during the implementation phase. The PEES score was a significant predictor of ED visits, but not 30-day readmissions. Nurses were not always certain how to best integrate patient preferences for engagement into their care delivery and suggested integrating the PPET13 into the electronic health record to assist with streamlining the assessment and communicating preferences across the care team. Assessing patients' preferences for engagement using the PPET13 was associated with an improved experience of engagement, which was found to mediate the relationship between utilization of PPET13 and ED usage within 30 days postdischarge. Use of a patient engagement preference tool, such as the PPET13, can help inform the delivery of individualized engagement strategies to improve patient and family engagement and outcomes; however, nurses need formalized education on how to tailor their care to meet the individual engagement preferences of their patients.

Taking into Account Patient Preferences: A Consensus Study on the Assessment of Psychological Dimensions Within Patient Preference Studies.

Patient preferences are gaining recognition among key stakeholders involved in benefit-risk decision-making along the medical product lifecycle. However, one of the main challenges of integrating patient preferences in benefit-risk decision-making is understanding differences in patient preference, which may be attributable to clinical characteristics (eg age, medical history) or psychosocial factors. Measuring the latter may provide valuable information to decision-makers but there is limited guidance regarding which psychological dimensions may influence patient preferences and which psychological instruments should be considered for inclusion in patient preference studies. This paper aims to provide such guidance by advancing evidence and consensus-based recommendations and considerations. Findings of a recent systematic review on psychological constructs having an impact on patients’ preferences and health-related decisions were expanded with input from an expert group (n = 11). These data were then used as the basis for final recommendations developed through two rounds of formal evaluation via an online Delphi consensus process involving international experts in the field of psychology, medical decision-making, and risk communication (n = 27). Three classes of recommendations emerged. Eleven psychological constructs reached consensus to be recommended for inclusion with the strongest consensus existing for health literacy, numeracy, illness perception and treatment-related beliefs. We also proposed a set of descriptive and checklist criteria to appraise available psychological measures to assist researchers and other stakeholders in including psychological assessment when planning patient preference studies. These recommendations can guide researchers and other stakeholders when designing and interpreting patient preference studies with a potential high impact in clinical practice and medical product benefit-risk decision-making processes.

Physician\u2013patient communication in decision-making about Caesarean sections in eight district hospitals in Bangladesh: a mixed-method study

BackgroundCaesarean sections (CS) in Bangladesh have risen eight-fold in the last 15 years. Few studies have explored why. Anecdotally, physicians suggest maternal request for CS is a reason. Women and families suggest physicians influence their decision-making. The aim of this research was to understand more about the decision-making process surrounding CS by exploring physician–patient communication leading to informed-consent for the operation.MethodsWe conducted a mixed-method study using structured observations with the Option Grid Collaborative’s OPTION5 tool and interviews with physicians and women between July and December 2018. Study participants were recruited from eight district public-sector hospitals. Eligibility criteria for facilities was ≥ 80 births every month; and for physicians, was that they had performed CSs. Women aged ≥ 18 years, providing consent, and delivering at a facility were included in the observation component; primigravid women delivering by CS were selected for the in-depth interviews. Quantitative data from observations were analysed using descriptive statistics. Following transcription and translation, a preliminary coding framework was devised for the qualitative data analysis. We combined both inductive and deductive approaches in our thematic analysis.ResultsIn total, 306 labour situations were observed, and interviews were conducted with 16 physicians and 32 women who delivered by CS (16 emergency CS; 16 elective CS). In 92.5% of observations of physician–patient communication in the context of labour situations, the OPTION5 mean scores were low (5–25 out of 100) for presenting options, patient partnership, describing pros/cons, eliciting patient preferences and integrating patient preferences. Interviews found that non-clinical factors prime both physicians and patients in favour of CS prior to the clinical encounter in which the decision to perform a CS is documented. These interactions were both minimal in content and limited in purpose, with consent being an artefact of a process involving little communication.ConclusionsInsufficient communication between physicians and patients is one of many factors driving increasing rates of caesarean section in Bangladesh. While this single clinical encounter provides an opportunity for practice improvement, interventions are unlikley to impact rates of CS without simultaneoulsy addressing physician, patient and health system contextual factors too.

Patient Preferences: Results of a German Adaptive Choice-Based Conjoint Analysis (Market Research Study Sponsored by Eli Lilly and Company) in Patients on Palliative Treatment for Advanced Breast Cancer

Introduction: Integration of patient preferences into shared decision making improves disease-related outcomes, but such data from patients with advanced breast cancer (aBC) are limited. The objective of this study was to demonstrate the relative importance of overall survival (OS) and progression-free survival (PFS) in relation to quality of life (QoL) and therapy-associated side effects from the perspective of patients with aBC. Methods: Postmenopausal patients with hormone receptor-positive, human epidermal growth factor receptor 2-negative aBC receiving first- or second-line treatment were recruited throughout Germany. Patient-relevant attributes for aBC therapy assessment were collected using a stepwise multimodal approach. A conjoint matrix was developed, resulting in 2 attributes for therapy goals (OS and PFS), 4 for QoL, and 6 for side effects. An online quantitative survey was then performed using adaptive choice-based conjoint (ACBC) methodology. Results: The quantitative survey included 104 patients: 67 (64.4%) receiving first-line treatment and 37 (35.6%) receiving second-line treatment. The QoL attribute “physical agility and mobility” received the highest utility score (19.4 of 100%), reflecting the greatest importance to patients, followed by treatment goals (OS [15.2%] and PFS [14.4%]). Therapy-related side effects were less important, with nausea/vomiting being the most important (9.3%), followed by infection (6.4%) and hair loss (5.0%). The McFadden pseudo R² (0.805), the root likelihood (0.864), and the χ² test (2,809.041; p < 0.0001) indicated a very good fit of the statistical model. Conclusion: Using ACBC analysis, it appears that QoL, OS, and PFS are most important to postmenopausal patients with aBC in relation to cancer treatment. Side effects seem to be less important if OS or PFS are prolonged and the QoL is maintained. Thus, QoL, OS, and PFS should be considered equally when making treatment decisions in aBC.

Heart Failure and Shared Decision-Making: Patients Open to Medication-Related Cost Discussions.

Discussions of medication costs between patients and clinicians are infrequent and often suboptimal. In the context of recently introduced drugs that are effective but expensive, patients with heart failure with reduced ejection fraction provide an ideal population to understand the perspectives of patients with chronic illness on medication cost and cost discussions. To explore patients' perspectives on discussing out-of-pocket medication costs with clinicians, 49 adults, aged 44 to 70 years, with heart failure with reduced ejection fraction were recruited from outpatient heart failure clinics. Descriptive qualitative analysis was performed on open-ended text data. Participants who had prior medication-related cost discussions described their experience as generally positive, but about half of the participants had never had a cost discussion with their clinician. Most participants were open to cost discussions with clinicians and preferred that the clinician initiate discussions regarding medication cost. Importantly, these preferences held constant across reported levels of financial burden. These data suggest a substantial willingness on the part of patients with heart failure with reduced ejection fraction to incorporate cost discussions into their care and identify important aspects of these discussions for clinicians to consider when engaging in conversations where cost is relevant. Improving understanding about how to integrate patient preferences regarding cost discussions into clinical encounters is an important priority for advancing patient-centered care.