Patient Preferences for Pain Management in Advanced Cancer: Results from a Discrete Choice Experiment
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Pain from advanced cancer remains prevalent, severe and often under-treated.
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.
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.
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.
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.
KeywordsPain Management Pain Control Cancer Pain Discrete Choice Experiment Palliative Care Service
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.
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.
Compliance with Ethical Standards
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.
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.
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