Incorporating the Patient Voice into Attribute and Level Selection for a Preference Study: A Qualitative Study in...

Bacillus Calmette-Guerin (BCG) following transurethral resection of bladder tumor (TURBT) is the current standard of care (SOC) for high-risk non-muscle invasive bladder cancer (HR-NMIBC). Several emerging therapies, such as immune checkpoint inhibitor (ICI) therapies in combination with BCG will provide new treatment options for patients. Patient preference studies can provide quantitative evidence of the trade-offs patients are willing to make among attributes of current and emerging treatments. Qualitative research is critical to developing preference elicitation instruments that capture decision-relevant treatment attributes. This study aimed to elicit information about HR-NMIBC patients' treatment priorities and evaluate a preliminary list of attributes and levels to be used in a patient preference survey.

A targeted literature review produced a preliminary list of 11 attributes. Qualitative, semi-structured, multi-method telephone interviews with 12 patients with HR-NMIBC in the USA were used to explore treatment decision drivers and assess comprehension and relevance of the attributes and levels. Patients with HR-NMIBC were recruited via patient advocacy groups. A combination of concept elicitation, cognitive debriefing, and rating and ranking exercises were used to assess patients' priorities and perspectives regarding decision-relevant treatment attributes.

Efficacy (event-free survival) was the most important attribute to all patients. The risk of serious/life-threatening events was also very important to patients. The risk of experiencing bladder problems and the choice between different administration procedures (route, frequency) were also important in the context of patients' treatment choices. The preliminary list of attributes and levels was subsequently refined to reflect patient priorities and incorporate feedback from expert advisors.

This is the first study, to our knowledge, that provides qualitative evidence regarding patients' preference for potential future treatment options for HR-NMIBC. Findings will inform the final selection and framing of attributes and levels to be included in an upcoming benefit-risk preference study. Future research is warranted to quantify any trade-offs that patients with HR-NMIBC are willing to make regarding administration, benefit, and risk attributes.