Patient Treatment Preferences Research Articles

Abstract 4126971: Advanced Care Planning in the CCU: What are the Numbers?

Introduction: Advanced care planning (ACP) is an important, though often neglected, part of medicine. It can promote goal-concordant care and improve communication between the medical team and patient. This is especially important in the intensive care unit, where important health decisions are made by patients and families. Previous studies have shown that patients and families are interested in ACP discussions, especially in intensive care units. Studies are limited, however, in analyzing the prevalence of these discussions prior to and during admission to the cardiac intensive care unit (CCU). Methods: This was a retrospective cohort study. Baseline demographics were collected on patients admitted or transferred to the CCU between January 1, 2022- July 1, 2022. The presence of any ACP (documentation including POLST forms, advance directives, or power of attorney forms) filled out prior to and during admission was recorded. Length of stay, outcome of admission, discharge disposition, and baseline comorbidity index using the Charlson Comorbidity Index (CCI) were also recorded. Transplant patients, patients admitted for transplant, and patients who underwent multiple admissions were excluded from the study. Results: Between January and July, 400 patients met criteria for inclusion. The average age was 67, with males accounting for 62% of patients. The average CCI amongst these patients was 6.95. Of the 400 patients, 31 had ACP completed prior to their admission (7.75%). Out of the 369 patients who did not have ACP in place upon admission, 9 had ACP completed during their stay in the CCU (2.44%). There was no difference in CCU hours amongst those who had ACP prior to admission compared to those who did not (p=.9). There was, however, a difference among CCI index: those with ACP prior to admission had an average CCI of 9.94 compared to 6.7 in those without ACP (p<.001). Conclusions: Patients at risk of cardiac-related mortality can benefit from ACP discussions prior to the onset of critical illness; however, only a small fraction of patients admitted to the CCU have proper documentation of this process. Inpatient and outpatient ACP can target at-risk patients to improve both the conversation and documentation of patient values and treatment preferences. Possible interventions to provide this care include physician education, consistent discussion of ACP during rounds, or flagging patients without ACP in the EMR.

Biologics and oral systemic treatment preferences in patients and physicians for moderate-to-severe atopic dermatitis: a discrete choice experiment in the United Kingdom and Germany

Background: As the available treatments for moderate-to-severe atopic dermatitis (AD) expand, understanding patient and physician preferences becomes crucial for informed decision-making. Objective: To quantify patient and physician preferences for biologics and oral systemic AD treatment attributes. Materials and methods: We conducted a cross-sectional, online discrete choice experiment (DCE) involving 306 AD patients and 206 physicians throughout the United Kingdom and Germany. Qualitative interviews identified the key attributes for inclusion in the DCE. Each choice task comprised two hypothetical patient profiles. Data were analyzed using a random-parameters logit model. Results: Results indicated a significant emphasis on efficacy, with reducing sleep disturbance and itch ranking first and second among patients, and the reverse for physicians. Time to itch relief was the third most important efficacy attribute for both groups, but relatively more important for patients than for physicians. For both groups, the risk of eye problems was the most important safety concern of those included. Mode of administration was not of great importance compared to efficacy and safety attributes. Conclusions: Our findings suggest patients prioritize sleep disturbance, an attribute not captured in prior preference studies in AD, time to itch relief and itch. These findings emphasize the importance of addressing sleep-related issues, whilst also targeting fast itch control, to enhance patients’ well-being.

Treatment preferences of patients with muscle invasive bladder cancer: A discrete choice experiment.

When faced with treatment options, patients are asked to participate in decision-making. We sought to determine which treatment aspects matter most for individuals treated for muscle invasive bladder cancer (MIBC), with an aim to improve understanding of patient preferences and what trade-offs patients are willing to accept. Our study consisted of a discrete choice experiment (DCE): a type of questionnaire used to elicit preferences in the absence of real-world choice. The DCE had five attributives, each with three levels. Participants were asked to complete a questionnaire in which they were asked to choose between two hypothetical MIBC treatments. The data were analysed using a conditional logit model, and preferences for, and trade-offs between, attributes were estimated. We recruited patients with MIBC who had either already completed, were undergoing or had yet to commence radical treatment for MIBC (n= 60). Participants indicated a strong preference for treatments that increased their life expectancy (p= <0.001), had a lower risk of long-term complications (p= <0.001) and less changes to their body image (p= <0.001). Changes to sexual wellbeing (p= 0.09) or an increase in acute side effects (p= 0.99) did not influence preferences. Patients were willing to accept treatments with higher risk of long-term complications to improve their life expectancy or body image. When deciding on the type of treatment, increased life expectancy is the most important consideration for people with MIBC. The risk of long-term complications and changes to overall body image as a result of treatment are also important. Our study also highlighted that patients are willing to accept a higher risk of long-term complications to improve other treatment outcomes. Understanding patient preferences is important for shared decision-making, which has an impact on quality of care for people living with MIBC.

Patient preferences for conservative treatment of shoulder pain: a discrete choice experiment.

Shoulder pain is common amongst adults, but little is known about patients' preferences. The aim of this study was to determine patients' preferences for treatment options offered for shoulder pain in primary care. A discrete choice experiment was used to investigate these preferences. Adults with shoulder pain were asked to make 12 choices between two treatment options, or to opt-out. The attributes of the 12 treatment options were presented as varying in: treatment effectiveness (50%, 70%, or 90%), risk of relapse (10%, 20%, or 30%), time to pain reduction (2 or 6 weeks), prevention of relapse (yes/no), requiring injection (yes/no), and including physiotherapy (none, 6, or 12 sessions). A conditional logit model with latent class analysis was used for the analysis and a class assignment model. Three hundred and twelve participants completed the questionnaire with mean age of 52 ± 15.2 years. Latent class analysis revealed three groups. Group 1 preferred to opt-out, unless the attributes were highly favorable (90% effectiveness). Group 2 preferred treatment, but not an injection. Group 3 preferred to opt-out and did not opt for treatment. The likelihood of a participant belonging to one of these groups was 68.8%, 9.3%, and 21.9%, respectively. The class assignment was related to having previously received injection or physiotherapy, as they did not prefer that same treatment again. This study showed that most patients with shoulder pain prefer to opt-out, unless treatment attributes are highly favorable. Characteristics of influence on this decision was whether the patient had received an injection or physiotherapy before.

How Much Better is Faster? Empirical Tests of QALY Assumptions in Health-Outcome Sequences.

This study was designed to test hypotheses regarding the path dependence of health-outcome values in the form of linear additivity of health-state utilities and diminishing marginal utility of health outcomes. We employed a discrete-choice experiment to quantify patient treatment preferences for major depressive disorder. In a series of choice questions, participants evaluated seven symptom-improvement sequences and out-of-pocket costs over 6-week durations. Money-equivalent values were derived from a deductive latent-class mixed-logit analysis. The discrete-choice experiment was completed by 751 respondents with self-reported major depressive disorder recruited from an online commercial panel. The class-membership probability was 0.83 for latent-class preferences consistent with supporting relative importance weights for all symptom-improvement sequences in the study design. First, we found strong support for diminishing marginal utility in symptom-improvement sequences. The money-equivalent value of an initial week of normal mood was $147 (95% confidence interval: $128, $166) and a second week of normal mood was $70 ($49, $91). Furthermore, for short treatment durations where conventional discounting was not a factor, equivalent changes in health status were valued more highly for an earlier onset of effect: holding subsequent symptom patterns constant, $338 (211, 454) versus $70 (49, 91) for improvements starting in week 2 versus week 3 and $147 ($128, $166) versus $29 (-$4, $64) for improvements starting in week 3 versus week 4. Our findings imply that conventional quality-adjusted life-year calculations in which health values are assumed to be path independent can understate the value of health improvements that appear earlier in a sequence.

Elevating the patient voice: Understanding treatment preferences in patients with advanced prostate cancer.

262 Background: With multiple oral non-chemotherapy medications for prostate cancer patients, there is a need to explore the impact of pill burden on overall quality of life, patient experience, and adherence. This study aimed to understand medication preferences from patients with advanced prostate cancer. Methods: We conducted a cross-sectional, online survey of patients with advanced prostate cancer living in the United States. Inclusion criteria included: men with a self-reported diagnosis of prostate cancer that has spread beyond the prostate and are receiving any treatment for prostate cancer. This survey was conducted in January 2024. Patients were recruited through physician referral. Results: The survey enrolled 100 participants with a median age of 65 years (range 39-75). 53 (53%) patients identified as white, 31 (31%) identified as black, 15 (15%) were Hispanic. 81 (81%) stated that they had undergone previous chemotherapy and 80 (80%) patients reported taking oral medications for prostate cancer. Regarding overall pill burden, 48 (48%) took &gt;5 pills/day and 50 (50%) took &gt;3 pills/day including treatment for prostate cancer. Regarding treatment frequency, 63 (63%) patients reported difficulty remembering to take the pills multiple times per day and 92 (92%) patients said they would choose a 1 pill once daily option over a multi-pill regimen. 20 (20%) patients admitted to either having difficulty swallowing pills or being unsure about swallowing pills. Of these 20, 18 (95%) consider it important if a pill can be dispersed in water, or vehicles such as applesauce. 89 (89%) patients said they would prefer a non-chemotherapy treatment option compared to a chemotherapy-containing regimen. Conclusions: Most patients prefer the option of an oral treatment regimen compared with chemotherapy. Due to the challenges of polypharmacy as well as worsening memory, most patients also prefer a one pill once a day regimen. In an older population, therapies with formulations that allow for patient choice in administration schedule may avoid treatment interruptions. When discussing treatment options with patients, providers should take these factors into consideration.

No sex-based differences in odds of starting or time to treatment of generalized myasthenia gravis: A single center cohort study.

Females with generalized myasthenia gravis (gMG) report lower quality of life (QoL) and have more severe disease than males. Sex differences in disease characteristics exist, however whether there are sex differences in the treatment of gMG that may contribute to QoL disparities is unknown. Our objective is to determine whether there are sex differences in the treatment of gMG. We performed a single-center retrospective study of people diagnosed with gMG at the University of Calgary between 1997 and 2021. Primary outcome was proportion starting treatment and secondary outcome was time from diagnosis to treatment initiation. Treatments included pyridostigmine, prednisone, steroid sparing therapies (azathioprine, mycophenolate mofetil [MMF], methotrexate [MTX], or tacrolimus), intravenous immunoglobulin (IVIg), plasmapheresis, rituximab, eculizumab, cyclosporine, stem cell transplantation, and thymectomy. Multivariable logistic and Cox proportional hazards regression models were used to examine treatment associations with sex, adjusted for time from onset to diagnosis, age at diagnosis, presence of thymoma, and antibody status. A total of 179 people with gMG were included (41.9% female). Odds of starting treatment were not statistically associated with sex after adjustment for confounders and correction for multiple testing. Results of the secondary analysis using time to treatment initiation as the outcome were similar. We found no sex differences in odds of starting treatment or time to treatment initiation that might explain previously observed sex-based differences in QoL. Future work should capture physician and patient treatment preferences that may influence disease management.

Patient and Healthcare Professional Satisfaction, Acceptability, and Preference Experiences With Mirikizumab Administration for Ulcerative Colitis: An International Survey.

There is a need to better understand ulcerative colitis (UC) patient and healthcare provider (HCP) treatment satisfaction, acceptability, and preferences. Two international, cross-sectional, web-based surveys were conducted among participants of a phase 3 mirikizumab study (NCT03519945). The questions captured moderate-to-severe UC patients' experience, HCPs' perception of patients' experience, and HCPs' own experience with mirikizumab administration through intravenous (IV) infusions and subcutaneous (SC) injections. Respondents included 93 patients and 42 HCPs from 11 countries. The majority of patients had UC >4 years (74.2%), were bionaive (68%), in remission at the time of the survey (63%). HCPs were primarily from the United States (57%), generally nurses (41%) or gastroenterologists (26%) with ≥6 years of experience in treating UC (57%). Most patients were "very satisfied/satisfied" (IV, 83%; SC, 91%), "completely/somewhat" accepting of mirikizumab administration (IV, 87%; SC, 97%), and agreed that improvement to their UC outweighed any administration dissatisfaction (90%). HCPs' perspectives of patients' experiences were higher: "very satisfied/satisfied" (IV, 93%; SC, 100%); "completely/somewhat" accepting (IV, 90%; SC, 98%). HCPs themselves were "very satisfied/satisfied" (IV, 81%; SC, 95%); gastroenterologists were "very satisfied" (IV, 82%; SC, 82%) more than nurses (IV, 29%; SC, 65%) who were generally at least "satisfied" (IV, 53%; SC, 35%). Two SC and monthly SC injections were "completely acceptable" by the patients (76% and 85%) and per HCPs' perceptions of patients' preferences (69% and 100%). Both patients and HCPs were satisfied with and accepted mirikizumab IV induction followed by monthly maintenance SC injections. UC improvement outweighed any administration dissatisfaction.

A Discrete-Choice Experiment Assessing the Patient Preferences and Real-World Experiences of Patients with Migraine in Japan.

Migraine is a debilitating headache disorder with a high prevalence in Japan that imposes significant societal burden. Although the Japanese Clinical Practice Guideline for Headache Disorders 2021 recommends both acute and preventive migraine treatments, the usage of preventive treatments is still limited. Therefore, it is crucial to understand the treatment preferences of patients with migraine pertaining to both acute and preventive treatments. A mixed-methods study including a discrete choice experiment (DCE) was conducted with Japanese patients with migraine (10 for the qualitative interviews, and 400 for the DCE) who were recruited from the Rakuten Insight panel. The DCE presented hypothetical treatment options including oral acute, oral preventive, and injectable preventive medications. Six attributes (method of delivery, reduction of pain, impact of headaches on daily routines, dosage adjustability, and temporary and persistent side effects) each with three levels were included in the survey. A hierarchical Bayesian model was used to estimate relative attribute importance scores (RAI) for all attributes. For the 400 participants in the DCE, the most common age bracket was 40-49years old, and the majority were female (66.75%). RAI estimates indicated that "method of delivery" was the most important attribute for patients (RAI 51.92, SD = 10.20), followed by "reduction of pain when experiencing a headache" (RAI 17.00, SD = 7.74). Oral preventive treatments were preferred over injectable preventive treatments. The qualitative interviews showed that patients prefer oral medications to injectable treatments, and a lack of awareness regarding preventive treatments. This study found that the "method of delivery" was the most important driver of treatment preferences of patients with migraine in Japan, with oral acute medications being preferred. Oral preventive treatments were found to be preferred over injectable treatments. These results may indicate the need for increased education regarding preventive treatments, as well as the need for further development of these treatments.

Self-management support program delivered in the sub-acute phase after traumatic injury—study protocol for a pragmatic randomized controlled trial

BackgroundTraumatic injuries, defined as physical injuries with sudden onset, are a major cause of distress and disability, with far-reaching societal consequences. A significant proportion of trauma survivors report persistent symptoms and difficulties after the injury, and studies show unmet health care needs. Self-management programs delivered in the sub-acute phase after traumatic injuries are scarcely evaluated. The aim of the present study is to evaluate the effectiveness of a self-management program (SEMPO), delivered 3–4 months after moderate-to-severe traumatic injury.MethodsThis study protocol describes a pragmatic randomized controlled trial (RCT) with two classical RCT arms (intervention and control) and an explorative self-selection arm. 220 patients will be recruited from Oslo University Hospital, the largest Trauma Referral Centre in Norway. Patients aged 18–72 years residing in the south-east region of Norway, admitted to the Trauma Centre directly or within 72 h after having sustained a moderate to severe traumatic injury, defined as a New Injury Severity Score > 9, having at least 2 days hospital stay, and reporting injury-related symptoms and impairment at discharge from the acute hospital will be included. Patients will be randomly assigned to either a classical RCT randomization arm (intervention or control arm) or to a self-selection arm. In the randomization arm, participants are further randomized into intervention or control group. Participants allocated to the self-selection arm will choose to partake either in the intervention or control arm. The primary outcome is the level of self-efficacy in trauma coping assessed 6 months after completion of the intervention, with a similar time point for the control group. Secondary outcomes include symptom burden, physical functioning and disability, return to work and health care utilization, health-related quality of life, and communication competency. In addition, patients will be asked to nominate one domain-related measurement as their preferred outcome measure.DiscussionThis RCT will determine the effect of a self-management program tailored to patients with moderate to severe physical trauma, and the self-selection arm incorporates the potential influence of patient treatment preferences on intervention results. If the intervention proves effective, cost-effectiveness and cost-utility analyses will be performed and thereby provide important information for clinicians and policy makers.Trial registrationThe study is registered in Clinical Trials with the identifier: NCT06305819. Registered on March 05, 2004.

Integration of Palliative Care in Neurosurgical Critical Care : Insights from a Single-Center Perspective.

Palliative care is a specialized approach designed to enhance the quality of life for both patients and their families, offering patient-centered care through comprehensive assessment and care planning. However, the integration of palliative care within neuro-critical care settings has been relatively understudied. This descriptive study aims to identify the characteristics, palliative care needs, and outcomes of patients referred to palliative care services during admission to the neurosurgical intensive care unit (NS-ICU). A retrospective analysis of adults admitted to the NS-ICU at a referral hospital between December 2019 and December 2021 was conducted. The study focused on those referred to the inpatient palliative care team with diagnoses of non-traumatic brain hemorrhage, traumatic brain injury, or brain neoplasm. Excluded were patients who died before palliative care consultation or lacked sufficient information. The investigation assessed demographic and clinical characteristics at consultation, along with post-consultation hospital outcomes derived from medical records and interview notes. In this study involving 38 enrolled patients, the median age was 65, with 42.1% females. The most prevalent diagnosis was non-traumatic brain hemorrhage (47.4%). Reasons for palliative care consultation included psychosocial support (95%), goal-of-care discussions (68%), decision-making support (50%), and communication facilitation (39%). The median time from NS-ICU admission to consultation was 3.5 days (range: 1-8 days), and all interviews involved family members. Key decision topics encompassed mechanical ventilation (23.7%) and tracheostomy (21.1%). Patient preferences for life-sustaining treatment could be estimated in only 47.4% of cases, often resulting in treatment disagreement. Among the 38 patients, 26 (68.4%) died during admission. Before the consultation, full code status, partial code status, and comfort care alone were reported as 32%, 66%, and 2%, respectively; post-consultation, these figures shifted to 11%, 42%, and 47%, respectively. Palliative care was predominantly sought for psychosocial support and discussions concerning goals of care. Despite challenges in ascertaining patient treatment preferences, palliative care consultations proved invaluable in aiding family members and facilitating treatment decision-making. Our study suggests the potential integration of palliative care within neuro-critical care, contributing to a heightened utilization of comfort care at the end-of-life.

Treatment Preferences in Patients with Hypothyroidism: an Analysis of Eleven Randomized Controlled Trials.

Levothyroxine (L-T4) monotherapy is the standard of care for the treatment of hypothyroidism. A minority of the L-T4-treated patients remain symptomatic and report better outcomes with combination therapy that contains liothyronine (L-T3) or with desiccated thyroid extract (DTE). To assess patient preferences in the treatment of hypothyroidism. A systematic review, meta-analysis, meta-regression, and network meta-analysis (NMA) of randomized controlled trials (RCTs) comparing treatments for adults with hypothyroidism (L-T4 vs. L-T4+L-T3 or DTE). Searches were conducted in PubMed, Embase, and Cochrane databases up to April 10, 2024. Data extraction and quality assessment were independently performed by four researchers. Eleven RCTs (eight cross-over studies) with a total of 1,135 patients were considered. Overall, 24% of patients preferred L-T4 versus 52 % who preferred L-T4+L-T3 or DTE; 24% had no preference. The meta-analysis confirmed the preference for combination therapy over L-T4 monotherapy (RR: 2.20, 95% CI: 1.38 to 3.52; p = 0.0009). Excluding four studies reduced the high heterogeneity (I2 = 81%) without affecting the results (RR: 1.97, 95% CI: 1.52 to 2.54; p < 0.00001; I2 = 24%). This preference profile remained when only crossover studies were considered (RR: 2.84, 95% CI: 1.50 to 5.39; p < 0.00001). Network meta-analysis confirmed the preference for DTE and L-T3+L-T4 versus L-T4 alone. Patients with hypothyroidism prefer combination therapy (L-T3+L-T4 or DTE) over L-T4 monotherapy. The strength of these findings justifies considering patient preferences in the setting of shared decision-making in the treatment of hypothyroidism.

Understanding treatment preferences and cognitive outcomes in patients with gliomas.

Understanding how glioma patients value cognitive outcomes is essential to personalizing their treatment plans. The purpose of this study was to identify the modifiable cognitive functions most affected by treatment and most important to patient quality of life. Patients with gliomas were prospectively enrolled in focus groups and individual interviews using a standardized guide focusing on cognitive functions until saturation was achieved. Patient values and treatment preferences were elicited and compared to the frequency of reported deficits. NVivo natural language processing software was used to perform thematic qualitative analyses. Quantitative analysis with Fischer's exact test was used for each cognitive function to assess for an association between experiencing a deficit and rating that function as important to quality of life. Twenty participants participated, of whom 60% were female. Racial identification consisted of 75% White, 15% Black/African American, and 10% OtherRacial Identification. The cognitive functions most essential to the quality of life in this cohort were sense of self (80% of participants), memory (70% of participants), and communication (25% of participants). The functions that experienced the most deficits because of treatment were memory (65% of participants), concentration (65% of participants), and special senses (40% of participants). "Dealbreakers" to treatment were complete loss of independence, sense of self, and/orthe ability to interact with loved ones. Fischer's exact test showed no associations between experiencing a cognitive function deficit and rating that function as important to quality of life. Glioma patients in this study prioritized cognitive functions according to memory, personal identity, and their ability to communicate with loved ones independently of experiencing deficits in these functions. Further study should comparepatient prioritization and decision-making between surgically curable and noncurable grade gliomas as well as investigate the quality of life benefits of incorporating the connectomics of highly valued cognitive functions in surgical planning.

High-dose chemotherapy for patients with stage III breast cancer with homologous recombination deficiency: a discrete choice experiment among healthcare providers.

High-dose chemotherapy with autologous stem cell rescue (HDCT) is currently under investigation as a potential therapy for patients with stage III HER2-negative breast cancer with homologous recombination deficiency (HRD). In addition to survival, the impact on short- and long-term side effects might influence the uptake of HDCT by healthcare professionals. As part of the SUBITO trial, we investigated healthcare professionals' treatment (outcome) preferences for patients with HRD stage III HER2-negative breast cancer and established how healthcare professionals make trade-offs between these treatment outcomes. We conducted a discrete choice experiment in which healthcare professionals were asked to choose repeatedly between scenarios with two treatment options (HDCT or standard of care (SOC)) that varied in outcome with respect to 10-year overall survival (OS), short-term toxicity, long-term cognitive impairment, and premature menopause. We analysed treatment preferences, relative importance, and trade-offs using a multinomial logistic model. Thirty-five of the 151 dedicated breast cancer professionals with extensive experience in treating breast cancer patients completed the survey. The 10-year OS and long-term cognitive impairment were the most important attributes. The results indicate a requirement of 10.4% and 25.1% absolute additional improvement in the 10-year survival rate to justify accepting moderate or severe long-term cognitive impairment as a trade-off, respectively. Therefore, we found in our dataset that healthcare professionals expected a large improvement in 10-year OS to accept moderate to severe cognitive impairment. This information calls for further research into chemotherapy-related cognitive impairment, shared decision-making, and treatment preferences for patients with stage III breast cancer.

Exploring patient perception of decision-making in carpal tunnel release surgery: A systematic review and thematic synthesis of qualitative studies.

Carpal tunnel syndrome is a common condition, but some controversies remain regarding diagnostics and the most effective treatments. As a result, patients often experience decisional conflicts, especially when considering carpal tunnel release surgery. Understanding factors that influence decision-making in surgery can help clinicians better grasp patient treatment preferences and priorities, reducing decisional conflicts, and enabling patients to make informed, value-aligned choices through shared decision-making. This qualitative evidence synthesis aims to explore patient perceptions of carpal tunnel release, examine the decision-making factors, and critically appraise and synthesise the existing evidence. A systematic search was conducted across four electronic databases (MEDLINE, EMBASE, CINAHL Ultimate, PsycINFO) from inception to August 2023, supplemented by referencing and citation searching to identify eligible qualitative studies. Thematic synthesis was adopted as synthesis methodology, involving a line-by-line coding of the primary study findings, and the development of descriptive and analytical themes. Quality appraisal was conducted using the modified Critical Appraisal Skills Programme checklist, supplemented with the COnsolidated criteria for REporting Qualitative research checklist. Synthesis of six qualitative studies encompassing 66 participants generated five analytical themes: (1) Journey to normalcy, (2) Patient-centred care, (3) Work and life considerations, (4) Weighing up alternatives, and (5) Shaping the expectations, highlighting the complexity of patient decision-making in carpal tunnel release. In the management of carpal tunnel syndrome, therapists should consider various decision-making factors, prioritising communication and shared decision-making. This, along with personalised interactions, achieves patient-centred care and enhances patient care quality and therapeutic alliance.

Treatment Patterns and Preferences for Graves' Disease in Korea: Insights from a Nationwide Cohort Study.

Treatment patterns and preferences for patients with Graves' disease (GD) vary across countries. In this study, we assessed the initial therapies and subsequent treatment modalities employed for GD in real-world clinical practice in Korea. We analyzed 452,001 patients with GD from 2004 to 2020, obtained from the Korean National Health Insurance Service database. Initial treatments included antithyroid drug (ATD) therapy (98% of cases), thyroidectomy (1.3%), and radioactive iodine (RAI) therapy (0.7%). The rates of initial treatment failure were 58.5% for ATDs, 21.3% for RAI, and 2.1% for thyroidectomy. Even among cases of ATD treatment failure or recurrence, the rates of RAI therapy remained low. Regarding initial treatment, the 5-year remission rate was 46.8% among patients administered ATDs versus 91.0% among recipients of RAI therapy; at 10 years, these rates were 59.2% and 94.0%, respectively. Our findings highlight a marked disparity in the use of RAI therapy in Korea compared to Western countries. Further research is required to understand the reasons for these differences in treatment patterns.

Treatment Preferences of Adult Patients with Attention-Deficit/Hyperactivity Disorder - A Discrete Choice Experiment.

Understanding patient preferences for treatments may facilitate shared decision-making. This study assessed adult patient preferences for attention-deficit/hyperactivity disorder (ADHD) treatments in a sample of 600 patients in the United States (US). A web-based discrete choice experiment (DCE) survey was conducted among treated adults with ADHD. Participants were recruited from Dynata's US panel (06/22/2023-07/06/2023). Attributes and levels, identified based on clinical inputs and published data, included efficacy and safety. Participants' preferences were estimated using conditional logistic regression. Willingness to trade-off and attributes' relative importance were calculated. Overall preferences for treatment profiles approximating centanafadine, lisdexamfetamine, atomoxetine, and viloxazine were estimated using adjusted total utilities. Results were stratified by current treatment status. Sensitivity analyses including participants who passed validity tests were conducted. Among the 600 participants (mean age 37.9 years; 66.2% female; 50.8% treated), all attributes had a statistically significant impact on preferences for ADHD treatments (p < 0.001); the most important attribute was improvement in ADHD symptoms (36%), followed by risks of nausea (25%), insomnia (20%), anxiety (8%), dry mouth (6%), and feeling jittery (5%). Together, safety attributes accounted for >60% of relative importance in decision-making. Participants were willing to forgo 0.59, 0.57, 0.49, 0.32, and 0.17 percentage points of symptom improvement to achieve one-percentage-point reduced risk of insomnia, nausea, anxiety, feeling jittery, and dry mouth, respectively. Centanafadine profile had consistently higher adjusted total utilities than its comparators. Similar results were obtained in the subgroup and sensitivity analyses. Efficacy was the most important attribute for patients when making treatment decision, but taken together, AEs had greater relative importance than efficacy alone. Accordingly, a profile resembling that of centanafadine would be preferred by an average patient compared to key competitors due to its favorable safety profile. These findings may help improve treatment decision-making, enhance treatment satisfaction, and foster adherence.

Revolutionizing diffuse uterine leiomyomatosis treatment: A case report and literature review on "no-distension" hysteroscopic myomectomy with thoracic tissue forceps.

Diffuse uterine leiomyomatosis (DUL) is a prevalent leiomyoma variant in women of childbearing age, characterized by a uniformly enlarged uterus with numerous interconnected small myomas. Given that most DUL patients are in their reproductive years, treatments that preserve fertility are increasingly vital. This case report introduces an innovative hysteroscopic technique that forgoes uterine distension to remove multiple submucosal fibroids in a single procedure, maintaining endometrial integrity and fertility. A 27-year-old single woman experienced prolonged and heavier menstruation. Magnetic resonance imaging (MRI) scans showed an enlarged uterus with several round-like masses in the uterine wall/submucosa. Addressing the patient's financial limitations and treatment preferences, a groundbreaking hysteroscopic surgery was performed using thoracic tissue forceps, alongside bedside ultrasonography, enabling fibroid excision without uterine distension. In total, 38 uterine fibroids were successfully excised without complications such as uterine perforation or hyponatremia. According to the FIGO classification system: three were type III, nine were type II, 15 were type I, and 11 were type 0. Postoperative follow-up indicated normalized menstrual cycles, improved hemoglobin levels, and no recurrence of fibroids. A hysteroscopic examination 1 month after surgery revealed no significant fibroids or endometrial thickening. This case report underscores the effectiveness of a novel hysteroscopic surgical approach in treating DUL. This method eliminates the need for multiple staged surgeries and the risks of endometrial damage inherent in traditional techniques. It offers a minimally invasive, fertility-preserving alternative for young DUL patients, marking a significant advancement in gynecologic surgery.

A randomized controlled trial of shared decision-making treatment planning process to enhance shared decision-making in patients with MBC

PurposeOpportunities exist for patients with metastatic breast cancer (MBC) to engage in shared decision-making (SDM). Presenting patient-reported data, including patient treatment preferences, to oncologists before or during a treatment plan decision may improve patient engagement in treatment decisions.MethodsThis randomized controlled trial evaluated the standard-of-care treatment planning process vs. a novel treatment planning process focused on SDM, which included oncologist review of patient-reported treatment preferences, prior to or during treatment decisions among women with MBC. The primary outcome was patient perception of shared decision-making. Secondary outcomes included patient activation, treatment satisfaction, physician perception of treatment decision-making, and use of treatment plans.ResultsAmong the 109 evaluable patients from December 2018 to June 2022, 28% were Black and 12% lived in a highly disadvantaged neighborhood. Although not reaching statistical significance, patients in the intervention arm perceived SDM more often than patients in the control arm (63% vs. 59%; Cramer’s V = 0.05; OR 1.19; 95% CI 0.55–2.57). Among patients in the intervention arm, 31% were at the highest level of patient activation compared to 19% of those in the control arm (V = 0.18). In 82% of decisions, the oncologist agreed that the patient-reported data helped them engage in SDM. In 45% of decision, they reported changing management due to patient-reported data.ConclusionsOncologist engagement in the treatment planning process, with oncologist review of patient-reported data, is a promising approach to improve patient participation in treatment decisions which should be tested in larger studies.Trial registrationNCT03806738.

Development of the treatment preference in myelodysplasia questionnaire for clinicians, carers, and patients.

This study reports the development activities for the Treatment Preference Myelodysplasia Questionnaires (TPMQ) for clinicians (mTPMQ), carers (cTPMQ), and patients (pTPMQ). These tools are intended to evaluate treatment preferences for patients with myelodysplastic syndromes (MDS). This was a non-interventional, cross-sectional qualitative interview study consisting of interviews with clinicians, patients, and those caring for patients with MDS. All participants were located in Australia and data were collected from qualitative mixed-method interviews composed of concept elicitation and cognitive debriefing related to initial drafts of the questionnaires. Fifteen individuals participated in interviews (five from each group). Based on the concept elicitation portion of interviews, concepts of importance were classified and reasons for treatment preference were documented. From cognitive debriefing, the questionnaires were generally deemed to be clear and easy to understand. Participant input from both concept elicitation and cognitive debriefing portions was used to revise initial drafts of the questionnaires. The mTPMQ, cTPMQ, and pTPMQ were developed with direct input from clinicians, patients, and caregivers to assess the key concepts of interest related to the preference for the treatment of MDS and are ready to be used and evaluated further in clinical trials.