Purpose: Despite improvements in availability of effective treatments in primary care, older primary care patients are often reluctant to initiate depression treatment. One reason for this reluctance may relate to discordance between patients and physicians with respect to assumptions about what various treatments involve. In this study we looked for patterns of depression treatment preferences using two different messaging frames: a treatment-centered and a patient-centered frame.
Method: 246 patients aged 55 and older were recruited from urban primary care practices. Conjoint analysis was used to assess patients’ relative preferences for various characteristics of depression treatment. Participants completed two conjoint analysis assessments. One assessment used a treatment-centered frame to describe treatment (comparing mechanism of action, side effects and time to effect) while the other used a patient-centered frame (comparing treatments based on whether or not the treatment involved self-help, spirituality, interaction with others and integration of mental and physical health). Preference patterns (profiles) were determined using latent profile analysis.
Result: In both the treatment-centered and patient-centered frame, three profiles emerged. The first profile was characterized by patients who were ambivalent about the treatment mechanism and avoidant of sleep and weight gain side-effects; the second profile consisted of patients who preferred “talking about problems" and the third profile consisted of patients who prefered “natural” treatments. The natural profile was significantly more likely to be depressed and more likely to have sought treatment in the past. In the patient-centered frame, the three profiles consisted of patients who preferred self-help and interaction; patients who avoided spiritual treatment; and patients who prefered integrated mental and physical health treatments.
Conclusion: Our findings suggest that combining conjoint analysis and latent profile analysis is a useful method for identifying common preference patterns and patient profiles, based on relative preferences for teratment characteristics. Furthermore, the frame used in describing the treatment characteristics in a conjoint task may help identify important subgroups. Next steps will involve assessing whether treatment centered or patient centered treatment profiles are predictive of treatment choice and treatment initiation.
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