Patient preferences for whole-body MRI or conventional staging pathways in lung and colorectal cancer: a discrete choice experiment.

Autor: Miles A; Department of Psychological Sciences, Birkbeck, University of London, Malet Street, London, WC1E 7HX, UK. ae.miles@bbk.ac.uk., Taylor SA; Centre for Medical Imaging, University College London, Charles Bell House, 43-45 Foley Street, London, W1W 7TS, UK., Evans REC; Department of Psychological Sciences, Birkbeck, University of London, Malet Street, London, WC1E 7HX, UK., Halligan S; Centre for Medical Imaging, University College London, Charles Bell House, 43-45 Foley Street, London, W1W 7TS, UK., Beare S; Cancer Research UK and University College London Clinical Trials Centre, 90 Tottenham Court Road, London, W1T 4TJ, UK., Bridgewater J; UCL Cancer Institute, Paul O Gorman Building, 72 Huntley Street London, London, WC1E 6DD, UK., Goh V; Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, Strand, London, WC2R 2LS, UK., Janes S; Lungs for Living Research Centre, Division of Medicine, University College London, Gower Street, London, WC1E 6BT, UK., Navani N; Department of Thoracic Medicine, UCLH and Lungs for Living Research Centre, University College London, London, WC1E 6BT, UK., Oliver A; National Cancer Research Institute, Angel Building, 407 St John Street, London, EC1V 4AD, UK., Morton A; National Cancer Research Institute, Angel Building, 407 St John Street, London, EC1V 4AD, UK., Rockall A; Department of Surgery and Cancer, Imperial College London, Kensington, London, SW7 2AZ, UK.; Department of Radiology, Royal Marsden NHS Foundation Hospital Trust, Fulham Road, London, SW3 6JJ, UK., Clarke CS; Research Department of Primary Care and Population Health, University College London, Upper Third Floor, UCL Medical School (Royal Free Campus), Rowland Hill Street, London, NW3 2PF, UK., Morris S; Research Department of Applied Health Research, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK.
Jazyk: angličtina
Zdroj: European radiology [Eur Radiol] 2019 Jul; Vol. 29 (7), pp. 3889-3900. Date of Electronic Publication: 2019 Apr 01.
DOI: 10.1007/s00330-019-06153-4
Abstrakt: Objectives: To determine the importance placed by patients on attributes associated with whole-body MRI (WB-MRI) and standard cancer staging pathways and ascertain drivers of preference.
Methods: Patients recruited to two multi-centre diagnostic accuracy trials comparing WB-MRI with standard staging pathways in lung and colorectal cancer were invited to complete a discrete choice experiment (DCE), choosing between a series of alternate pathways in which 6 attributes (accuracy, time to diagnosis, scan duration, whole-body enclosure, radiation exposure, total scan number) were varied systematically. Data were analysed using a conditional logit regression model and marginal rates of substitution computed. The relative importance of each attribute and probabilities of choosing WB-MRI-based pathways were estimated.
Results: A total of 138 patients (mean age 65, 61% male, lung n = 72, colorectal n = 66) participated (May 2015 to September 2016). Lung cancer patients valued time to diagnosis most highly, followed by accuracy, radiation exposure, number of scans, and time in the scanner. Colorectal cancer patients valued accuracy most highly, followed by time to diagnosis, radiation exposure, and number of scans. Patients were willing to wait 0.29 (lung) and 0.45 (colorectal) weeks for a 1% increase in pathway accuracy. Patients preferred WB-MRI-based pathways (probability 0.64 [lung], 0.66 [colorectal]) if they were equivalent in accuracy, total scan number, and time to diagnosis compared with a standard staging pathway.
Conclusions: Staging pathways based on first-line WB-MRI are preferred by the majority of patients if they at least match standard pathways for diagnostic accuracy, time to diagnosis, and total scan number.
Key Points: • WB-MRI staging pathways are preferred to standard pathways by the majority of patients provided they at least match standard staging pathways for accuracy, total scan number, and time to diagnosis. • For patients with lung cancer, time to diagnosis was the attribute valued most highly, followed by accuracy, radiation dose, number of additional scans, and time in a scanner. Preference for patients with colorectal cancer was similar. • Most (63%) patients were willing to trade attributes, such as faster diagnosis, for improvements in pathway accuracy and reduced radiation exposure.
Databáze: MEDLINE
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