Meads DM, O'Dwyer JL, Hulme CT, Chintakayala P, Vinall-Collier K, Bennett MI. Patient preferences for pain management in advanced cancer: results from a discrete choice experiment. Patient. 2017 Oct;10(5):643-51. doi: 10.1007/s40271-017-0236-x

BACKGROUND: Pain from advanced cancer remains prevalent, severe and often under-treated.

AIM: The aim of this study was to conduct a discrete choice experiment with patients to understand their preferences for pain management services and inform service development.

METHODS: Focus groups were used to develop the attributes and levels of the discrete choice experiment. The attributes were: waiting time, type of healthcare professional, out-of-pocket costs, side-effect control, quality of communication, quality of information and pain control. Patients completed the discrete choice experiment along with clinical and health-related quality of life questions. Conditional and mixed logit models were used to analyse the data.

RESULTS: Patients with cancer pain (n = 221) and within palliative care services completed the survey (45% were female, mean age 64.6 years; age range 21-92 years). The most important aspects of pain management were: good pain control, zero out-of-pocket costs and good side-effect control. Poor or moderate pain control and £30 costs drew the highest negative preferences. Respondents preferred control of side effects and provision of better information and communication, over access to certain healthcare professionals. Those with lower health-related quality of life were less willing to wait for treatment and willing to incur higher costs. The presence of a carer influenced preferences.

: Outcome attributes were more important than process attributes but the latter were still valued. Thus, supporting self-management, for example by providing better information on pain may be a worthwhile endeavour. However, service provision may need to account for individual characteristics given the heterogeneity in preferences.

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