Patient Treatment Preferences Research Articles

Shared decision making: Does a decision aid support patients with an atypical cartilaginous tumor in making a decision about treatment.

Due to new insights, atypical cartilaginous tumors (ACTs) of the long bones are no longer considered malignant and treatment is shifting from surgery to active surveillance. We developed a decision aid in order to support in shared decision making on treatment.The aim of this study is to evaluate the treatment preferences of patients with an ACT in the long bones. During thirty-four months, patients received a decision aid digitally with information about the disease, the treatment options, and the risks and benefits of active surveillance and surgical treatment. The given answers to patients' preference questions were evaluated qualitatively in relation to the final choice of treatment. Eighty-four patients were included. None of the patients who preferred active surveillance later underwent surgery. Only four patients underwent surgery based on patient preference. In our experience the decision aid is useful for shared decision making as it provides the patient with information and the clinician with insight into patient's preferences. The preference for treatment generally corresponds to the eventual treatment. When treatment changes, due to new insights, a decision aid seems helpful for both patients and clinicians to discuss the treatment that best suits the patient's situation.

Racial and Ethnic Differences in Hospice Use and End‐of‐life Hospitalizations among Medicare Beneficiaries with Dementia

AbstractBackgroundThe pool of studies examining ethnoracial differences in hospice use and end‐of‐life hospitalizations among patients with dementia is limited and results are conflicting. This study examined how dementia end‐of‐life care utilization and patient treatment preferences differ by race and ethnicity.MethodsUsing U.S. national survey data from the Health and Retirement Study linked with Medicare and Medicaid claims, our sample included 5,058 beneficiaries aged ≥65 years diagnosed with dementia who died in 2000‐2016. We examined the frequency and costs of hospice care, emergency department (ED) visits, and hospitalizations during the last 180 days of life among Medicare decedents with dementia. We analyzed the proportion of dementia decedents with advance care planning and their end‐of‐life care preferences.ResultsLess than half of beneficiaries with dementia in our sample (48%) used hospice in the last 180 days of life; of these, one in three hospice users received the service for seven days or less. In adjusted analysis, non‐Hispanic (NH) Blacks, nursing home residents, and survey respondents represented by a proxy were less likely to use hospice, whereas older age, females, higher education, more severe cognitive impairment, and more IADL limitations were associated with higher hospice enrollment. Among dementia decedents, NH Blacks and Hispanics used more ED and inpatient services and incurred >50% higher inpatient expenditures at the end of life, compared with NH whites. More NH Black and Hispanic beneficiaries with dementia enrolled in hospice were subsequently admitted to the ED or hospital before death. The proportion of dementia beneficiaries completing advance care planning was significantly lower among NH Blacks and Hispanics compared with NH whites (21% and 21% vs. 57%, p<0.01). More NH Black and Hispanic decedents with dementia had written instructions choosing all care possible to prolong life, whereas more NH whites preferred to limit care in certain situations, withhold treatments, and forgo extensive life‐prolonging measures.ConclusionOur results highlighted substantial unmet end‐of‐life care needs among older adults with dementia, especially among NH Blacks and Hispanics. Medicare should consider alternative payment models to promote culturally competent end‐of‐life care and reduce low‐value interventions and costs among the population with dementia.

A Comparison Between the Rates of Radiation Oncologist and Urologist Consultations in Men Diagnosed With Prostate Cancer in Northern Ontario, Canada

PurposeRecommendations from Cancer Care Ontario stress the importance of multidisciplinary care from radiologists and urologists for prostate cancer treatment. The present study sought to examine what percentage of patients had a consultation with a radiation oncologist before undergoing a radical prostatectomy in Ontario, Canada, between 2010 and 2019. Methods and MaterialsAdministrative health care databases were used to analyze the number of consultations billed to the Ontario Health Insurance Plan from radiologists and urologists who treated men with a first prostate cancer diagnosis (n = 22,169). ResultsIn Ontario, 94.70% of Ontario Health Insurance Plan billings for patients with prostate cancer who had a prostatectomy within 1 year of a prostate cancer diagnosis were from urology, and 37.66% and 1.77% of billings were received from radiation oncology and medical oncology specialties, respectively. When sociodemographic variables were examined, having a lower neighborhood income (adjusted odds ratio [aOR], 0.69; confidence interval [CI], 0.62-0.76) and a rural residence (aOR, 0.72; CI, 0.65-0.79) were associated with lower odds of receiving a consultation from a radiation oncologist. When billings for consultations were examined geographically by region, Northeast Ontario (Local Health Integrated Network 13) had the lowest odds of receiving a radiation consultation compared with the rest of Ontario (aOR, 0.50; CI, 0.42-0.59). ConclusionsThe results of this study show that differences in equitable access to multidisciplinary health care exist for men with a first prostate cancer diagnosis who reside in more northern and rural regions within Ontario, relative to the rest of the province. The reasons for these findings are likely multifactorial and may include factors such as patient treatment preference and distance/travel to receive treatment. However, as diagnosis year increased, so did the chances of receiving a radiation oncologist consultation, and this upward trend may reflect the implementation of Cancer Care Ontario guidelines.

Treatment Preferences of Patients with Relapsed or Refractory Multiple Myeloma (RRMM) in the United States, United Kingdom, France, Spain, Italy, and Germany: Results from a Discrete Choice Experiment

Introduction: As the RRMM treatment landscape evolves, it is imperative to understand how differences in benefits, risks, and administration influence patients’ preferences for treatment. This study quantified patient preferences to inform healthcare professionals in shared decision-making when choosing between treatments for RRMM. Methods: Adults with RRMM in the USA, UK, France, Spain, Italy, and Germany completed an online discrete choice experiment (DCE) including 12 experimental and 2 internal validity choice tasks (Feb-Jun 2022). In each task, participants chose between 2 hypothetical treatment profiles with different levels of benefits and risks and modes of administration, guided by evidence on approved treatments for RRMM. Patients also completed sociodemographic, quality of life, and clinical questionnaires. Attributes and levels of interest were informed by a targeted literature review, clinical data on RRMM treatments, qualitative concept elicitation interviews with 19 patients (US, UK, Germany each n=5 and France n=4), clinical expert input, and patient advocacy group feedback. The DCE was refined through 12 patient interviews (n=2 per country) to ensure that attributes and levels were comprehensible. Final DCE attributes included overall response rate (ORR), duration of response (DOR), overall survival (OS), peripheral neuropathy, ocular adverse events, cytokine release syndrome (CRS), severe diarrhea, and mode of administration. Preference data were analyzed using an error-component logit model and relative attribute importance (RAI) scores were calculated (higher values indicate larger effects of an attribute on overall preference). Results: In total, 296 patients completed the DCE (US n=100, UK n=49, France n=39, Spain n=20, Italy n=45, Germany n=43). Mean (SD) age was 64 (8) years, 52% were male, and 84% had a caregiver. Of the US sample 41% were Black/African American and 27% were White. At the time of the survey, patients had received a median of 3 (range 2-8) lines of therapy, were diagnosed on average 5.9 years prior, and most were in either partial (46%) or complete response (31%). When evaluating their quality of life over the past week, 64% of participants reported mild to moderate cancer symptoms (19% severe, 4% very severe), 61% moderate to very severe pain, and 44% severe to very severe fatigue. Figure 1 shows patients’ preferences by treatment attribute level, and Figure 2 describes the overall relative importance of each attribute. Patients significantly preferred treatments with higher ORR and longer OS; increasing ORR from 25% to 85% (RAI: 29.8% [95% CI: 26.5%, 33.2%]) and increasing OS from 6 months to 2 years (RAI: 20.4% [95% CI: 17.3%, 23.4%]) had the greatest influence on treatment preferences. Administration route was also considered an important attribute (RAI: 12.4% [95% CI: 9.2%; 15.7%]). With respect to side effects assessed in this study, patients showed concern for CRS (RAI: 11.9% [95% CI: 9.7%, 14.1%]) and peripheral neuropathy (RAI: 9.2% [95% CI: 6.9%, 11.6%]). Reducing the risk of ocular side effects (from 60% to 0%) was one of the least important attributes to patients (RAI: 7.1% [95% CI: 4.4%, 9.8%]; 1.6x and 1.3x less important than reducing the risk of CRS and peripheral neuropathy, respectively, and 4.2x less important than increasing ORR (from 25% to 85%). Intravenous (IV) or subcutaneous (SC) administration every 3 weeks (Q3W) were preferred over procedures associated with CAR-T therapy (1-2 months including apheresis, bridging therapies, hospitalization, and caregiver support). While ORR was the most important attribute to patients, they would tolerate a 41% reduction in ORR to increase OS from 6 months to 2 years, 25% reduction to switch from procedures associated with CAR-T therapy to IV/SC administration Q3W, and 24% to reduce the risk of CRS from 85% to no risk. Conclusions: Treatment preferences of patients with RRMM were strongly focused on maximizing ORR and OS, accounting for half the total RAI. Consistent with current medical understanding, patients generally preferred to avoid side effects, but this was less important than increasing efficacy. This study provides insights on patients’ valuation of treatment attributes and should be considered by healthcare professionals to inform shared decision-making in treatment selection. Funding: GSK (212408) Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

What is confirmed in the treatment of colon cancer?

Colorectal cancer is the second most common cancer diagnosed in Germany and is the third most frequent cause of cancer-related death in both males and females. The majority of colorectal cancers occur via the adenoma-carcinoma sequence of origin. This means that colorectal cancers can be endoscopically detected in premalignant stages and can be curatively treated within the framework of early detection. Screening colonoscopy and, to a lesser extent, fecal occult blood testing, have led to areduction in the colon cancer-related incidence and mortality. The acceptance and the use of screening colonoscopy should therefore be developed further. Treatment strategies for colorectal cancer are based on TNM staging, supplemented by anatomical and histopathological risk features as well as individual patient characteristics and treatment preferences. The molecular tumor profile is increasingly used to complement decision-making in the surgical, adjuvant and palliative treatment of colorectal cancer. Colon and rectal cancer have many similarities; however, they differ in the preoperative, surgical and adjuvant treatment strategies. This article focuses on colon cancer.

Before-After Study of a Checklist to Improve Acute Care to ICU Handoffs.

Transferring care of a patient is a critical process. The objective of this study was to evaluate a checklist to standardize handoffs from acute care to the intensive care unit (ICU). This was a single-center, before-after study of a checklist to standardize transfers of patients from acute care to the medical-cardiac ICU. Clinicians completed surveys about handoffs before and after checklist implementation. The association between study period and survey data was analyzed using multivariable logistic regression with cross-classified multilevel models. Surveys were completed by 179 clinicians. After checklist implementation, handoffs were more likely to occur in the ICU (OR 17.23; 95% CI, 1.81-164.19) and cover patient treatment preferences (OR 2.73; 95% CI, 1.12-6.66). However, checklist uptake was suboptimal (30% of responses indicated checklist use). Implementation of a checklist during acute care to ICU transfers is challenging. Signals suggesting process improvement warrant additional study.

Information needs, expectations, and treatment preference of patients considering spinal surgery: A case-control survey

Study designCase-control survey. ObjectivesTo explore intrapersonal factors associated with decision of patients with degenerative back pain for surgery. MethodsFrom September 2018 to May 2019 patients were invited to complete a questionnaire. Patients who decided on (case) and declined surgery (control) were later confirmed from medical records. ResultsSeventy-five patients were recruited. Male patients (75.0%, p = 0.019), those who were married (78.7%, p = 0.0045), and had spousal care-givers (89.2%, p < 0.0001) were more likely to decide for surgery. All patients who decided on surgery expressed need for information on “the severity of their spine conditions” (p = 0.039). Those who decided on surgery did not have as the high expectation on “to sleep more comfortably” as those who declined (4.71 vs. 4.91, p = 0.022). The predictive factors for surgery decision by logistic regression analysis were: male gender (OR = 3.23, 95% CI: 1.19–8.77, p = 0.021); married (OR = 5.231, 95% CI: 1.87–14.61, p = 0.002); with available spousal care-giver (OR = 1.85, 95% CI: 0.198–3.89, p = 0.031); and those who preferred to treat/cure the spine disorder by pharmacological treatment (OR = 2.77, 95% CI: 1.02–7.50, p = 0.045). ConclusionPatients who decided on surgery were likely to indicate need of medical information related to their condition. Patients were in hope of better relief of physical symptoms, especially related to sleep comfort. Patients would escalate their treatment from conservative to surgery when conservative treatments were no longer effective.

Adjuvant Treatment Decisions among Older Women with Early-Stage Breast Cancer Seen in Multidisciplinary Consultation vs. Standard Consultation

<h3>Purpose/Objective(s)</h3> Randomized studies and national guidelines support de-escalation of adjuvant therapy for a target population of woman ≥65 years with Stage I, ER positive breast cancer after breast conserving surgery. We sought to evaluate the impact of a multidisciplinary clinic (MDC) in this population by comparing treatment patterns and patient perceptions of adjuvant radiation therapy (RT) and hormone therapy (HT) between patients seen in MDC vs. standard consultation. <h3>Materials/Methods</h3> Medical records were retrospectively reviewed for women in the above target population who underwent surgery between 8/2020-11/2021 at our institution. Two cohorts were included: (1) patients seen in MDC, and 2) patients seen in standard clinic separately by medical and radiation oncology (non-MDC cohort). The non-MDC patients either declined MDC, could not attend an MDC clinic day, and/or were not referred to the MDC. Patients in the MDC cohort were also prospectively administered validated questionnaires to evaluate patient treatment preferences including the Decision Autonomy Preference Scale (DAPS) and Medical Maximizing-Minimizing Scale (MMS). Chi square, t-tests, and non-parametric equivalents compared demographics and logistic and linear regression evaluated RT and HT use and survey score outcomes between cohorts. <h3>Results</h3> A total of 90 patients met inclusion criteria, with 23 MDC and 67 non-MDC patients. There was no difference between the cohorts in age, Oncotype Recurrence Score, margin status, or tumor histology, grade, or focality. For the MDC cohort, there were significantly fewer sentinel lymph node biopsies performed (44% vs. 74%, p=0.006), and tumor size was smaller (0.6 vs. 1.1 cm, p<0.005), although all tumors were pT1c or less. Significantly fewer MDC patients received RT (61% vs. 82%, OR=0.34, p=0.046). The MDC cohort was more likely to undergo accelerated (vs. standard hypofractionated) RT (57% vs. 27%, OR 3.61, p=0.039). There was no difference in use of HT between cohorts (75% vs 76%, OR 1.08, p=0.885). Among the MDC cohort, all who preferred decisions be made "mostly by the patient" on the DAPS elected RT. Increasing MMS total score was associated with higher odds of RT (OR 1.43, p=0.027), with no "minimizers" (score <40) electing RT. <h3>Conclusion</h3> For women ≥65 years with early stage, ER positive breast cancer, MDC participation was associated with lower use of adjuvant RT and selection of shorter RT regimens versus standard consultation. These results support the role of the MDC in facilitating shared decision-making, perhaps enhancing patient comfort with forgoing more aggressive therapies. Responses from the DAPS and MMS tools indicate that patient treatment preference may be predictable, highlighting an opportunity to better tailor consultation discussions and recommendations based on intrinsic patient preferences and individual goals.

Aesthetic considerations for treating the North American multi-ethnic patient: Thriving in diversity international roundtable series.

The United States is becoming increasingly diverse, and between 2016 and 2019, an increase of 945 832 aesthetic procedures was recorded for Hispanic, African American, and Asian American patients combined. In aesthetics, where outcomes are technique dependent and tied to the clinician's ability to tailor treatment to the needs of individual patients, a knowledge of ethnic differences in anatomy and how aesthetic issues can be safely and effectively addressed in different groups is paramount. To discuss similarities and difference in anatomy and treatment preferences of patients from a variety of ethnic and racial backgrounds and how these differences may influence the products or techniques utilized to achieve natural-looking results and minimize side effects. In support of clinicians who wish to serve a diverse patient population, a 6-part international roundtable series focused on diversity in aesthetics was conducted from August 24, 2021, to May 16, 2022. The results of the first roundtable in the series, the North American Multiethnic Patient, are described here. A diverse range of patients can benefit from the tailored use of fillers, fat transfer, neuromodulators, lasers, and energy-based devices, as long as differences in structural support, skin, and aging patterns, are appreciated.

Adjuvant treatment decisions among women age &gt; 65 with early-stage, hormone-receptor breast cancer seen in multidisciplinary clinic versus standard consultation.

281 Background: Randomized studies and national guidelines support de-escalation of adjuvant therapy for a target population of woman &gt;65 years with Stage I, ER positive breast cancer after breast conserving surgery. We sought to evaluate the impact of a multidisciplinary clinic (MDC) in this population by comparing treatment patterns and patient perceptions of adjuvant radiation therapy (RT) and hormone therapy (HT) between patients seen in MDC vs. standard consultation. Methods: Medical records were retrospectively reviewed for women in the above target population who underwent surgery between 8/2020- 5/2022at our institution. Two cohorts were included: (1) patients seen in MDC, and 2) patients seen in standard clinic separately by medical and radiation oncology (non-MDC cohort). The non-MDC patients declined, could not attend, and/or were not referred to the MDC. Patients in the MDC cohort were prospectively administered validated questionnaires to evaluate patient reported data including the Decision Autonomy Preference Scale (DAPS), e-Prognosis, and Medical Maximizing-Minimizing Scale (MMS). Chi square, t-tests, and non-parametric equivalents compared demographics and logistic and linear regression evaluated RT and HT use and survey score outcomes between cohorts. Results: A total of 128 patients met inclusion criteria, with 33 MDC and 94 non-MDC patients. There was no difference between the cohorts in age, margin status, histology, grade, or focality. In the MDC cohort there were significantly fewer sentinel lymph node biopsies (42.4% vs. 71.3%, p = 0.003) and mean tumor size was smaller (0.69 vs. 0.96 cm, p &lt; 0.003). There was no significant difference in receipt of RT (65% MDC vs 77% standard; OR = 0.55, p = 0.189, HT (78% MDC vs 72% standard; OR = 1.36, p = 0.534), or both (65% MDC vs 77% standard; OR = 0.7, p = 0.430). The MDC cohort was significantly more likely to undergo accelerated (vs. standard hypofractionated) RT (70% vs 39%; OR = 3.60, p = 0.020). In MDC patients with completed questionnaires (n = 33), by DAPS, all “mostly patient (n = 8)” chose RT while all “mostly doctor (n = 1)” chose no RT (p = 0.063). Based on e-Prognosis, there were lower odds of RT for increasing Schonberg score/ higher 10yr mortality risk (OR 0.600, p = 0.048). MIMS score &gt; 40 (“maximizer”) was strongly correlated with the use of RT (OR 18.57, p = 0.011). Conclusions: For women &gt; 65 years with early stage, ER positive breast cancer, MDC participation was not associated with lower use of adjuvant RT or HT versus standard consultation but was significantly associated with shorter RT courses. DAPS and MMS results indicate that patient treatment preference may be predictable, highlighting an opportunity to tailor consultation discussions and recommendations based on intrinsic patient preferences and individual goals.

Patient preferences and current practice for adults with steroid-resistant ulcerative colitis: POPSTER mixed-methods study.

Corticosteroids are a mainstay of the treatment of moderately severe relapses of ulcerative colitis, yet almost 50% of patients do not respond fully to these and risk prolonged steroid use and side effects. There is a lack of clarity about the definitions of steroid resistance, the optimum choice of treatment, and patient and health-care professional treatment preferences. The overall aim of this research was to understand how steroid-resistant ulcerative colitis is managed in adult secondary care and how current practice compares with patient and health-care professional preferences. A mixed-methods study, including an online survey, qualitative interviews and discrete choice experiments. NHS inflammatory bowel disease services in the UK. Adults with ulcerative colitis and health-care professionals treating inflammatory bowel disease. We carried out a survey of health-care professionals (n = 168), qualitative interviews with health-care professionals (n = 20) and patients (n = 33), discrete choice experiments with health-care professionals (n = 116) and patients (n = 115), and a multistakeholder workshop (n = 9). The interviews with and survey of health-care professionals showed that most health-care professionals define steroid resistance as an incomplete response to 40 mg per day of prednisolone after 2 weeks. The survey also found that anti-tumour necrosis factor drugs (particularly infliximab) are the most frequently offered drugs across most steroid-resistant (and steroid-dependent) patient scenarios, but they are less frequently offered to thiopurine-naive patients. Patient interviews identified several factors influencing their treatment choices, including effectiveness of treatment, recommendations from health-care professionals, route of administration and side effects. Over time, depending on the severity and duration of symptoms and, crucially, as medical treatment options become exhausted, patients are willing to try alternative treatments and, eventually, to undergo surgery. The discrete choice experiments found that the probability of remission and of side effects strongly influences the treatment choices of both patients and health-care professionals. Patients are less likely to choose a treatment that takes longer to improve symptoms. Health-care professionals are willing to make difficult compromises by tolerating greater safety risks in exchange for therapeutic benefits. The treatments ranked most positively by patients were infliximab and tofacitinib (each preferred by 38% of patients), and the predicted probability of uptake by health-care professionals was greatest for infliximab (62%). The survey and the discrete choice experiments with patients and health-care professionals are limited by their relatively small sample sizes. The qualitative studies are subject to selection bias. The timing of the different substudies, both before and during the COVID-19 pandemic, is a potential limitation. We have identified factors influencing treatment decisions for steroid-resistant ulcerative colitis and the characteristics to consider when choosing treatments to evaluate in future randomised controlled trials. The findings may be used to improve discussions between patients and health-care professionals when they review treatment options for steroid-resistant ulcerative colitis. This research highlights the need for consensus work to establish an agreed definition of steroid resistance in ulcerative colitis and a greater understanding of the optimal use of tofacitinib and surgery for this patient group. A randomised controlled trial comparing infliximab with tofacitinib is also recommended. This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 41. See the NIHR Journals Library website for further project information.

Supporting the Heterogeneous and Evolving Treatment Preferences of Patients With Heart Failure Through Collaborative Home-Based Palliative Care.

Background We characterized the treatment preferences, care setting, and end-of-life outcomes among patients with advanced heart failure supported by a collaborative home-based model of palliative care. Methods and results This decedent cohort study included 250 patients with advanced heart failure who received collaborative home-based palliative care for a median duration of 1.9 months of follow-up in Ontario, Canada, from April 2013 to July 2019. Patients were categorized into 1 of 4 groups according to their initial treatment preferences. Outcomes included location of death (out of hospital versus in hospital), changes in treatment preferences, and health service use. Among patients who initially prioritized quantity of life, 21 of 43 (48.8%) changed their treatment preferences during follow-up (mean 0.28 changes per month). The majority of these patients changed their preferences to avoid hospitalization and focus on comfort at home (19 of 24 changes, 79%). A total of 207 of 250 (82.8%) patients experienced an out-of-hospital death. Patients who initially prioritized quantity of life had decreased odds of out-of-hospital death (versus in-hospital death; adjusted odds ratio, 0.259 [95% CI, 0.097-0.693]) and more frequent hospitalizations (mean 0.45 hospitalizations per person-month) compared with patients who initially prioritized quality of life at home. Conclusions Our results yield a more detailed understanding of the interaction of advanced care planning and patient preferences. Shared decision making for personalized treatment is dynamic and can be enacted earlier than at the very end of life.

Sex differences in systemic lupus erythematosus (SLE): an inception cohort of the Chinese SLE Treatment and Research Group (CSTAR) registry XVII.

The onset and clinical presentation of systemic lupus erythematosus (SLE) are sex-related. Few studies have investigated the distinctions in clinical characteristics and treatment preferences in male and female SLE patients in the initial cohort. This study aimed to improve the understanding of Chinese SLE patients by characterizing the different sexes of SLE patients in the inception cohort. Based on the initial patient cohort established by the Chinese SLE Treatment and Research Group, a total of 8713 patients (795 men and 7918 women) with newly diagnosed SLE were enrolled between April 2009 and March 2021. Of these, 2900 patients (347 men and 2553 women) were eligible for lupus nephritis (LN). A cross-sectional analysis of the baseline demographic characteristics, clinical manifestations, laboratory parameters, organ damage, initial treatment regimens, and renal pathology classification was performed according to sex. In the SLE group, as compared to female patients, male patients had a later age of onset (male vs. female: 37.0 ± 15.8 years vs. 35.1 ± 13.7 years, P = 0.006) and a higher SLE International Collaborative Clinic/American College of Rheumatology damage index score (male vs. female: 0.47 ± 1.13 vs. 0.34 ± 0.81, P = 0.015), LN (male vs. female: 43.6% vs. 32.2%, P < 0.001), fever (male vs. female: 18.0% vs. 14.6%, P = 0.010), thrombocytopenia (male vs. female: 21.4% vs. 18.5%, P = 0.050), serositis (male vs. female: 14.7% vs. 11.7%, P = 0.013), renal damage (male vs. female: 11.1% vs. 7.4%, P < 0.001), and treatment with cyclophosphamide (CYC) (P < 0.001). The frequency of leukopenia (male vs. female: 20.5% vs. 25.4%, P = 0.002) and arthritis (male vs. female: 22.0% vs. 29.9%, P < 0.001) was less in male patients with SLE. In LN, no differences were observed in disease duration, SLE Disease Activity Index score, renal biopsy pathological typing, or 24-h urine protein quantification among the sexes. In comparisons with female patients with LN, male patients had later onset ages (P = 0.026), high serum creatinine (P < 0.001), higher end-stage renal failure rates (P = 0.002), musculoskeletal damage (P = 0.023), cardiovascular impairment (P = 0.009), and CYC use (P = 0.001); while leukopenia (P = 0.017), arthritis (P = 0.014), and mycophenolate usage (P = 0.013) rates were lower. Male SLE patients had more severe organ damage and a higher LN incidence compared with female SLE patients; therefore, they may require more aggressive initial treatment compared to female patients.

Research protocol to evaluate the effectiveness of shockwave therapy, photobiomodulation and physical therapy in the management of non-insertional Achilles tendinopathy in runners: a randomised control trial with elective cross-over design

BackgroundAchilles tendinopathy (AT) is a common overuse injury in runners. While the mainstay of treatment for AT is tendon loading exercises (physical therapy and exercise programme (EXER)), some patients have...

Comparative effectiveness of trauma-focused and non-trauma-focused psychotherapy for PTSD among veterans with comorbid substance use disorders: Protocol & rationale for a randomized clinical trial

BackgroundCo-occurrence of posttraumatic stress disorder (PTSD) and substance use disorders (SUDs) is common and concurrent treatment is recommended. Relatively little is known about which evidence-based psychotherapies for PTSD are most effective for patients with varying substance use profiles. We aim to examine the comparative effectiveness of trauma-focused therapy (TFT) and non-trauma-focused therapy (NTFT) among Veterans with PTSD and SUD. TFT has been found to be effective among those with PTSD/SUD, though effects are smaller and rates of treatment non-completion are higher than in those without SUD. NTFTs suggested for the treatment of PTSD, such as Present Centered Therapy, (PCT) have not been examined among those with co-occurring SUD, despite lower rates of treatment dropout. We will also examine the comparative effectiveness of TFT and NTFT for patients with varying SUD severity, type of substances used, and patient treatment preference. Method420 Veterans with PTSD and SUD will be randomized in a prospective, pragmatic comparative effectiveness trial at 14 Veterans Health Administration facilities. Participants will receive either TFT (Prolonged Exposure or Cognitive Processing Therapy) or NTFT (PCT) after enrolling in concurrent SUD treatment-as-usual. Assessments will occur at baseline, posttreatment, 3- and 6 -months posttreatment. Main outcomes are PTSD symptom severity and PTSD treatment dropout. Clinician, patient, and leadership stakeholder panels advise study activities, and a process evaluation will identify strategies to enhance the implementation of evidence-based PTSD treatments in SUD care settings. ConclusionsResults will provide critical information to guide clinicians when recommending PTSD treatments to patients with comorbid SUD.ClinicalTrials.gov Identifier: NCT04581434.

Understanding patient preferences in anti-VEGF treatment options for age-related macular degeneration.

(1) To investigate the relative importance of convenience (consultation frequency and injection frequency) against treatment outcomes (visual and anatomical outcomes) and out-of-pocket medical costs via a discrete choice experiment (DCE), and (2) to investigate how patient characteristics affect patient treatment preferences. Eligibility criteria were: (1) receiving a neovascular age-related macular degeneration (nAMD) diagnosis; (2) receiving anti-VEGF treatment; (3) being ≥21 years old, and (4) being able to speak and understand English/Mandarin. Patients were presented with eight choice tasks and asked to choose between their current treatment and two hypothetical treatments that varied by six attributes: number of clinic visits in a year, number of injections in a year, vision quality, control of swelling in retina, drug labelling and out-of-pocket cost. This analysis involved 180 patients. Based on latent class logistic regressions, vision quality was the most important attribute (34%) followed by cost (24%). The frequency of total clinic visits (15%) was the third most-important attribute, closely followed by labelling (12%) and control of retina swelling (11%). Injection frequency was the least important attribute (4%). Vision quality was the most important attribute followed by the out-of-pocket costs. Given the same outcomes, patients preferred treatment regimens which require fewer total clinic visits. In comparison, injection frequency alone did not influence patient preferences. With increasing treatment options for nAMD, understanding patients' preferences can help clinicians in selecting agents and treatment regimen most preferred for each patient, which may lead to improved long-term adherence and outcomes.

Patient preferences regarding treatment options for Waldenström's macroglobulinemia: A discrete choice experiment.

Treatment options for Waldenström's Macroglobulinemia (WM) have expanded rapidly in the last decades. However, there is no consensus on a preferred treatment. Therefore, patient preferences become increasingly important in making individualized treatment plans. Still, WM patients' priorities and perspectives regarding their treatment options are unknown. We evaluated treatment preferences of WM patients using a discrete choice experiment (DCE). A mixed-method approach was utilized for identification and selection of attributes/levels. The DCE questionnaire included five attributes: type of agent (targeted versus chemotherapy); frequency and route of administration; 5-year progression-free survival (PFS); adverse events; and risk of secondary malignancies. An orthogonal design and a mixed logit panel data model were used to construct choice tasks and assess patient preferences, respectively. Three hundred thirty WM patients participated in the project. In total, 214 (65%) complete questionnaires were included for data analysis. The 5-year PFS, followed by risk of secondary malignancies were the most important attributes for making treatment choices. Regarding side effects, patients chose to avoid neuropathy the most compared to nausea/vomiting and extreme fatigue. Patients preferred a fixed-duration treatment with IV/SC administration at the hospital over a continuous daily oral regimen at home. These are the first systematic data obtained on WM patient preferences for treatment. The results may help discussions with individual patients about their treatment choices. Also, these data can help design clinical trials in WM and inform health-care decision-making regarding outcomes that are most relevant to patients.

Patient preferences for treatment in relapsed/refractory diffuse large B-cell lymphoma: a discrete choice experiment

Aim: We quantified patient preferences for second-line diffuse large B-cell lymphoma therapies, including attributes of chimeric antigen receptor (CAR) T-cell therapy. Materials & methods: Using a discrete choice experiment, we surveyed 224 diffuse large B-cell lymphoma patients from the USA and Europe. Patients chose between two treatment options defined by six attributes with predefined levels for overall survival, adverse events (severe cytokine-release syndrome, severe neurological toxicities, severe infection) and time to return to pre-treatment functioning. Results: Increasing the probability of 1-year survival was most important to patients, followed by avoiding risks of cytokine-release syndrome and neurological toxicities. Respondents required a 13-14 percentage point increased 1-year survival probability to accept risks of treatment-associated adverse events. Conclusion: Patients prioritize survival and will accept certain adverse event risks to gain survival improvements.

Impact of preference for yoga or cognitive behavioral therapy in patients with generalized anxiety disorder on treatment outcomes and engagement

There is some, but inconsistent, evidence to suggest that matching patient treatment preference enhances treatment engagement and outcome. The current study examined differential preferences and factors associated with treatment preference for 12-week group cognitive behavioral therapy (CBT), yoga, or stress education in 226 adults with generalized anxiety disorder (GAD; 70% female, Mean age = 33 ± 13.5). In a subsample of 165 patients who reported an intervention preference and were randomized to yoga or CBT, we further examined whether match to preferred intervention improved the primary treatment outcome (responder status on Clinical Global Impressions Scale) and engagement (dropout, homework compliance). Preferences for CBT (44%) and yoga (40%) were similar among patients. Women tended to prefer yoga (OR = 2.75, p = .01) and CBT preference was associated with higher baseline perceived stress (OR = 0.92, p = .04) and self-consciousness meta-cognitions (OR = 0.90, p = .02). Among those not matched to their preference, treatment response was higher for those receiving CBT than yoga (OR = 11.73, p = .013); there were no group differences for those matched to their treatment preference. In yoga, those who received their preference were more likely to drop than those who did not (OR = 3.02, 95% CI = [1.20, 7.58], p = .037). This was not the case for CBT (OR = 0.37, 95% CI = [0.13, 1.03], p = .076). Preference match did not predict homework compliance. Overall, results suggest that treatment preference may be important to consider to optimize outcome and engagement; however, it may vary by treatment modality. Future research incorporating preference, especially with yoga for anxiety, is aligned with personalized medicine. Trial registrationclinicaltrials.gov: NCT01912287; https://clinicaltrials.gov/ct2/show/NCT01912287.

PCR16 Stroke Rehabilitation Treatment Preferences of Chinese Physicians and Patients during the COVID-19 Pandemic: A Discrete Choice Experiment

ObjectivesExploring physicians' and patients' preferences for stroke rehabilitation treatment during the pandemic and the differences between preferences.MethodsWe designed an online questionnaire to survey participants in hospitals. The selected attributes included 'Acceptable hospital distances,' 'Acceptable hospital grades,' 'Duration of each treatment,' 'Main treatment methods,' 'Total acceptable length of treatment,' and 'Total cost of treatment(¥).' After data collection was completed, we built a multinomial logit model and a latent class model. We performed subgroup analysis to observe their treatment preferences and willingness to pay and to see whether the difference in preferences between them was statistically significant.ResultsIn the logit model, we found that people wanted 30 days of exercise therapy or physical therapy at a university-affiliated hospital that was close to home and inexpensive, with the shortest possible total treatment time. The highest preference weight was the level at which the total treatment cost was zero. In the subgroup analysis, we found that physicians and patients did not have the same concerns, with physicians focusing on 'Main treatment method' and 'Total cost of treatment(¥),' while patients were more concerned with 'Acceptable hospital distances' and 'Acceptable hospital grades,' and this difference between them was statistically significant.ConclusionsThese results confirmed what physicians and patients think, which could also give us an idea of the weight of their preferences for rehabilitation treatment. Physicians should take treatment preferences into account when treating patients, as this will help improve patients' compliance and further improve the effectiveness and safety of clinical care, which also help stroke patients to some extent and provide the scientific basis and sound advice to Chinese health authorities. ObjectivesExploring physicians' and patients' preferences for stroke rehabilitation treatment during the pandemic and the differences between preferences. Exploring physicians' and patients' preferences for stroke rehabilitation treatment during the pandemic and the differences between preferences. MethodsWe designed an online questionnaire to survey participants in hospitals. The selected attributes included 'Acceptable hospital distances,' 'Acceptable hospital grades,' 'Duration of each treatment,' 'Main treatment methods,' 'Total acceptable length of treatment,' and 'Total cost of treatment(¥).' After data collection was completed, we built a multinomial logit model and a latent class model. We performed subgroup analysis to observe their treatment preferences and willingness to pay and to see whether the difference in preferences between them was statistically significant. We designed an online questionnaire to survey participants in hospitals. The selected attributes included 'Acceptable hospital distances,' 'Acceptable hospital grades,' 'Duration of each treatment,' 'Main treatment methods,' 'Total acceptable length of treatment,' and 'Total cost of treatment(¥).' After data collection was completed, we built a multinomial logit model and a latent class model. We performed subgroup analysis to observe their treatment preferences and willingness to pay and to see whether the difference in preferences between them was statistically significant. ResultsIn the logit model, we found that people wanted 30 days of exercise therapy or physical therapy at a university-affiliated hospital that was close to home and inexpensive, with the shortest possible total treatment time. The highest preference weight was the level at which the total treatment cost was zero. In the subgroup analysis, we found that physicians and patients did not have the same concerns, with physicians focusing on 'Main treatment method' and 'Total cost of treatment(¥),' while patients were more concerned with 'Acceptable hospital distances' and 'Acceptable hospital grades,' and this difference between them was statistically significant. In the logit model, we found that people wanted 30 days of exercise therapy or physical therapy at a university-affiliated hospital that was close to home and inexpensive, with the shortest possible total treatment time. The highest preference weight was the level at which the total treatment cost was zero. In the subgroup analysis, we found that physicians and patients did not have the same concerns, with physicians focusing on 'Main treatment method' and 'Total cost of treatment(¥),' while patients were more concerned with 'Acceptable hospital distances' and 'Acceptable hospital grades,' and this difference between them was statistically significant. ConclusionsThese results confirmed what physicians and patients think, which could also give us an idea of the weight of their preferences for rehabilitation treatment. Physicians should take treatment preferences into account when treating patients, as this will help improve patients' compliance and further improve the effectiveness and safety of clinical care, which also help stroke patients to some extent and provide the scientific basis and sound advice to Chinese health authorities. These results confirmed what physicians and patients think, which could also give us an idea of the weight of their preferences for rehabilitation treatment. Physicians should take treatment preferences into account when treating patients, as this will help improve patients' compliance and further improve the effectiveness and safety of clinical care, which also help stroke patients to some extent and provide the scientific basis and sound advice to Chinese health authorities.