scholarly journals Japanese Patients’ and Physicians’ Preferences for Anticoagulant Use in Atrial Fibrillation: Results from a Discrete-choice Experiment

10.36469/9904 ◽  
2015 ◽  
Vol 2 (2) ◽  
pp. 207-220 ◽  
Author(s):  
Ken Okumura ◽  
Hiroshi Inoue ◽  
Masahiro Yasaka ◽  
Juan Marcos Gonzalez ◽  
A. Brett Hauber ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Discrete Choice Experiment ◽  
Discrete Choice ◽  
Major Bleeding ◽  
Stroke Prevention ◽  
Choice Experiment ◽  
Clinical Decision Making ◽  
Japanese Patients ◽  
Risk Of Bleeding ◽  
Increased Risk

Background: Anticoagulants are recommended for stroke prevention in patients with atrial fibrillation (AF), but are associated with an increased risk of bleeding; therefore, physicians face benefit-risk tradeoffs when prescribing anticoagulants to AF patients. Although the unmet medical need for safer anticoagulants has been well-documented, there is limited information about the importance that patients and physicians place on cardiovascular events. Objectives: The aim of this study was to quantify patients’ and physicians’ willingness to accept tradeoffs between the benefits and risks of anticoagulants in order to 1) document the potential differences between patients’ and physicians’ perceptions of benefits and risks and 2) support physicians’ clinical decision making. Methods: Preferences from Japanese AF patients and board-eligible or board-certified physicians were elicited using a discrete-choice experiment. Random-parameters logit models were used to estimate importance weights for treatment-related changes in the annual risk of stroke, myocardial infarction, embolism, and bleeding. Results: Japanese patients (N=152) and physicians (N=164) showed different preferences. In particular, among non-fatal outcomes, patients considered disabling stroke to be 16 times more important than non-major clinically relevant bleeding and 2.6 times more important than extra-cranial major bleeding. In contrast, physicians considered the same stroke risk to be 2.7 times more important than non-major clinically relevant bleeding and equally important as major bleeding. Conclusions: Results suggest that Japanese patients are willing to tolerate a greater risk of bleeding in exchange for stroke prevention than are Japanese physicians. The findings demonstrate the importance of physician-patient communication in treatment decisions involving stroke preventative therapies.

scholarly journals A discrete choice task to measure preferences for harsh discipline among parents of young children

2017 ◽  
Author(s):  
Eric Green ◽  
Rhea Chase ◽  
John Zayzay ◽  
Amy Finnegan ◽  
Eve Puffer
Keyword(s):  
Discrete Choice Experiment ◽  
Response Bias ◽  
Discrete Choice ◽  
Choice Experiment ◽  
Controlled Trial ◽  
Choice Task ◽  
Self Report ◽  
Harsh Discipline ◽  
Increased Risk ◽  
Parent Preferences

Maltreatment in early childhood is difficult to measure. Self-report surveys of parents and guardians are the most common method used, but in many settings social desirabil- ity may lead to underestimates of prevalence. There is also reason to be concerned about response bias in the context of intervention trials. To diversify the tools available to in- tervention researchers, we created and tested a discrete choice experiment to elicit parent preferences for harsh discipline. This study was conducted in Liberia as part of a random- ized controlled trial of a positive parenting program. Baseline data were collected from 609 parents and guardians living in Monrovia and caring for a child age 3 or 4. Participants completed a discrete choice experiment that consisted of 12 parenting vignettes, in addition to a survey of parenting attitudes and behaviors. The vignettes were presented to parents as digital comic strips. Each scene could vary on four attributes: child gender; child offense; setting; number of adults present. For each scene, participants selected 1 of 5 discipline strategies that they would in that situation. The visual discrete choice task was easy to implement, well understood by participants, and has evidence of construct validity as a measure of parent preferences for harsh discipline. Tools like this expand the options for researchers studying the maltreatment of pre-school age children, particularly in the con- text of program evaluations where post-intervention observations may be at increased risk of response bias. It may also be useful in a clinical context.

scholarly journals Patients With Atrial Fibrillation Taking Nonsteroidal Anti-Inflammatory Drugs and Oral Anticoagulants in the ARISTOTLE Trial

Circulation ◽  
2020 ◽  
Vol 141 (1) ◽  
pp. 10-20 ◽  
Author(s):  
Frederik Dalgaard ◽  
Hillary Mulder ◽  
Daniel M. Wojdyla ◽  
Renato D. Lopes ◽  
Claes Held ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Gastrointestinal Bleeding ◽  
Major Bleeding ◽  
Oral Anticoagulants ◽  
Clinical Trial Registration ◽  
Risk Of Bleeding ◽  
Number Of Patients ◽  
Increased Risk ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

Background: The use of nonsteroidal anti-inflammatory drugs (NSAIDs) with oral anticoagulants has been associated with an increased risk of bleeding. We investigated the risk of bleeding and major cardiovascular outcomes in patients with atrial fibrillation taking NSAIDs and apixaban or warfarin. Methods: The ARISTOTLE trial (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation; n=18 201) compared apixaban with warfarin in patients with atrial fibrillation at an increased risk of stroke. Patients in ARISTOTLE without severe renal (creatine clearance ≤30 mL/min) or liver disease were included in this analysis (n=17 423). NSAID use at baseline, NSAID use during the trial (incident NSAID use), and never users were described. The primary outcome was major bleeding. Secondary outcomes included clinically relevant nonmajor bleeding, gastrointestinal bleeding, heart failure hospitalization, stroke or systemic embolism, and all-cause mortality. NSAID use during the trial, and the interaction between randomized treatment, was analyzed using time-dependent Cox proportional hazards models. Results: Those with baseline NSAID use (n=832 [4.8%]), incident NSAID use (n=2185 [13.2%]), and never users were similar in median age (age [25th, 75th]; 70 [64, 77] versus 70 [63, 75] versus 70 [62, 76]). Those with NSAID use at baseline and incident NSAID use were more likely to have a history of bleeding than never users (24.5% versus 21.0% versus 15.6%, respectively). During a median follow-up (25th, 75th) of 1.8 (1.4, 2.3) years and when excluding those taking NSAID at baseline, we found that incident NSAID use was associated with an increased risk of major bleeding (hazard ratio [HR], 1.61 [95% CI, 1.11–2.33]) and clinically relevant nonmajor bleeding (HR, 1.70 [95% CI, 1.16–2.48]), but not gastrointestinal bleeding. No significant interaction was observed between NSAID use and randomized treatment for any outcome. Conclusions: A substantial number of patients in the ARISTOTLE trial took NSAIDs. Incident NSAID use was associated with major and clinically relevant nonmajor bleeding, but not with gastrointestinal bleeding. The safety and efficacy of apixaban versus warfarin appeared not significantly to be altered by NSAID use. This study warrants more investigation of the effect of NSAIDs on the outcomes of patients treated with apixaban. Clinical Trial Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT00412984.

Can a Discrete Choice Experiment contribute to person-centred healthcare?

2015 ◽  
Vol 3 (4) ◽  
pp. 431 ◽  
Author(s):  
Mette Kjer Kaltoft ◽  
Jesper Bo Neilsen ◽  
Glenn Salkeld ◽  
Jack Dowie
Keyword(s):  
Decision Making ◽  
Discrete Choice Experiment ◽  
Discrete Choice ◽  
Clinical Relevance ◽  
Choice Experiment ◽  
Clinical Decision Making ◽  
Individual Preference ◽  
Clinical Decision ◽  
Group Level ◽  
The Individual

In person-centred decision making the relative importance of the considerations that matter to the person is elicited and combined, at the point of decision, with the best estimates available on the performance of the available options on those criteria. Whatever procedure is used to implement this in a clinical decision, average preferences emerging from group or subgroup research cannot contribute directly, since they can have only a statistical relationship with the preferences of the individual person. The precise relationship is knowable by eliciting those of the individual concerned, but there would be little point consulting the averages if this is done. A scan of recent Discrete Choice Experiment (DCE) publications reveals frequent claims that the group-level results can somehow contribute to, or facilitate, better clinical decision making. Typically there are only vague or ambiguous indications of how this could happen, the ambiguity often arising from the use and positioning of the apostrophe in the words persons and patients. Only when the person opts out of preference provision and asks to be treated as ‘average’, can the results of a DCE have clinical relevance in genuinely person-centred healthcare. One cannot derive an ought from an is and one cannot derive an I from a they. DCE researchers should refrain from implying that their results could, let alone should, have any impact on person-centred clinical decisions. Group-level DCE results are clearly conceptually appropriate for health system or service decisions, but the suggestion that they have clinical relevance is a serious deterrent to the development and provision of effective means of individual preference elicitation and specification at the point of decision. Those who wish to foster person-centred care should be alert to the dangers of claims based on group-level analyses such as DCEs.  

Consensus Document: Antithrombotic therapy in patients with atrial fibrillation undergoing coronary stenting

2011 ◽  
Vol 106 (10) ◽  
pp. 571-584 ◽  
Author(s):  
John Eikelboom ◽  
Peter Berger ◽  
David Holmes ◽  
Deepak Bhatt ◽  
Richard Becker ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Risk Assessment ◽  
Triple Therapy ◽  
Major Bleeding ◽  
National Guidelines ◽  
Risk Of Bleeding ◽  
Consensus Document ◽  
Increased Risk ◽  
Optimal Regimen ◽  
Adequate Data

SummaryThe optimal regimen of the anticoagulant and antiplatelet therapies in patients with atrial fibrillation who have had a coronary stent is unclear. It is well recognised that “triple therapy” with aspirin, clopidogrel, and warfarin is associated with an increased risk of bleeding. National guidelines have not made specific recommendations given the lack of adequate data. In choosing the best antithrombotic options for a patient, consideration needs to be given to the risks of stroke, stent thrombosis and major bleeding. This document describes these risks, provides specific recommendations concerning vascular access, stent choice, concomitant use of proton-pump inhibitors and the use and duration of triple therapy following stent placement based upon the risk assessment.

scholarly journals Discrete choice experiment to evaluate preferences of patients with cystic fibrosis among alternative treatment-related health outcomes: a protocol

BMJ Open ◽  
2019 ◽  
Vol 9 (8) ◽  
pp. e030348
Author(s):  
Charlie McLeod ◽  
Richard Norman ◽  
Andre Schultz ◽  
Steven Mascaro ◽  
Steve Webb ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Discrete Choice Experiment ◽  
Discrete Choice ◽  
Choice Experiment ◽  
Clinical Decision Making ◽  
Treatment Success ◽  
Lung Damage ◽  
Preference Information ◽  
Trade Offs ◽  
Pulmonary Exacerbations

IntroductionClinical decision-making is a complex process. Patient preference information regarding desirable health states should inform treatment and is critical to agreeing on goals of therapy. Cystic fibrosis (CF) is a common, inheritable multisystem disorder for which the major manifestation is progressive, chronic lung disease. Intermittent pulmonary exacerbations are a hallmark of disease and these drive lung damage that results in premature death. We suspect that clinicians make assumptions, most likely implicit assumptions, about outcomes that are desired by patients who are treated for pulmonary exacerbations. The aim of this study is to identify and quantify the preferences of patients with cystic fibrosis regarding treatment outcomes.Methods and analysisWe will develop a discrete choice experiment (DCE) in collaboration with people with CF and their carers, and evaluate how patients make trade-offs between different aspects of health-related status when considering treatment options.Ethics and disseminationEthics approval for all aspects of this study was granted by the Western Australia Child and Adolescent Health Service Human Research Ethics Committee [RGS903]. Weighted preference information from the DCE will be used to develop a multiattribute utility instrument as a measure of treatment success in the upcoming Bayesian Evidence-Adaptive Trial to optimise management of CF. Dissemination of results will also occur through peer-reviewed publications and presentations to relevant stakeholders and research networks.

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