Candidate for the Lee B. Lusted Student Prize Competition
Treatment adherence for attention deficit hyperactivity disorder (ADHD), a highly prevalent and chronic childhood mental illness, is suboptimal despite the availability of many evidence-based treatments. This patient-centered research on preference elicitation for treatment options that are most valued by caregivers of children with ADHD will generate new information that could potentially inform better treatment planning and shared decision-making to improve adherence.
Method:
A discrete choice experiment survey of caregiver preferences for treatment attributes and delivery options for their child’s ADHD was conducted. The seven treatment attributes assessed included medication administration frequency, child therapy location, school coordination, parent training, provider communication, provider specialty, and monthly cost of care. Each attribute has three levels of variation in delivery. The survey uses a Best Worse Scaling design with 18 different profiles from which participants selected one best and one worst option for each profile. Preferences, measured as the utility of the treatment attribute and calculated as the proportion of ‘best minus worst’ selections, ranged from values of 0 (least desirable) to 1 (most desirable). The difference between the highest and lowest utility for each attribute level was calculated. The greater the variation across attribute levels, the greater the relative importance of that attribute overall.
Result:
Fifty caregivers (mean age: 44, 94% females, 35% White and 58% African American) who had a child aged 4 – 14 and currently in care for ADHD were recruited from January to May 2013. Treatment attributes where all levels were associated with positive utilities included: location of child therapy (range: 0.108 – 0.288; p<0.0001), coordination with school (range: 0.090 – 0.284; p<0.0001), and care management professional (range: 0.032 – 0.211). Out-of-pocket cost was associated with a negative utility (range: -0.405 – -0.613; p<0.0001) across all levels. Parent behavior management training (23%) followed by medication frequency (19%) accounted for the treatment attributes with the maximum difference in preferences, and thus the delivery options for these attributes had the most influence on caregivers’ decision.
Conclusion:
This preliminary research suggests that preferences for evidence-based treatment modalities vary substantially depending upon how it is delivered in clinical practice. Knowledge of how variation in the delivery of treatment influences caregivers’ preferences for desirable versus undesirable treatment highlights the importance of careful, individualized treatment planning and shared decision-making.