FACTORS INFLUENCING PHYSICIANS' THERAPEUTIC DECISION WHEN PRESCRIBING CHEMOTHERAPY: A DISCRETE CHOICE EXPERIMENT

Purpose:  Despite guidelines on cancer management, the increasing availability of targeted therapies has deeply challenged classical patterns of cancer treatment. Our objective was to analyze the relative influence of efficacy, tolerability, adherence and route of chemotherapy administration on medical decision-making.

Method: A Discrete Choice Experiment was performed among 203 French physicians involved in cancer treatment (i.e oncologists, haematologists and physicians qualified in oncology). In a questionnaire of six scenarios, respondents were asked to choose between two treatments which differed with respect to four attributes: efficacy, tolerability, adherence and route of administration. Three of those attributes (efficacy, tolerability and adherence) had two modalities (good vs. moderate) and the later (route of administration) had three modalities (intravenous, oral and oral with a patient support program). To analyze the effect of the therapeutic goal on physicians’ preferences, the six scenarios were first presented for curative setting then for palliative setting. The attributes presented in the questionnaire were drawn from a literature review submitted to expert opinion. The effects of each attribute on physicians’ preferences were analyzed using conditional logistic regression models. 

Result: The efficacy attribute was the predominant criteria in choosing a chemotherapy treatment either in curative setting (moderate vs. good: β=-2.1145, p <0.0001) or in palliative setting (moderate vs. good: β=-1.0628, p <0.0001). The route of administration had a positive effect in palliative setting, for which physicians preferred the oral route (β=0.6125, p<.0.003) particularly in the haematologists group. Removing the efficacy attribute of the model, we found that tolerability (moderate vs. good: β=-1.2277, p<0.0001) and adherence had also significant effects on decision (moderate vs. good: β=-1.2228, p<0.0001) but only for curative treatment, and that the oral route with a patient support program remained decisive in palliative setting (β=0.431, p<0.0001).

Conclusion: Our results highlights a consensus on the priority of the efficacy attribute reflecting a good compliance of physicians to guidelines. On condition of equivalent efficacy between two treatments, the oral route of administration was the only criteria considered in palliative setting. This is consistent with the priority to maintain patient’s quality of life by staying at home at the advanced-stage of disease. Financial disclosure: Funding for the study was provided by GlaxoSmithKline and had no influence on the study design, execution and publication of results.