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.
Similar content being viewed by others
References
Breivik H, Cherny N, Collett B, et al. Cancer-related pain: a pan-European survey of prevalence, treatment, and patient attitudes. Ann Oncol. 2009;20(8):1420–33.
Fisch MJ, Lee J-W, Weiss M, et al. Prospective, observational study of pain and analgesic prescribing in medical oncology outpatients with breast, colorectal, lung, or prostate cancer. J Clin Oncol. 2012;30(16):1980–8.
Van den Beuken-van Everdingen M, De Rijke J, Kessels A, et al. Prevalence of pain in patients with cancer: a systematic review of the past 40 years. Ann Oncol. 2007;18(9):1437–49.
Shi Q, Smith TG, Michonski JD, et al. Symptom burden in cancer survivors 1 year after diagnosis. Cancer. 2011;117(12):2779–90.
Portenoy RK, Lesage P. Management of cancer pain. Lancet. 1999;353(9165):1695–700.
Fortner BV, Okon TA, Portenoy RK. A survey of pain-related hospitalizations, emergency department visits, and physician office visits reported by cancer patients with and without history of breakthrough pain. J Pain. 2002;3(1):38–44.
Gomes B, Higginson I, Calanzani N, et al. Preferences for place of death if faced with advanced cancer: a population survey in England, Flanders, Germany, Italy, the Netherlands, Portugal and Spain. Ann Oncol. 2012;23(8):2006–15.
Department of Health. End of life care strategy: promoting high quality care for all adults at the end of life. London: DH Publications Orderline; 2008.
Adam R, Wassell P, Murchie P. Why do patients with cancer access out-of-hours primary care? A retrospective study. Br J Gen Pract. 2014;64(619):e99–104.
Faculty of Medicine and Health, University of Leeds. What is the IMPACCT programme? http://medhealth.leeds.ac.uk/info/655/impacct/907/what_is_the_impacct_programme. Accessed 1 Apr 2015.
Campbell NC, Murray E, Darbyshire J, et al. Designing and evaluating complex interventions to improve health care. BMJ. 2007;334(7591):455–9.
Bate P, Robert G. Experience-based design: from redesigning the system around the patient to co-designing services with the patient. Qual Saf Health Care. 2006;15(5):307–10.
de Bekker-Grob EW, Ryan M, Gerard K. Discrete choice experiments in health economics: a review of the literature. Health Econ. 2012;21(2):145–72.
Clark MD, Determann D, Petrou S, et al. Discrete choice experiments in health economics: a review of the literature. Pharmacoeconomics. 2014;32(9):883–902.
Ryan M, Gerard K, Amaya-Amaya M. Using discrete choice experiments to value health and health care. Dordrecht: Springer; 2007.
Molassiotis A, Emsley R, Ashcroft D, et al. Applying best-worst scaling methodology to establish delivery preferences of a symptom supportive care intervention in patients with lung cancer. Lung Cancer. 2012;77(1):199–204.
Mühlbacher AC, Junker U, Juhnke C, et al. Chronic pain patients’ treatment preferences: a discrete-choice experiment. Eur J Health Econ. 2015;16(6):613–28.
Chancellor J, Martin M, Liedgens H, et al. Stated preferences of physicians and chronic pain sufferers in the use of classic strong opioids. Value Health. 2012;15(1):106–17.
Gregorian RS, Gasik A, Kwong WJ, et al. Importance of side effects in opioid treatment: a trade-off analysis with patients and physicians. J Pain. 2010;11(11):1095–108.
Meghani SH, Chittams J, Hanlon AL, Curry J. Measuring preferences for analgesic treatment for cancer pain: how do African–Americans and Whites perform on choice-based conjoint (CBC) analysis experiments? BMC Med Inform Decis Mak. 2013;13(1):118.
de Bekker-Grob EW, Donkers B, Jonker MF, Stolk EA. Sample size requirements for discrete-choice experiments in healthcare: a practical guide. Patient. 2015;8(5):373–84.
Coast J, Al-Janabi H, Sutton EJ, et al. Using qualitative methods for attribute development for discrete choice experiments: issues and recommendations. Health Econ. 2012;21(6):730–41.
Clarke V, Braun V. Thematic analysis. In: Teo T, editor. Encyclopedia of critical psychology. New York: Springer; 2014. p. 1947–52.
Brooks R. EuroQol: the current state of play. Health Policy. 1996;37(1):53–72.
Bech M, Gyrd-Hansen D. Effects coding in discrete choice experiments. Health Econ. 2005;14(10):1079–83.
Payne K, McAllister M, Davies LM. Valuing the economic benefits of complex interventions: when maximising health is not sufficient. Health Econ. 2013;22(3):258–71.
Brennan VK, Dixon S. Incorporating process utility into quality adjusted life years: a systematic review of empirical studies. Pharmacoeconomics. 2013;31(8):677–91.
Loomis J. What’s to know about hypothetical bias in stated preference valuation studies? J Econ Surv. 2011;25(2):363–70.
Brazier JE, Dixon S, Ratcliffe J. The role of patient preferences in cost-effectiveness analysis. Pharmacoeconomics. 2009;27(9):705–12.
Acknowledgements
The authors thank the centres and patients who participated in the study—without their efforts the study would not have been possible. We also thank Lucy Ziegler who helped prepare the ethics application for the focus groups and helped run one of the groups; and Joachim Marti who gave advice on the analysis. This report presents independent research commissioned by the National Institute for Health Research under its Programme Grants for Applied Research programme [Improving the Management of Pain from Advanced Cancer in the Community (IMPACCT) RP-PG-0610-10114]. The views expressed in this report are those of the authors and not necessarily those of the National Health Service, the National Institute for Health Research or the Department of Health.
Author contributions
DMM designed the study, analysed the data and wrote the manuscript. JLO’D helped design the study, write the protocol, was involved in the generation, testing and refinement of the survey, and managed the data collection. CTH was involved in the study design and interpretation of results. PC provided guidance on the survey design, analysis and interpretation. KV-C helped with the ethics application, conducted the qualitative analysis and helped with site co-ordination. MIB assisted with the survey design and set-up, provided clinical input, helped interpret the results and write the paper.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
David M. Meads, John L. O’Dwyer, Phani Chintakayala, Karen Vinall-Collier and Claire T. Hulme have no conflicts of interests directly relevant to the content of this study. Michael I. Bennett has no financial interests to declare but has conducted research that aims to improve the self-management of symptoms in the community.
Ethics approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Consent to participate
Informed consent was obtained from all individual participants included in the study.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Meads, D.M., O’Dwyer, J.L., Hulme, C.T. et al. Patient Preferences for Pain Management in Advanced Cancer: Results from a Discrete Choice Experiment. Patient 10, 643–651 (2017). https://doi.org/10.1007/s40271-017-0236-x
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40271-017-0236-x