Discrete choice experiments: helping to understand how patients make decisions and promoting non-paternalistic care K Hemming School of Health and Diseases in Populations, University of Birmingham, Birmingham, UK Linked article: This article is a mini commentary on KJB Notten et al., pp. 873–80 in this issue. To view this article visit http://dx.doi.org/10.1111/1471-0528.12924. Published Online 16 July 2014. Discrete choice experiments are a technique used primarily by health economists to inform healthcare policy decisions in settings of limited resources. They are most commonly used to elucidate which attributes of policies are important to patients (for example do patients prefer longer weekday clinic opening times or more capacity within the normal working day). The technique can also be used to explore, in depth, patient preferences for individual (as opposed to policy) treatment decisions. Patient preferences, joint care decisions, and a non-paternalistic ethos are key to patient-centred care. So, understanding what is important to patients when making healthcare choices should be encouraged and is probably an under-researched area. Here, Notten et al. have used this technique to investigate what is important to patients when choosing between mesh surgery and anterior colporrhaphy for the primary correction of pelvic organ prolapse (POP). The high risk of dyspareunia under mesh surgery was found to be important to patients, and a reason
why many of the patients preferred anterior colporrhaphy over mesh surgery. Whether these decisions varied by age was not considered here (appropriately so, as the study sample was not large), but presumably this may become less important with increasing age. Risk of infection, although relatively low in comparison with the other risks (realistic risk in the region of 2–5%), was also found to be important for women; whereas risk of recurrence, although deemed important a priori, and found to be statistically significant here (realistic risk in the region of 30%), was found to be relatively less important than risk of infection. In this study, all of the women in the sample had made a treatment choice for anterior colporrhaphy, so it is perhaps little surprising that the majority preferred this treatment option. Being very sceptical, we might even interpret these findings as telling us that 26% changed their minds after full consideration of the risks and benefits. Ideally, for results to be generalisable, patients should not have made their treatment decision
ª 2014 Royal College of Obstetricians and Gynaecologists
before participation in a discrete choice experiment. What’s more, participation in a study like this, before a treatment decision is made, could also benefit the individual, allowing them to make a treatment decision informed by up-to-date evidence and a full explanation and consideration of the risks and benefits. Of course, this is simply how all treatment decisions should be made, with a full explanation of the uncertainty of the evidence base and a treatment decision made by the patient dependent on what is important to them. Ensuring that we promote the patient-centred ethos in decisionmaking, however, we must take care that although a large majority of the women in this study preferred anterior colporrhaphy, not all did, and it therefore remains important to elicit the preferences of all women at the time of decision-making.
Disclosure of interest The author has no conflicts of interest to disclose. &
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Copyright of BJOG: An International Journal of Obstetrics & Gynaecology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
why many of the patients preferred anterior colporrhaphy over mesh surgery. Whether these decisions varied by age was not considered here (appropriately so, as the study sample was not large), but presumably this may become less important with increasing age. Risk of infection, although relatively low in comparison with the other risks (realistic risk in the region of 2–5%), was also found to be important for women; whereas risk of recurrence, although deemed important a priori, and found to be statistically significant here (realistic risk in the region of 30%), was found to be relatively less important than risk of infection. In this study, all of the women in the sample had made a treatment choice for anterior colporrhaphy, so it is perhaps little surprising that the majority preferred this treatment option. Being very sceptical, we might even interpret these findings as telling us that 26% changed their minds after full consideration of the risks and benefits. Ideally, for results to be generalisable, patients should not have made their treatment decision
ª 2014 Royal College of Obstetricians and Gynaecologists
before participation in a discrete choice experiment. What’s more, participation in a study like this, before a treatment decision is made, could also benefit the individual, allowing them to make a treatment decision informed by up-to-date evidence and a full explanation and consideration of the risks and benefits. Of course, this is simply how all treatment decisions should be made, with a full explanation of the uncertainty of the evidence base and a treatment decision made by the patient dependent on what is important to them. Ensuring that we promote the patient-centred ethos in decisionmaking, however, we must take care that although a large majority of the women in this study preferred anterior colporrhaphy, not all did, and it therefore remains important to elicit the preferences of all women at the time of decision-making.
Disclosure of interest The author has no conflicts of interest to disclose. &
881
Copyright of BJOG: An International Journal of Obstetrics & Gynaecology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
