膀胱输尿管反流是一种常见的儿科泌尿系统疾病,通常根据病情的严重程度有几种合理的治疗选择。为了给孩子选择最好的治疗方法,预计父母会做出权衡治疗费用等属性的判断,有效性,和并发症发生率。先前的研究表明,医院和外科医生等因素也会影响患者的治疗选择。
本研究使用概况案例最佳-最差尺度评估父母对反流治疗的偏好,泌尿科和医疗保健偏好估计中的一项新兴技术。该研究还使用潜在类别分析(LCA)来识别具有不同偏好的父母子类。
数据是通过发布到亚马逊的MechanicalTurk在线社区的多媒体最佳-最差扩展调查工具从父母的社区样本中收集的。经过广泛的文献回顾,选择反流属性和属性水平以符合可用的治疗方法.概况情况最佳-最差缩放练习引起了对反流治疗颗粒属性的偏好。使用多项逻辑回归和类别分析对数据进行分析,以区分偏好异质性。概率缩放值(PSV)反映了属性的期望顺序。属性偏好重要性也被重新调整为美元单位以进行比较。
我们分析了248名受访者的数据。最高的治疗效果比所有其他水平的治疗属性更理想(PSV17.8,所有p<0.01)(表)。低并发症发生率和医生推荐是其他最理想的治疗属性(分别为PSV11.3和9.0)。潜在类别分析确定了一个具有更极端偏好的类别,对于医生建议和避免住院的人,特别可取.
在这个基于社区的样本中,高治疗效果和低并发症发生率是父母最理想的治疗属性,尽管父母可能有异质的治疗偏好结构。结合父母偏好的父母-医生共同决策可能会更有效,未来有针对性的决策。
Vesicoureteral reflux is a common pediatric urologic condition that often has several reasonable treatment options depending on condition severity. In order to choose the best treatment for their child, parents are expected to make judgements that weigh attributes such as treatment cost, effectiveness, and complication rate. Prior research has shown that factors such as treating hospital and surgeon also influence patient treatment choice.
This study evaluates parental preferences for reflux treatment using profile
case best-worst scaling, an emerging technique in both urologic and health care preference estimation. The study also uses latent class analysis (LCA) to identify parental sub-classes with different preferences.
Data were collected from a community sample of parents via a multimedia best-worst scaling survey instrument published to Amazon\'s Mechanical Turk online community. After extensive review of the literature, reflux attributes and attribute levels were selected to correspond with available treatments. The profile
case best-worst scaling exercise elicited preferences for granular attributes of reflux treatments. Data were analyzed using multinomial logistic regression and class analysis to distinguish preference heterogeneity. Probability scaled values (PSVs) reflected the order of desirability of the attributes. Attribute preference importance was rescaled into dollar units for comparison as well.
We analyzed data for 248 respondents. The highest treatment effectiveness was more desirable than all other leveled treatment attributes (PSV 17.8, all p < 0.01) (Table). Low complication rate and doctor recommendation were amongst the other most desirable treatment attributes (PSV 11.3 and 9.0, respectively). Latent class analysis identified a class with more extreme preferences, for whom doctor recommendation and avoiding hospitalization were particularly desirable.
In this community-based sample, high treatment effectiveness and low complication rate were the most desirable treatment attributes to parents, though parents likely have heterogenous treatment preference structures. Shared parent-physician decision-making that incorporates parental preferences will likely allow more effective, targeted decision-making in the future.