Methods to Summarize Discrete-Choice Experiments in a Systematic Review: A Scoping Review

What Next for the Science of Patient Preference? Interoperability, Standardization, and Transferability

Using patient preference information (PPI) to incorporate patient voices into the drug development lifecycle can help align therapies with the needs and values of patients. However, several barriers have limited the use of PPI, including a lack of clarity on its use by decision-makers, a need for greater decision-maker trust in PPI, and a lack of time, budgets, and access to specialist expertise. The value proposition for PPI could be enhanced by making it FAIR: Findable, Accessible, Interoperable, and Reusable. To support the development of a research agenda to deliver FAIR PPI, we reviewed related endeavors in the development of repositories of existing studies, disease models, benefit transfer, and common data standards. We concluded that developing FAIR PPI would require advances in the science of PPI, including the establishment of a consortium, mirroring the Clinical Data Interchange Standards Consortium (CDISC) or Observational Medical Outcomes Partnership (OPOM), to develop PPI data standards, and research into the sources of variation in patient preferences. This will require the science of PPI to graduate from being a body of empirical observations to developing theories that explain variations in patient preferences, simultaneously driving both efficiency in the generation of PPI and trust in PPI.

Preferences of Cancer Survivors for Follow-Up Care: A Systematic Review of Discrete Choice Experiments

BACKGROUND AND OBJECTIVE

Cancer survivors frequently encounter multiple challenges, including physical, psychological, social, emotional, and financial difficulties. These challenges significantly impact their quality of life and recovery process. This systematic review intends to delineate and assess the evidence gathered from discrete choice experiments, aiming to unravel the preferences of cancer survivors towards their follow-up care.

METHODS

A systematic literature review was conducted across PubMed, Web of Science, Embase, CINAHL, PsycINFO, CNKI, Wanfang, and SinoMed databases up to July 2024. Two reviewers independently conducted the screening, data extraction, and quality appraisal of the studies. The collected data were synthesized through a narrative approach. Additionally, semi-quantitative analyses were used to evaluate the frequency, importance, and significance of each attribute.

RESULTS

Eight studies conducted across four countries were analyzed, yielding 41 distinct attributes grouped into eight main categories and 14 subcategories, further refined by subject matter. Despite the differences in payment systems between countries, the type of provider topped the list of preferences for cancer survivors' follow-up care. Next in preference was the contact modality. Service quality (comprehensive plans, personalized service, detailed information) was also valued. However, opinions diverged on continuity, additional support, and service frequency.

CONCLUSIONS

The attributes of follow-up care preferences integrated in this review demonstrate a diverse range among cancer survivors. Generally, they prioritize skilled professionals, flexible contact modality, and other high-quality follow-up care elements. Future studies should analyze cancer survivors' preferences for follow-up care from the perspectives of different stakeholders, and further consider internal and external factors to ensure authentic decision making.

Patients' values and preferences for health states in allergic rhinitis-An artificial intelligence supported systematic review

BACKGROUND

Allergic rhinitis (AR) impacts patients' physical and emotional well-being. Assessing patients' values and preferences (V&P) related to AR is an essential part of patient-centered care and of the guideline development process. We aimed to systematically summarize the information about patients' V&P on AR and its symptoms and impact on daily life.

METHODS

We conducted systematic review in a MEDLINE, Embase, PsychInfo, and CINAHL databases. We included studies which quantitatively assessed patients' V&P for specific outcomes in AR by assessing utilities, applying discrete choice approaches, or rating and ranking outcomes. We grouped outcomes as AR symptoms, functional status, and care-related patient experience. Study selection and data extraction were supported by the Laser AI tool. We rated the certainty of evidence (CoE) using the GRADE approach.

RESULTS

Thirty-six studies (41 records) were included: nine utility studies, seven direct-choice studies and 21 studies of rating or ranking outcomes. Utilities were lower with increased AR severity and with the concomitant presence of asthma, but not with whether AR was seasonal or perennial (CoE = low-high). Patients rated AR symptom-related outcomes as more important than those related to care-related patient experience and functional status (CoE = very low-moderate). Nasal symptoms (mainly nasal congestion) followed by breathing disorders, general and ocular symptoms were rated as the symptoms with the highest impact.

CONCLUSIONS

This systematic review provides a comprehensive overview of V&P of patients with AR. Patients generally considered nasal symptoms as the most important. Future studies with standardized methods are needed to provide more information on V&P in AR.

Stakeholders' preferences for the design and delivery of virtual care services: A systematic review of discrete choice experiments

This systematic review aimed to synthesise evidence from discrete choice experiments (DCEs) eliciting preferences for virtual models of care, as well as to assess the quality of those DCEs and compare the relative preferences for different stakeholder groups. Articles were included if published between January 2010 and December 2022. Data were synthesised narratively, and attributes were assessed for frequency, significance, and relative importance using a semi-quantitative approach. Overall, 21 studies were included encompassing a wide range of virtual care modalities, with the most common setting being virtual consultations for outpatient management of chronic conditions. A total of 135 attributes were identified and thematically classified into six categories: service delivery, service quality, technical aspects, monetary aspects, health provider characteristics and health consumer characteristics. Attributes related to service delivery were most frequently reported but less highly ranked. Service costs were consistently significant across all studies where they appeared, indicating their importance to the respondents. All studies examining health providers' preferences reported either system performance or professional endorsement attributes to be the most important. Substantial heterogeneity in attribute selection and preference outcomes were observed across studies reporting on health consumers' preferences, suggesting that the consideration of local context is important in the design and delivery of person-centred virtual care services. In general, the experimental design and analysis methods of included studies were clearly reported and justified. An improvement was observed in the quality of DCE design and analysis in recent years, particularly in the attribute development process. Given the continued growth in the use of DCEs within healthcare settings, further research is needed to develop a standardised approach for quantitatively synthesising DCE findings. There is also a need for further research on preferences for virtual care in post-pandemic contexts, where emerging evidence suggests that preferences may differ to those observed in pre-pandemic times.

How Do Patients With Type 2 Diabetes Mellitus Value the Importance of Outcomes? An Overview of Reviews

OBJECTIVES

We aimed to assess how patients value the importance of type 2 diabetes mellitus (T2DM) related outcomes.

METHODS

Overview of systematic reviews (SRs) reporting patients' utilities or disutilities for T2DM outcomes. We searched 3 databases from inception until June 2021. Study selection and data extraction were conducted in pairs. We evaluated the quality of SRs with the Joanna Briggs Institute Checklist, and the overlap with the corrected covered area. We estimated descriptive statistics, and, when possible, conducted metanalysis.

RESULTS

We identified 11 SRs, including 119 studies and 70 outcomes. Most reviews were high-quality SRs. The outcomes with the lowest utilities were hypoglycemia with very severe symptoms (acute complications), stroke (macrovascular complications), diabetic peripheral neuropathy with severe pain (microvascular complications), extreme obesity (comorbidities), and insulin only or combined (management of diabetes). Good/excellent glucose control and noninsulin injectable showed higher values than T2DM without complications. The outcomes with the highest disutilities were amputation, depression, major hypoglycemia, stroke, and management using only insulin.

CONCLUSIONS

We provide standardized, reliable utility values (or associated disutilities) for T2DM, acute, microvascular and macrovascular complications, related comorbidities and treatments that may support judgments when making clinical recommendations, designing decision support tools, and developing interventions and economic analysis.

Factors influencing choice of b/ts DMARDs in managing inflammatory arthritis from a patient perspective: a systematic review of global evidence and a patient-based survey from Hong Kong

OBJECTIVES

To investigate factors concerning patients regarding biological/target synthetic disease-modifying antirheumatic drugs (b/ts DMARDs) in treating inflammatory arthritis (IA).

DESIGN

This study consists of a systematic review and a cross-sectional survey in Hong Kong. A systematic review of literature following Preferred Reporting Items for Systematic Reviews and Meta-Analyses was conducted on PubMed, Web of Science, Cochrane and Embase between 1 January 2000 and 1 January 2022. Content analysis was conducted to summarise factors grouped by four themes-social aspects (SA), clinical aspects (CA), medicine characteristics (MC) and financial aspects (FA) in the decision-making process. One cross-sectional survey among Hong Kong patients with IA was conducted to add to global evidence.

SETTING

A systematic review of global evidence and a patient-based survey in Hong Kong to complement scarce evidence in Asia regions.

RESULTS

The systematic review resulted in 34 studies. The four themes were presented in descending order consistently but varied with frequency throughout decision-making processes. During decision-making involving medication initiation, preference and discontinuation, MC (reported frequency: 83%, 86%, 78%), SA (56%, 43%, 78%) and FA (39%, 33%, 56%) were the three most frequently reported factors, whereas CA was less studied. Local survey also revealed that MC factors such as treatment efficacy and the probability of severe adverse events, and SA factors such as the availability of government or charity subsidy, influenced patients' initiation and preference for b/ts DMARDs. Meanwhile, self-estimated improvement in disease conditions (SA), drug side effects (MC) and drug costs (FA) were associated with treatment discontinuation.

CONCLUSIONS

Global and local evidence consistently indicate that MC and SA are important considerations in patients' decisions regarding novel DMARDs. Health policies that reduce patients' financial burden and enhances healthcare professionals' engagement in decision-making and treatment delivery should be in place with an efficient healthcare system for managing IA optimistically.