{Reference Type}: Journal Article
{Title}: Chronic pain treatment preferences change following participation in N-of-1 trials, but not always in the expected direction.
{Author}: Kravitz RL;Marois M;Sim I;Ward D;Kanekar SS;Yu A;Dounias P;Yang J;Wang Y;Schmid CH;
{Journal}: J Clin Epidemiol
{Volume}: 139
{Issue}: 0
{Year}: Nov 2021
{Factor}: 7.407
{DOI}: 10.1016/j.jclinepi.2021.08.007
{Abstract}: <B>OBJECTIVE: </B>To examine pain treatment preferences before and after participation in an N-of-1 trial.<BR><B>METHODS: </B>In this observational study nested within a randomized trial, we examined chronic pain patients' preferences before and after treatment in relation to N-of-1 trial results; assessed the influence of different schemes for defining comparative "superiority" on potential conclusions; and generated classification trees illustrating the relationship between pre-treatment preferences, N-of-1 trial results, and post-treatment preferences.<BR><B>RESULTS: </B>Treatment preferences differed pre- and post-trial for 40% of participants. The proportion of patients whose N-of-1 trials demonstrated "superiority" of one treatment regimen over the other varied depending on how superiority was defined and ranged from 24% (using criteria that required statistically significant differences between regimens) to 62% (when relying only on differences in point estimates). Regardless of criteria for declaring treatment superiority, nearly three-fourths of patients with equivocal N-of-1 trial results nevertheless expressed definite preferences post-trial.<BR><B>CONCLUSIONS: </B>A large segment of patients undergoing N-of-1 trials for chronic pain altered their treatment preferences. However, the direction of preference change did not necessarily correspond to the N-of-1 results. More research is needed to understand how patients use N-of-1 trial results, why preferences are "sticky" even in the face of personalized data, and how patients and clinicians might be educated to use N-of-1 trial results more informatively.