OBJECTIVES: The objectives of the PREFERENCE Study are to characterize preferences of MGUS and SMM patients for early intervention according to attributes of the intervention, and to identify patient characteristics that predict intervention preference patterns.
METHODS: We developed a survey instrument that contained a conjoint survey, a brief demographic survey, and validated survey instruments to assess numeracy, tolerance for uncertainty, and perceived risk of cancer. The survey was distributed to 301 patients with MGUS or SMM. We analyzed the conjoint data using conditional logistic regression models to investigate the attributes that drive patient decisions about early intervention. We next used latent profile analysis to investigate whether there are latent classes of patients defined by their choice preferences. We then estimated posterior probabilities to evaluate which patient characteristics predict class membership.
RESULTS: We found that for every 10% increase in the ability of a treatment to prevent myeloma, there was an 86% increase in selecting the treatment strategy, and for every $100 increase in monthly cost, there was a 11% decrease in selecting the strategy. High personal inconvenience led to a 38% decrease in selecting a treatment strategy, and a high risk of side effects led to a 91% decrease in selecting a strategy. Latent profile analysis revealed three classes of patients. A class of patients who were willing to accept less efficacious therapies with a higher monthly cost to prioritize avoiding side effects, a class of patients who were willing to accept less efficacious therapies and some risk of side effects to keep monthly cost low, and a class of patients who were willing to accept some risk of side effects and a higher monthly cost to prioritize efficacious therapy. The posterior probabilities did not show a significant difference in class membership based on age, and participants with higher education and higher income were less likely to fall into the latent class prioritizing low cost. Results also showed that choosing efficacious therapy is not perfectly coupled with risk of multiple myeloma.
CONCLUSION: These results emphasize that the “one-size-fits-all” approach in treatment of MM precursor conditions will not meet the needs and preferences of MGUS and SMM patients. In broad populations there are diverse preferences leading to a need for comprehensive intervention portfolios.
| Identifer | oai:union.ndltd.org:bu.edu/oai:open.bu.edu:2144/48163 |
| Date | 21 February 2024 |
| Creators | Downey, Katelyn R. |
| Contributors | Franzblau, Carl, Ghobrial, Irene |
| Source Sets | Boston University |
| Language | en_US |
| Detected Language | English |
| Type | Thesis/Dissertation |
| Rights | Attribution 4.0 International, http://creativecommons.org/licenses/by/4.0/ |
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