Dataset Information

Preferences of Patients With Chronic Kidney Disease for Invasive Versus Conservative Treatment of Acute Coronary Syndrome: A Discrete Choice Experiment.

ABSTRACT: Background Patients with chronic kidney disease (CKD) can experience acute coronary syndromes (ACS) with high morbidity and mortality. Early invasive management of ACS is recommended for most high-risk patients; however, choosing between an early invasive versus conservative management approach may be influenced by the unique risk of kidney failure for patients with CKD. Methods and Results This discrete choice experiment measured the preferences of patients with CKD for future cardiovascular events versus acute kidney injury and kidney failure following invasive heart procedures for ACS. The discrete choice experiment, consisting of 8 choice tasks, was administered to adult patients attending 2 CKD clinics in Calgary, Alberta. The part-worth utilities of each attribute were determined using multinomial logit models, and preference heterogeneity was explored using latent class analysis. A total of 140 patients completed the discrete choice experiment. The mean age of patients was 64 years, 52% were male, and mean estimated glomerular filtration rate was 37 mL/min per 1.73 m². Across the range of levels, risk of mortality was the most important attribute, followed by risk of end-stage kidney disease and risk of recurrent myocardial infarction. Latent class analysis identified 2 distinct preference groups. The largest group included 115 (83%) patients, who placed the greatest value on treatment benefits and expressed the strongest preference for reducing mortality. A second group of 25 (17%) patients was identified who were procedure averse and had a strong preference toward conservative management of ACS and avoiding acute kidney injury requiring dialysis. Conclusions The preferences of most patients with CKD for management of ACS were most influenced by lowering mortality. However, a distinct subgroup of patients was strongly averse to invasive management. This highlights the importance of clarifying patient preferences to ensure treatment decisions are aligned with patient values.

SUBMITTER: Wilson TA

PROVIDER: S-EPMC10111540 | biostudies-literature | 2023 Mar

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Preferences of Patients With Chronic Kidney Disease for Invasive Versus Conservative Treatment of Acute Coronary Syndrome: A Discrete Choice Experiment.

Wilson Todd A TA Hazlewood Glen S GS Sajobi Tolulope T TT Wilton Stephen B SB Pearson Winnie E WE Connolly Carol C Javaheri Pantea A PA Finlay Juli L JL Levin Adeera A Graham Michelle M MM Tonelli Marcello M James Matthew T MT

Journal of the American Heart Association 20230309 6

Background Patients with chronic kidney disease (CKD) can experience acute coronary syndromes (ACS) with high morbidity and mortality. Early invasive management of ACS is recommended for most high-risk patients; however, choosing between an early invasive versus conservative management approach may be influenced by the unique risk of kidney failure for patients with CKD. Methods and Results This discrete choice experiment measured the preferences of patients with CKD for future cardiovascular ev ...[more]

PMID: 36892063

Similar Datasets

Project description:BackgroundChronic kidney disease is associated with a high incidence of acute coronary syndrome and related morbidity and mortality. Treatment choices for patients with chronic kidney disease involve trade-offs in the potential benefits and harms of invasive management options.ObjectiveThe objective was to quantify preferences of patients with chronic kidney disease toward invasive heart procedures.DesignDesign and pilot a discrete choice experiment.SettingWe piloted the discrete choice experiment in 2 multidisciplinary chronic kidney disease clinics in Calgary, Alberta, using an 8-question survey.PatientsEligible patients included those aged 18 years and older, an estimated glomerular filtration rate < 45 mL/min/1.73 m2, not currently receiving dialysis, and able to communicate in English.MeasurementsQuantification of the average importances of key attributes of invasive heart procedures.MethodsWe identified attributes most important to patients and physicians concerning invasive versus conservative management for acute coronary syndrome, using semi-structured qualitative interviews. Levels for each attribute were derived from analysis of early invasive versus conservative acute coronary syndrome management clinical trials and cohort studies, where subgroups of patients with chronic kidney disease were reported. We designed the pilot study with patient partners with relevant lived experience and considered statistical efficiency to estimate main effects and interactions, as well as response efficiency. Hierarchical Bayesian estimation was used to quantify average importances of attributes.ResultsWe recruited 43 patients with chronic kidney disease, mean (SD) age 67 (14) years, 67% male, and 35% with a history of cardiovascular disease, of whom 39 completed the survey within 2 weeks of enrollment. The results of the pilot revealed acute kidney injury requiring dialysis and permanent kidney replacement therapy, as well as death within 1 year were the most important attributes. Measures of internal validity for the pilot discrete choice experiment were comparable to those for other published discrete choice experiments.LimitationsDiscrete choice experiments are complex instruments and often cognitively demanding for patients. This survey included multiple risk attributes which may have been challenging for some patients to understand.ConclusionsThis pilot study demonstrates the feasibility of a discrete choice experiment to quantify preferences of patients with chronic kidney disease toward the benefits and trade-offs related to invasive versus conservative management for acute coronary syndrome. These preliminary findings suggest that patients with chronic kidney disease may be on average similarly risk averse toward kidney replacement therapy and death. This pilot information will be used to inform a larger discrete choice experiment that will refine these estimates of patient preferences and characterize subgroups with distinct treatment preferences, which should provide new knowledge that can facilitate shared decision-making between patients with chronic kidney disease and their care providers in the setting of acute coronary syndrome.

Project description:OBJECTIVES:It is desirable that public preferences are established and incorporated in emergency healthcare reforms. The aim of this study was to investigate preferences for local versus centralised provision of all emergency medical services (EMS) and explore what individuals think are important considerations for EMS delivery. DESIGN:A discrete choice experiment was conducted. The attributes used in the choice scenarios were: travel time to the hospital, waiting time to be seen, length of stay in the hospital, risks of dying, readmission and opportunity for outpatient care after emergency treatment at a local hospital. SETTING:North East England. PARTICIPANTS:Participants were a randomly sampled general population, aged 16 years or above recruited from Healthwatch Northumberland network database of lay members and from clinical contact with Northumbria Healthcare National Health Service Foundation Trust via Patient Experience Team. PRIMARY AND SECONDARY OUTCOME MEASURES:Analysis used logistic regression modelling techniques to determine the preference of each attribute. Marginal rates of substitution between attributes were estimated to understand the trade-offs individuals were willing to make. RESULTS:Responses were obtained from 148 people (62 completed a web and 86 a postal version). Respondents preferred shorter travel time to hospital, shorter waiting time, fewer number of days in hospital, low risk of death, low risk of readmission and outpatient follow-up care in their local hospital. However, individuals were willing to trade off increased travel time and waiting time for high-quality centralised care. Individuals were willing to travel 9 min more for a 1-day reduction in length of stay in the hospital, 38 min for a 1% reduction in risk of death and 112 min for having outpatient follow-up care at their local hospital. CONCLUSIONS:People value centralised EMS if it provides higher quality care and are willing to travel further and wait longer.

Project description:BackgroundPsychiatric nurses are instrumental in enhancing accessibility to care and addressing the mental health care needs of individuals. However, the field faces a significant shortage of nurses coupled with a high turnover rate. Developing policies to attract or retain psychiatric nurses is imperative, but little is known about the preferences of psychiatric nurses regarding the economic and non-economic attributes of work. Here, a discrete choice experiment (DCE) was used to explore psychiatric nurses' job preferences.MethodsA survey instrument was developed adhering to the design-principles of DCE. Psychiatric nurses were surveyed nationwide based on convenience sampling. A mixed logit model was used to estimate the psychiatric nurses' preferences. Willingness to pay was calculated and the change in the probability of psychiatric nurses accepting a job when attribute levels changed was simulated.ResultsThe attribute level most valued by respondents was 'violent coping strategies-impeccable' (coefficient = 1.002, p < 0.01) and willingness to pay for it is 4476.5323 CNY. The most important attribute level for psychiatric nurses living in cities was 'respect-high' (coefficient = 0.505, p < 0.01), and for psychiatric nurses living in town is 'study assistance for children-thorough' (coefficient = 0.620, p < 0.01). Notably, psychiatric nurses with less than ten years of work experience exhibited significant preferences for 'opportunity to upgrade-sufficient' (coefficient = 0.417, p < 0.01), whereas this preference was insignificant among those with ten years or more of experience (p > 0.05). Changing 'violence coping strategies' from 'without' to 'impeccable' increased the probability of psychiatric nurses accepting the job by 37.04%. The optimal job increased the probability of psychiatric nurses accepting the job by 86.06%.ConclusionPsychiatric nurses would prefer jobs with higher income, more respect, better coping strategies with violence, better opportunities for promotion, and a good working atmosphere. Psychiatric nurses with different seniority and residence had different preferences.

Project description:Choosing hypodontia treatment requires young people and parents to consider a large amount of information, identify what is important to them, and make trade-offs between options. This study aimed to examine young people and parents' preferences for hypodontia treatment using discrete choice experiment (DCE). This was a cross-sectional survey of young people (12-16 y) with hypodontia of any severity, at any stage of treatment, and their parents. Participants were recruited from NHS Hospitals in England and Wales. A bespoke DCE questionnaire was developed to measure preferences for 6 attributes of hypodontia treatment (waiting time, treatment time, problems during treatment, discomfort during treatment, bite, appearance). The questionnaire was completed 1) online by young people and parents, individually or together, and 2) by child-parent dyads under observation. Preferences were analyzed using regression models. In total, 204 participants (122 young people, 56 parents, 26 dyads) completed the online questionnaire and 15 child-parent dyads completed the questionnaire under observation. The most important attribute in hypodontia treatment was improvement in appearance, but significant heterogeneity was found in preferences. Four distinct groups of participants were found: group 1 (39%): severe discomfort and problems were most important; group 2 (31%): most concerned about improvement in appearance of teeth and improvement in bite; group 3 (22%): appearance 3 times more important than any other attribute; and group 4 (9%): preferences difficult to interpret. There was variation in how child-parent dyads approached decision-making, with some negotiating joint preferences, while for others, one individual dominated. Making trade-offs in DCE tasks helped some people think about treatment and identify their preferences. Appearance is an important outcome from hypodontia treatment, but preferences vary and potential risks and functional outcome are also important to some people. There is a notable level of uncertainty in decision-making, which suggests further shared decision support would be valuable.

Project description:BackgroundMultiple chronic conditions (MCC) have become a leading cause of low vitality and high mortality among the Chinese population. Although a series of policies has been implemented to promote patients' rational access to health care, patients still prefer a higher level of inpatient service, hampering the efficient utilization of resources in county hospitals, which are the first point of contact for inpatient care. Thus, this study aimed to identify the factors that affect MCC patients' inpatient preferences and the extent to which these factors influence their decisions, thereby guiding inpatient service utilization among MCC patients.MethodsFive attributes (institution scale, waiting time for hospital admission, presence of acquaintances, travel time from residence to hospital, and out-of-pocket expenses per visit) were identified to estimate inpatient choice for MCC patients through a discrete choice experiment. A partial factor analysis was performed to generate selection sets. Data were collected from MCC patients aged between 35 and 75 years, in Fuqing City, China. A mixed logit model was used to analyse MCC patients' preferences for each attribute. Willingness to pay was estimated by regression coefficients, and interaction terms were included in the model to estimate the heterogeneity of inpatient preferences among MCC patients.ResultsA total of 504 valid questionnaires were included in the analysis. The most important attribute of patients when choosing inpatient care is out-of-pocket expenses per visit, followed by travel time from residence to hospital, waiting time for hospital admission, institution scale, and presence of acquaintances. In addition, patients were willing to pay ¥1253, ¥434, and ¥323 for shorter times from the residence to the hospital, larger institutional scale, and beds available on the day, respectively. The findings of the interaction analysis indicated that age and gender also influence MCC patients' inpatient preferences.ConclusionThis study provides evidence of the inpatient preferences of MCC patients. Increasing inpatient insurance reimbursement rates, bolstering the leading role of district and county hospitals in the area, and strengthening information systems will empower district and county hospitals to effectively serve as the first point of contact for inpatient care.

Dataset Information

Preferences of Patients With Chronic Kidney Disease for Invasive Versus Conservative Treatment of Acute Coronary Syndrome: A Discrete Choice Experiment.

Publications

Preferences of Patients With Chronic Kidney Disease for Invasive Versus Conservative Treatment of Acute Coronary Syndrome: A Discrete Choice Experiment.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets