Women's Treatment Preferences Research Articles

“There’s a big tag on my head”: exploring barriers to treatment seeking with women who use methamphetamine in Sydney, Australia

BackgroundAustralia has a high prevalence of regular use of methamphetamine. While half of people who use methamphetamine regularly are women, they make up only one third of people seeking treatment for methamphetamine use disorder. There is a lack of qualitative research into the facilitators and barriers to treatment for women who use methamphetamine regularly. The study seeks a better understanding of the experiences and treatment preferences of women who use methamphetamine, to inform person-centred changes in practice and policy that break down barriers to treatment.MethodsWe conducted semi-structured interviews with 11 women who frequently use methamphetamine (at least once a week), and who are not engaged in treatment. Women were recruited from health services surrounding a stimulant treatment centre at an inner-city hospital. Participants were asked about their methapmhetamine use and health service needs and preferences. Thematic analysis was completed using Nvivo® software.ResultsThree themes were developed from participants’ responses around experiences of regular methamphetamine use and treatment needs: 1. Resistance of stigmatised identity including dependence; 2. Interpersonal violence; 3. Institutionalised stigma. A fourth set of themes on service delivery preferences were also elicited, including continuity of care, integrated health care, and provision of non-judgmental services.ConclusionGender-inclusive health care services for people who use methamphetamine should actively work to address stigma, support a relational approach to assessment and treatment, and seek to provide structurally competent health care that is trauma and violence informed, and integrated with other services. Findings may also have application for substance use disorders other than methamphetamine.

Understanding Women's Treatment Preferences for Pelvic Floor Disorders [40F

INTRODUCTION: One in four women 20-years and older have at least one pelvic floor disorder (PFD). Studies show there is a lack of awareness and incorrect perception of PFDs among women of all ages. These factors may affect how women treat PFDs. Therefore, this study assessed women of different ages and risk levels knowledge, attitudes, and behaviors around PFDs to understand treatment decisions. METHODS: Researchers sought and gained informed consent from women of varying ages, ethnicities, and risk levels to participate in qualitative one-on-one interviews (n=20) and a focus group (n=6). After data collection, the participants' data were split into four groups for thematic analysis: women under 50 without PFD (n=12), women under 50 with PFD (n=3), women 50 or over without PFD (n=2), and women 50 or over with PFD (n=9). RESULTS: Age and risk level were not variables in participants’ treatment decisions. The majority of participants were not aware PFDs are a medical issue; they were more likely to say that they wouldn’t seek treatment from physicians, instead saying they would just wear pads or do Kegels. Once participants were made aware of PFDs being a legitimate medical issue, factors like time, income, convenience/ease of use, and perceived efficacy were cited as prefaces to treatment. Generally, noninvasive measures were the first choice of women of each category. Four out of five women who had a PFD-related surgery regretted it. CONCLUSION: Women of all categories need to be better informed of PFDs by their gynecologists in order to make more informed treatment decisions.

Women's perspectives on ovulation induction with or without IUI as treatment for normogonadotrophic anovulation: a discrete choice experiment.

Study QuestionWhat are the treatment preferences of women with normogonadotrophic anovulation treated with ovulation induction with or without intrauterine insemination (IUI)?Summary AnswerWomen with normogonadotrophic anovulation differ in their treatment preference; half of them base their preference on the lowest burden and half of them on the highest effectiveness.What is Known AlreadyCommon treatments for anovulatory women who wish to conceive are ovulation induction using clomiphene citrate or letrozole taken in tablet form or with injections containing gonadotrophins, all optionally combined with IUI. Patient preferences for these alternatives have not yet been examined in these women.Study Design, Size, and DurationBetween August 2014 and February 2017 we conducted a multicentre discrete choice experiment (DCE). The target sample size was calculated by including 20 women for six attributes in the main analysis resulting in the inclusion of 120 women to be able to assess heterogeneity across choices.Participants/Materials, Setting, MethodsWe invited treatment-naive women diagnosed with normogonadotropic anovulation and visiting the outpatient clinic of five Dutch centers (three teaching hospitals and two university hospitals) to participate in the DCE by completing a printed questionnaire. We asked women to indicate their preference in hypothetical alternative treatment scenarios by offering a series of choice sets from which they were to choose their preferred alternatives. The choice sets contained several treatment characteristics of interest, i.e. attributes concerning ovulation induction with clomiphene citrate or letrozole versus gonadotrophins, as well as intercourse and IUI. We selected six attributes: number of visits to the outpatient clinic during treatment; type of medication; intercourse or IUI; risk of side effects; willingness to pay; and pregnancy chances leading to the birth of a child after six treatment cycles.We used a multinominal logit model to determine the preferences of women and investigated heterogeneity in preferences through latent class analysis. To determine if women were willing to make a trade-off for higher pregnancy rates at the expense of a higher burden, we calculated the marginal rate of substitution.Main Results and the Role of ChanceThe questionnaire was completed by 145 women. All six attributes influenced women’s treatment preferences and those valued as most important were low risk of side effects, a minimal number of hospital visits and intercourse. A total of 55% of women were driven by the wish to conceive with the least medical interference and lowest burden. The remaining women were success driven and chose mainly for the highest chances to conceive, regardless of the burden. Age and duration of subfertility did not significantly differ between these women. Women were willing to trade-off some burden and costs for higher pregnancy chances.Limitations Reasons for CautionThe sample size of our study is relatively small which made it not possible to perform interaction tests and subgroup analyses.Wider Implications of the FindingsOur results may be used during the counseling of couples about their treatment options. These findings are an argument to explore if a woman prefers potentially fast success or a medically less intense route that might take longer. The preference for the less intense route would lead to the continuation of ovulation induction with oral drugs such as clomiphene citrate or letrozole rather than treatment with injected gonadotrophins, or even IVF.Study Funding/Competing Interest(s)B.W.M. is supported by a NHMRC Practitioner Fellowship (GNT1082548). B.W.M. reports consultancy for Merck, ObsEva and Guerbet. CBL reports grants from Merck and Ferring.Trial Registration NumberNone.

Factors influencing women's preferences for subsequent management in the event of incomplete evacuation of the uterus after misoprostol treatment for miscarriage.

What affects women's treatment preferences in the management of an incomplete evacuation of the uterus after misoprostol treatment for a first-trimester miscarriage? Women's treatment preferences in the management of an incomplete evacuation of the uterus after misoprostol treatment for miscarriage are most strongly influenced by 'the risk of a reduced fertility' followed by 'the probability of success'. Available treatment options in miscarriage are surgical, medical or expectant management. Treatment with misoprostol leads to an incomplete evacuation of the uterus and additional surgical treatment in 20-50% of women. To our knowledge, women's preferences for subsequent treatment of an incomplete evacuation of the uterus after misoprostol treatment for miscarriage have not been studied yet. Between April 2014 and January 2015, we conducted a prospective nationwide multicentre discrete-choice experiment (DCE). DCEs have become the most frequently applied approach for studying patient preferences in health care. In our DCE, which considerers five attributes, a target sample size was calculated including 20 patients per attribute for the main analysis. We intended to include 25% more patients, i.e. a total of 125 thus enabling us to assess heterogeneity of treatment choices. All women visiting the outpatient clinic with first-trimester miscarriage or incomplete miscarriage were invited to participate in the study. Women under 18 years of age, women who were unable to understand the Dutch questionnaire or women who already had received a treatment for the current miscarriage were excluded. Women's preferences were assessed using a DCE. A literature review, expert opinions and interviews with women from the general population were used to define relevant treatment characteristics. Five attributes were selected: (i) certainty about the duration of convalescence; (ii) number of days of bleeding after treatment; (iii) probability of success (empty uterus after treatment); (iv) risk of reduced fertility and (v) risk of complications requiring more time or readmission to hospital. Fourteen scenarios using these attributes were selected in the DCE. Each of these scenarios presented two treatment options, while treatment characteristics varied between the 14 scenarios. For each scenario, respondents were asked to choose the preferred treatment option. The importance of each attribute was analysed, and preference heterogeneity was investigated through latent-class analysis. One hundred and eighty-six women were included of whom 128 completed the DCE (69% response rate). The two attributes with the greatest effect on their preference were, probability of success and risk of reduced fertility. The latent-class analysis revealed two subgroups of patients with different preference patterns. Forty per cent of women were more influenced by treatment success and 59% were more influenced by risk. Most women were highly educated and were of Dutch origin, which limits the generalizability of our findings. Women with lower education levels, other cultural backgrounds and/or different previous experiences may differ from our findings. Patients preferences should be addressed when counselling patients with an incomplete miscarriage after misoprostol treatment. This study was embedded in the MisoREST trial, and funded by ZonMw, a Dutch organization for Health Research and Development, project number 80-82310-97-12066. There were no conflicts of interests. Dutch Trial Register NTR3310, http://www.trialregister.nl. 27 February 2012. 12 June 2012.

Highlights from the 15th St Gallen International Breast Cancer Conference 15-18 March, 2017, Vienna: tailored treatments for patients with early breast cancer.

The 15th St Gallen International Breast Cancer Conference was held in Vienna for the second time, from 15th–18th March 2017. 4000 people from 105 countries all over the world were invited to take part in the event. The real highlight of the conference was the last day with the International Consensus Session which was chaired by around 50 experts on breast cancer worldwide. With reference to data from scientific research, the consensus panel tried to offer guidelines for the management of breast cancer with the aim of providing patients with optimal treatment. The topics covered focused on the treatment of breast cancer, consideration of surgery, radiotherapy, neo-adjuvant, and adjuvant systemic therapy for breast cancer, as well as genetics and prevention of breast cancer.In particular, in terms of precision medicine, an important topic of the conference was ‘is it possible to think that it could become routine in clinical practice to use immunotherapy and targeted therapy based on genetic signatures?’In view of personalised therapy, it is important to take into consideration women’s treatment preferences. It is also important not only to offer guidelines which help breast cancer experts all over the world to choose the proper treatment for women with breast cancer but also to discuss the pros and cons of the therapy with the patient. This allows for a better understanding of the disease.‘From the maximum tolerable to the minimum effective treatment: it is essential to escalate treatment when necessary and to de-escalate when unnecessary’. These few words could summarise the meaning of the 15th St Gallen International Breast Cancer Conference. Prof Martine Piccart-Gebhart was awarded with the St Gallen International Breast Cancer Award 2017 for her fundamental clinical research contribution and Prof Giuseppe Curigliano with the Umberto Veronesi Memorial Award which aims to recognise a physician’s leading role in advancing the science and care of breast cancer patients. Curigliano, in his lecture, spoke about the revolutionary immunotherapy in the clinical management of breast cancer (BC). For the development of these therapies, it is necessary to identify the genetic determinants of BC immune phenotypes in which The Cancer Genome Atlas (TCGA) has contributed towards this.For example, the T helper (Th-1) phenotype (ICR4), which also exhibits upregulation of immune-regulatory transcripts (eg. PDL1, PD1, FOXP3, IDO1, and CTLA4), was associated with prolonged patients’ survival. Chromosome segment 4q21, which includes genes encoding the Th-1 chemokines CXCL9-11, was significantly amplified only in the immune favourable phenotype (ICR4). The mutation and neo-antigen load progressively decreased from ICR4 to ICR1 but could not explain immune phenotypic differences. Mutations of TP53 were enriched in the immune favourable phenotype (ICR4). Instead, the presence of MAP3K1 and MAP2K4 mutations were closely associated with an immune unfavourable phenotype (ICR1). Using both the TCGA and the validation dataset, the degree of MAPK deregulation segregates BC according to their immune disposition. These findings suggest that mutational-driven deregulation of MAPK pathways is linked to the negative regulation of intratumoural immune response in BC.The main themes of this congress were: 1) Surgery of the primary tumour and margins; 2) Surgery of the axilla; 3) Radiotherapy: hypofractionated, ‘boost’ to tumour bed, partial breast, regional node, after mastectomy, advanced technology; 4) Pathology: subtypes, TILs; 5) Multi-gene signatures and therapy; 6) Endocrine therapy: pre- and post-menopausal and duration; 7) Chemotherapy: subtypes, stages; 8) Anti-HER-2 therapy; 9) Neo-adjuvant therapy; 10) Adjuvant bisphosponates; 11) Adjuvant diet and exercise.

Women prefer adjuvant endocrine therapy to chemotherapy for breast cancer treatment

We attempted to determine the preferences of women regarding the benefits they considered necessary to make adjuvant therapy worthwhile, and to compare preferences for adjuvant endocrine therapy, chemotherapy, and trastuzumab therapy. We also investigated the effect of information about cost on women's treatment preferences. Consecutive women who had a medical examination at the Breast Clinic, Ota General Hospital, were included in our study. We collected a questionnaire from a total of 365 women; 297 completed responses were included in the study. Among 297 women, 105 had breast cancer that had been treated and 192 did not have breast cancer; 38% of women judged that a 5% or less gain in the probability of survival was sufficient to make endocrine therapy worthwhile; 28% of participants judged that chemotherapy was worthwhile; 24% of participants judged that trastuzumab therapy was worthwhile. Women indicated that they were more likely to receive adjuvant endocrine therapy than chemotherapy or trastuzumab therapy, for the same gains in the probability of survival. Cost information about treatments did not affect women's treatment preferences. Younger women tended to judge improvements in survival sufficient to make adjuvant endocrine and chemotherapy worthwhile, as compared to older women. The comparisons were statistically significant in the 10 and 20% categories for endocrine therapy and chemotherapy. Women prefer endocrine therapy to chemotherapy or trastuzumab therapy, given the same projected treatment benefits. Younger women prefer both chemotherapy and endocrine therapy as compared with older woman.

Reasons Underlying Treatment Preference

Very little is known about what factors influence women's treatment preferences after a sexual assault. To learn more about these factors, data were collected from 273 women who read a standard "if this happened to you, what would you do" scenario describing a sexual assault and subsequent trauma-related psychiatric symptoms. After reading standardized treatment options for a pharmacotherapy (sertraline) and a psychotherapy (cognitive behavioral treatment), participants made a hypothetical treatment choice and reported the main reasons for their choice. Women often cited reasons surrounding the effectiveness of a treatment as the primary reason for their treatment preference, suggesting potential masking of symptoms with the medication and more logical, long-lasting effects with the psychotherapy. Other common reasons underlying treatment preference were wariness of the medication and positive feelings about talking in psychotherapy. Better understanding factors that influence treatment preference may aid in refining psychoeducation materials regarding the psychological consequences of sexual assault and their treatment for the lay public and in helping clinicians further tailor their discussion of treatment alternatives for these women.

Risk-attitude and patient treatment preferences.

Women's treatment preferences for lupus nephritis vary widely even after adjusting for sociodemographic factors and disease severity. Attitude toward risk may partially explain interpatient variability in treatment preference. The objective of this study was to examine the association between 'risk-attitude' and patient treatment preferences in lupus nephritis. Sixty-five premenopausal women with systemic lupus erythematosus were interviewed. Patient preferences for cyclophosphamide versus azathioprine for the treatment of lupus nephritis were ascertained using an Adaptive Conjoint Analysis questionnaire. Risk-attitude was ascertained by asking patients to choose between a pair of lotteries having the same expected value but differing in spread (the difference between the worst and best outcomes). Respondents preferring the wider spread were classified as relatively more risk-seeking and those preferring the narrower spread were classified as relatively more risk-averse. Twenty-eight percent of respondents were classified as relatively more risk-seeking. Risk-seeking women were more likely to prefer cyclophosphamide for the treatment of lupus nephritis compared with risk-averse women [least square mean (+/- SD) preference for cyclophosphamide 63 +/- 3 among risk-seeking women versus 55 +/- 2 among risk-averse women (P < 0.03)]. The association between risk attitude and treatment preference persisted asthe probabilities of adverse events were varied to reflect the range of risks reported in the literature. Our results suggest that patients' relative risk-attitudes, as measured by a lottery task, are related to their treatment preferences. Differences in risk-attitude may help explain the inter-patient variability in treatment preferences.

Correlates of women’s preferences for treatment of heavy menstrual bleeding

This cross-sectional survey investigated factors associated with treatment preferences of women with menorrhagia. Women ( n=474) aged 35–54 years referred to gynaecology out-patient clinics for menorrhagia were mailed a self-administered questionnaire before their first clinic visit. The main outcome measure was treatment preference. Hysterectomy and conservative treatment (combined with no treatment) were favoured equally often. In a multivariate analysis, completed family size ( P=0.003), menstrual pain ( P=0.02), irregular periods ( P=0.03), and higher age ( P=0.04) predicted hysterectomy preference, as did lower education level ( P=0.001), gynaecologist consultations ( P=0.002), and unemployment ( P=0.03). The psychological factors assessed were not associated with treatment preference. In conclusion, rational considerations regarding stage of reproductive life and severity of symptoms were linked to women’s treatment preferences. However, education, employment status and use of specialists’ services guided women’s preferences even more powerfully than menstrual symptoms and burden caused by them. Doctors should pay more attention to motivating women for a trial of conservative treatment since only half of the women reported previous treatment for their menstrual problem.