Objective
To determine whether the use of a choice-based conjoint analysis (CA) exercise decreased
patients' decisional conflict about treatment preferences for surgical management
of urethral stricture disease. Understanding patient preferences for treatment decisions
assists in shared decision-making and emphasizes patient-centered outcomes. CA offers
a method to understand what risks patients are willing to take for what gains.
Methods
The CA methodology was used by providing participants with case-based choices to elucidate
the relative importance that individuals place on various treatment aspects. Patients'
decisional conflict regarding surgery for urethral stricture was assessed before and
after the CA exercise to assess the impact the exercise had on their decisional conflict.
Results
Completion of the CA exercise resulted in a significant decrease in decisional conflict
(P < .001). The majority (59.5%) of participants with decisional conflict before the
CA exercise experienced a decrease in decisional conflict afterwards, with only a
minority (16.5%) experiencing new decisional conflict after the exercise. Participants
felt the choice-based CA exercise was helpful in deciding what was important in making
treatment decisions (70%) and in expressing their priorities and treatment preferences
(82%). The number needed to counsel to achieve a decrease in decisional conflict was
1.69 and to achieve no decisional conflict was 3.65.
Conclusion
Choice-based CA improves patients' ability to express their treatment preferences
and decreases decisional conflict. CA may be a new tool that physicians and patients
can use to aid in shared decision-making with a focus on patient-centered outcomes.
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Article info
Publication history
Published online: September 16, 2016
Accepted:
July 22,
2016
Received:
April 19,
2016
Footnotes
This research was presented at the 2015 American Urological Association Annual Meeting in New Orleans, LA, in May 2015.
Financial Disclosure: The authors declare that they have no relevant financial interests.
Funding Support: Financial support for this study was provided in part by grants from NIDDK/NIH K12DK083021, the California Urology Foundation, and the UCSF CTSI Resident Research Funding. The funding agreement ensured the authors' independence in designing the study, interpreting the data, and writing and publishing the report.
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© 2016 Elsevier Inc. All rights reserved.
