PATIENT PREFERENCES FOR CANCER TREATMENT: A SCOPING REVIEW

Purpose: Understanding patient preferences are increasingly important for evaluation and medical-decision making. We sought to identify the literature, methods and measures currently used to assess preferences for cancer care (screening, treatment, palliative care) in the US.

Method: Using a scoping-review methodology, the PubMed, EMBASE, CINHAL, Scopus, PsycINFO, and EconLit databases were searched for studies examining patient preferences for cancer treatments published between January 2000 and March 2013. Studies were excluded if participants did not have cancer, or no primary preference information was collected. Two investigators independently reviewed titles, abstracts, and articles sequentially to select studies for data abstraction based on inclusion and exclusion criteria. Disagreements were resolved by consensus. Data on study year, number of respondents, preference elicitation method, number of attributes, and subgroup analyses were abstracted. In the absence of guidelines for assessing data quality and validity across different types of preference studies, risk of bias was assessed based on clear reporting of study objectives, preference assessment methods, whether respondents differed from non-respondents on key characteristics, whether all respondents were included in the analysis, and whether significance tests were used.

Result: Thirty-four of the 6999 citations met the inclusion criteria. The studies used qualitative interviews (n=19), conjoint analysis (n=5), time trade-off (n=7), and standard gamble (n=3) as stated preference methods.  Most studies conducted addressed treatment as the main outcome (n=18).  The remaining studies focused on screening for cancer (n=10) and palliative care (n=6).  Breast and colorectal cancer were the most prevalent diseases studied.  Two-thirds of studies were qualitatively adequate as defined by the study group criteria.  Most studies gave patients adequate information to make informed survey decisions. Overall, there was an increase in the annual rate of studies published over time.

Conclusion: This is the first systematic evaluation of the research into patient preferences for cancer treatments in the US and serves as a primary source of information for decision makers. Evidence quality of studies is moderate at best. The Patient Protection and Affordable Care Act supports patient preferences in medical decision-making and evaluation of patient centered outcomes. Future work is necessary to assess the applications of the results of preference studies and to develop best-practice guidelines for the reporting and conduct of preference studies and systematic reviews of such studies.