scholarly journals Breast Cancer Knowledge, Behaviors, and Preferences in Malawi: Implications for Early Detection Interventions From a Discrete Choice Experiment

2017 ◽  
Vol 3 (5) ◽  
pp. 480-489 ◽  
Author(s):  
Racquel E. Kohler ◽  
Satish Gopal ◽  
Clara N. Lee ◽  
Bryan J. Weiner ◽  
Bryce B. Reeve ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Early Detection ◽  
Discrete Choice Experiment ◽  
Discrete Choice ◽  
Rural Areas ◽  
Choice Experiment ◽  
Multivariable Analysis ◽  
Breast Health ◽  
Cancer Knowledge ◽  
Breast Cancer Knowledge

Purpose Breast cancer is the most common female cancer in Africa and leading cause of death resulting from cancer; however, many countries lack early detection services. In Malawi, women are frequently diagnosed with large tumors after long symptomatic periods. Little is known about local cancer knowledge. Methods We administered a cross-sectional survey with a discrete choice experiment to a random sample in urban and rural areas of Lilongwe district. Bivariable and multivariable analyses determined factors associated with knowledge. Preference utilities for early detection interventions were estimated using a hierarchical Bayesian model in Sawtooth software. Results Of 213 women recruited, fewer than half were aware of breast cancer. In multivariable analysis, electricity at home and knowing someone with cancer increased the odds of awareness. Women were more knowledgeable about symptoms than treatment or risk factors; more than 60% erroneously believed local misconceptions. Seventeen percent were aware of breast self-examination, and 20% were aware of clinical breast examination (CBE); few reported either behavior. Common barriers included not knowing where to access CBE and transportation difficulties. Discrete choice experiment results indicated the detection strategy (breast health awareness, CBE, or both) was the most important attribute of an intervention, followed by the encounter setting and travel time. Conclusion Addressing misconceptions in health messages and engaging survivors to promote early detection may help improve breast cancer knowledge in Malawi. Program designs accounting for women’s preferences should provide breast health education and CBEs in convenient settings to address transportation barriers, particularly for women with low socioeconomic position.

scholarly journals Job preferences of undergraduate pharmacy students in China: a discrete choice experiment

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Ping Liu ◽  
Shimeng Liu ◽  
Tiantian Gong ◽  
Quan Li ◽  
Gang Chen ◽  
...  
Keyword(s):  
Discrete Choice Experiment ◽  
Discrete Choice ◽  
Rural Areas ◽  
Choice Experiment ◽  
Job Characteristics ◽  
Pharmacy Students ◽  
Preference Heterogeneity ◽  
Short Supply ◽  
Job Preferences ◽  
Open Management

Abstract Background Pharmacists are a crucial part of the health workforce and play an important role in achieving universal health coverage. In China, pharmaceutical human resources are in short supply, and the distribution is unequal. This study aimed to identify the key job characteristics that influence the job preferences of undergraduate pharmacy students and to elicit the relative importance of different job characteristics to shed light on future policy interventions. Methods A discrete choice experiment was conducted to assess the job preferences of undergraduate pharmacy students from 6 provinces in mainland China. A face-to-face interview was used to collect data. Conditional logit and mixed logit models were used to analyse data, and the final model was chosen according to the model fit statistics. A series of policy simulations was also conducted. Results In total, 581 respondents completed the questionnaire, and 500 respondents who passed the internal consistency test were analysed. All attributes were statistically significant except for open management. Monthly income and work location were most important to respondents, followed by work unit (which refers to the nature of the workplace) and years to promotion. There was preference heterogeneity among respondents, e.g., male students preferred open management, and female students preferred jobs in public institutions. Furthermore, students with an urban background or from a single-child family placed higher value on a job in the city compared to their counterparts. Conclusion The heterogeneity of attributes showed the complexity of job preferences. Both monetary and nonmonetary job characteristics significantly influenced the job preferences of pharmacy students in China. A more effective policy intervention to attract graduates to work in rural areas should consider both incentives on the job itself and the background of pharmacy school graduates.

scholarly journals Physician treatment of metastatic triple-negative breast cancer in the immuno-oncology era: a discrete choice experiment

2020 ◽  
Vol 16 (33) ◽  
pp. 2713-2722
Author(s):  
Bruce Feinberg ◽  
Skyler Hime ◽  
Jeff Wojtynek ◽  
Igoni Dokubo ◽  
Ajeet Gajra ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Adjuvant Therapy ◽  
Discrete Choice Experiment ◽  
Discrete Choice ◽  
Triple Negative Breast Cancer ◽  
Choice Experiment ◽  
Triple Negative ◽  
Menopausal Status ◽  
Medical Oncologists ◽  
Clinical Scenarios

Aim: Guidelines list atezolizumab with nab-paclitaxel (ANP) as the preferred first-line (1L) therapy for metastatic triple-negative breast cancer (mTNBC) with PD-L1 expression ≥1%, but which clinical attributes impact ANP prescribing? Materials & methods: Medical oncologists participated in a discrete choice experiment (DCE) with four hypothetical mTNBC clinical scenarios to assess influences of: PD-L1 expression, menopausal status, prior adjuvant therapy and bulky liver metastases. Results: A total of 47% chose ANP in 1L irrespective of menopausal status, prior adjuvant therapy or tumor bulk. PD-L1 expression was the only attribute with a significant impact on ANP preference, with 69% choosing ANP for those with ≥1% expression versus only 26% for those with <1% (p < 0.00001). Conclusion: ANP choice for 1L mTNBC deviated from guidelines.

scholarly journals Do Patient Preferences Align With Value Frameworks? A Discrete-Choice Experiment of Patients With Breast Cancer

2020 ◽  
Vol 5 (1) ◽  
pp. 238146832092801
Author(s):  
Ilene L. Hollin ◽  
Juan Marcos González ◽  
Lisabeth Buelt ◽  
Michael Ciarametaro ◽  
Robert W. Dubois
Keyword(s):  
Breast Cancer ◽  
Discrete Choice Experiment ◽  
Discrete Choice ◽  
Patient Preferences ◽  
Treatment Efficacy ◽  
Choice Experiment ◽  
Route Of Administration ◽  
Systematic Evaluation ◽  
Individual Level ◽  
Preference Weights

Purpose. Assess patient preferences for aspects of breast cancer treatments to evaluate and inform the usual assumptions in scoring rubrics for value frameworks. Methods. A discrete-choice experiment (DCE) was designed and implemented to collect quantitative evidence on preferences from 100 adult female patients with a self-reported physician diagnosis of stage 3 or stage 4 breast cancer. Respondents were asked to evaluate some of the treatment aspects currently considered in value frameworks. Respondents’ choices were analyzed using logit-based regression models that produced preference weights for each treatment aspect considered. Aggregate- and individual-level preferences were used to assess the relative importance of treatment aspects and their variability across respondents. Results. As expected, better clinical outcomes were associated with higher preference weights. While life extensions with treatment were considered to be most important, respondents assigned great value to out-of-pocket cost of treatment, treatment route of administration, and the availability of reliable tests to help gauge treatment efficacy. Two respondent classes were identified in the sample. Differences in class-specific preferences were primarily associated with route of administration, out-of-pocket treatment cost, and the availability of a test to gauge treatment efficacy. Only patient cancer stage was found to be correlated with class assignment ( P = 0.035). Given the distribution of individual-level preference estimates, preference for survival benefits are unlikely to be adequately described with two sets of preference weights. Conclusions. Although value frameworks are an important step in the systematic evaluation of medications in the context of a complex treatment landscape, the frameworks are still largely driven by expert judgment. Our results illustrate issues with this approach as patient preferences can be heterogeneous and different from the scoring weights currently provided by the frameworks.

Sign in / Sign up

Export Citation Format

Share Document