Meads, DM orcid.org/0000-0003-1369-2483, O'Dwyer, JL orcid.org/0000-0002-7212-6089, Hulme, CT orcid.org/0000-0003-2077-0419 et al. (3 more authors) (2017) Patient Preferences for Pain Management in Advanced Cancer: Results from a Discrete Choice Experiment. The Patient - Patient-Centered Outcomes Research, 10 (5). pp. 643-651. ISSN 1178-1653
Abstract
Background: Pain from advanced cancer remains prevalent, severe and often under-treated. Aim: The aim of this study was to conduct a discrete choice experiment with patients to understand their preferences for pain management services and inform service development. Methods: Focus groups were used to develop the attributes and levels of the discrete choice experiment. The attributes were: waiting time, type of healthcare professional, out-of-pocket costs, side-effect control, quality of communication, quality of information and pain control. Patients completed the discrete choice experiment along with clinical and health-related quality of life questions. Conditional and mixed logit models were used to analyse the data. Results: Patients with cancer pain (n = 221) and within palliative care services completed the survey (45% were female, mean age 64.6 years; age range 21–92 years). The most important aspects of pain management were: good pain control, zero out-of-pocket costs and good side-effect control. Poor or moderate pain control and £30 costs drew the highest negative preferences. Respondents preferred control of side effects and provision of better information and communication, over access to certain healthcare professionals. Those with lower health-related quality of life were less willing to wait for treatment and willing to incur higher costs. The presence of a carer influenced preferences. Conclusions: Outcome attributes were more important than process attributes but the latter were still valued. Thus, supporting self-management, for example by providing better information on pain may be a worthwhile endeavour. However, service provision may need to account for individual characteristics given the heterogeneity in preferences.