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Reed SD, Sutphin J, Wallace MJ, Gonzalez JM, Yang JC, Reed Johnson F, Tsapatsaris J, Tarver ME, Saha A, Chen AL, Gebben DJ, Malone M, Farb A, Babalola O, Rorer EM, Parikh SA, Simons JP, Jones WS, Krucoff MW, Secemsky EA, Corriere MA. Quantifying patients' preferences on tradeoffs between mortality risk and reduced need for target vessel revascularization for claudication. Vasc Med 2024; 29:675-683. [PMID: 39415520 DOI: 10.1177/1358863x241290233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2024]
Abstract
BACKGROUND In 2019, the US Food and Drug Administration issued a warning that symptomatic relief from claudication using paclitaxel-coated devices might be associated with an increase in mortality over 5 years. We designed a discrete-choice experiment (DCE) to quantify tradeoffs that patients would accept between a decreased risk of clinically driven target-vessel revascularization (CDTVR) and increased mortality risk. METHODS Patients with claudication symptoms were recruited from seven medical centers to complete a web-based survey including eight DCE questions that presented pairs of hypothetical device profiles defined by varying risks of CDTVR and overall mortality at 2 and 5 years. Random-parameters logit models were used to estimate relative preference weights, from which the maximum-acceptable increase in 5-year mortality risk was derived. RESULTS A total of 272 patients completed the survey. On average, patients would accept a device offering reductions in CDTVR risks from 30% to 10% at 2 years and from 40% to 30% at 5 years if the 5-year mortality risk was less than 12.6% (95% CI: 11.8-13.4%), representing a cut-point of 4.6 percentage points above a baseline risk of 8%. However, approximately 40% chose the device alternative with the lower 5-year mortality risk in seven (20.6%) or eight (18.0%) of the eight DCE questions regardless of the benefit offered. CONCLUSIONS Most patients in the study would accept some incremental increase in 5-year mortality risk to reduce the 2-year and 5-year risks of CDTVR by 20 and 10 percentage points, respectively. However, significant patient-level variability in risk tolerance underscores the need for systematic approaches to support benefit-risk decision making.
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Affiliation(s)
- Shelby D Reed
- Preference Evaluation Research (PrefER) Group, Duke Clinical Research Institute, Durham, NC, USA
- Department of Population Health Sciences, Duke University, Durham, NC, USA
| | - Jessie Sutphin
- Preference Evaluation Research (PrefER) Group, Duke Clinical Research Institute, Durham, NC, USA
| | - Matthew J Wallace
- Preference Evaluation Research (PrefER) Group, Duke Clinical Research Institute, Durham, NC, USA
| | - Juan Marcos Gonzalez
- Preference Evaluation Research (PrefER) Group, Duke Clinical Research Institute, Durham, NC, USA
- Department of Population Health Sciences, Duke University, Durham, NC, USA
| | - Jui-Chen Yang
- Preference Evaluation Research (PrefER) Group, Duke Clinical Research Institute, Durham, NC, USA
| | - F Reed Johnson
- Preference Evaluation Research (PrefER) Group, Duke Clinical Research Institute, Durham, NC, USA
- Department of Population Health Sciences, Duke University, Durham, NC, USA
| | - Jennifer Tsapatsaris
- Preference Evaluation Research (PrefER) Group, Duke Clinical Research Institute, Durham, NC, USA
| | - Michelle E Tarver
- Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Anindita Saha
- Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Allen L Chen
- Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, MD, USA
- Current: Global Regulatory Affairs, Johnson & Johnson MedTech, Raritan, NJ, USA
| | - David J Gebben
- Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Misti Malone
- Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Andrew Farb
- Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Olufemi Babalola
- Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Eva M Rorer
- Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Sahil A Parikh
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Jessica P Simons
- Department of Surgery, University of Massachusetts Memorial Medical Center, Worcester, MA, USA
| | - W Schuyler Jones
- Department of Medicine, Duke University Health System, Durham, NC, USA
| | | | - Eric A Secemsky
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Matthew A Corriere
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
- Current: Department of Surgery, Ohio State University, Columbus, OH, USA
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Marcellis LHM, Sinnige A, Rutgers KM, Kittelson A, Spruijt S, Teijink JAW, van der Wees PJ, Hoogeboom TJ. Evaluating the implementation of personalised outcomes forecasts to optimise supervised exercise therapy in patients with intermittent claudication in the Netherlands: a multimethods study. BMJ Open Qual 2024; 13:e002594. [PMID: 38378615 PMCID: PMC10882410 DOI: 10.1136/bmjoq-2023-002594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 01/31/2024] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND To support the optimisation of supervised exercise therapy (SET) in patients with intermittent claudication, we developed personalised outcomes forecasts (POFs), which visualise estimated walking distance and quality of life for individual patients. The POFs may enable healthcare professionals, such as physical and exercise therapists, to improve shared decision-making and patient outcomes. OBJECTIVES To assess differences in patient outcomes (functional walking distance, maximal walking distance and health-related quality of life) and the level of shared decision-making before and after the implementation of POFs in the conservative treatment of patients with intermittent claudication. METHODS An interrupted time series design was used to compare preimplementation and postimplementation differences on patient outcomes. Using routinely collected data, differences from baseline to 6 months were compared between patients before and patients after the implementation. To compare levels of shared decision-making, we conducted observations of initial consults within a sample of physical or exercise therapists both before and after the implementation. Audiorecords of observations were scored on shared decision-making using the OPTION-5 instrument. RESULTS Differences in improvements between patients with whom POFs were discussed (n=317) and patients before the implementation of POFs (n=721) did not reach statistical significance for both functional walking distance (experimental vs. control=+23%, p=0.11) and maximal walking distance (experimental vs. control=+21%, p=0.08). For health-related quality of life, the POFs-informed patients showed a statistically significant greater improvement of 4% (p=0.04). Increased levels of shared decision-making were observed in postimplementation consults (n=20) when compared with preimplementation consults (n=36), as the median OPTION-5 total score showed a statistically significant increase from 45 to 55 points (p=0.01). CONCLUSIONS Integrating POFs into daily practice of SET for patients with intermittent claudication could assist in improving health-related quality of life and enhancing patient involvement. Using POFs did not result in statistically significant different improvements between groups on walking distances. TRIAL REGISTRATION NUMBER NL8838.
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Affiliation(s)
- Laura H M Marcellis
- Radboud university medical center, IQ Health science department, Nijmegen, The Netherlands
- Chronisch ZorgNet, Eindhoven, The Netherlands
| | - Anneroos Sinnige
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - Katrien M Rutgers
- Physique Preventiecentrum B.V, Arnhem, The Netherlands
- Physical Therapy Sciences, Program in Clinical Health Sciences, Utrecht University, Utrecht, The Netherlands
| | - Andrew Kittelson
- School of Physical Therapy and Rehabilitation Science, University of Montana, Missoula, Montana, USA
| | | | - Joep A W Teijink
- Department of Vascular Surgery, Catharina Hospital, Eindhoven, The Netherlands
- CAPHRI Research School, Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Philip J van der Wees
- Radboud university medical center, IQ Health science department, Nijmegen, The Netherlands
- Clinical Research and Leadership, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Thomas J Hoogeboom
- Radboud university medical center, IQ Health science department, Nijmegen, The Netherlands
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