在局部晚期直肠癌的临床完整反应后,与手术相比,对观察和等待的量化偏好:一个离散选择实验 (PrefCoRe)
Garima Dalal1, Stuart J Wright1, Lee Malcomson2
1Manchester Centre for Health Economics, University of Manchester, Oxford Road, Manchester M13 9PL, UK.
概括
患有直肠癌的患者本质上不喜欢观察和等待 (W&W) 或手术. 决策取决于特定的治疗属性,如生活质量和生存率,个人偏好各不相同.
科学领域:
- 在瘤学瘤学.
- 医疗决策的制定 医疗决策的制定
- 患者的偏好 患者的偏好
背景情况:
- 观察和等待 (W&W) 是在临床完整响应 (cCR) 的患者接受新辅助化学放射治疗后,针对局部晚期直肠癌的手术的替代方案.
- 关于患者在W&W和cCR之后的手术之间偏好的证据有限.
研究的目的:
- 量化患者偏好观察和等待 (W&W) 与在本地晚期直肠癌患者中实现cCR的大型手术.
- 确定影响治疗决策的关键属性.
主要方法:
- 一个离散选择实验与两个成年在线调查群体进行:那些有和没有癌症经验的人.
- 受访者根据包括再生,转移,紧急性,静脉栓塞,随访,生存和生活质量在内的属性,对W&W和手术进行了评估.
- 使用非相关的随机参数逻辑模型来建模偏好,在现实场景下预测W&W吸收概率.
主要成果:
- 没有发现W&W或手术的内在偏好;选择取决于属性.
- 生活质量和生存是最喜欢的属性,尽管存在显著的偏好异质.
- 预测W&W吸收率在癌症幸存者中为52.9%,在没有癌症经历的人中为57.2%.
结论:
- 个人对观察和等待或手术没有预先确定的偏好.
- 治疗决策是复杂的,由特定的属性驱动,并受到异质患者偏好的影响.
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