title: Probabilistic threshold technique showed that patients' preferences for specific trade-offs between pain relief and each side effect of treatment in osteoarthritis varied.
abstract: OBJECTIVE
  Therapeutic decisions in osteoarthritis (OA) often involve trade-offs between accepting risks of side effects and gaining pain relief. Our objectives were (1) to determine patients' maximum acceptable risk increments (MARI) for different adverse effects from OA medication and (2) to identify the predictors of these preferences.
  
  
  METHODS
  MARI were measured with a probabilistic threshold technique (TT). Risk and pain levels in the TT scenarios were controlled for in a 2x2 randomized factorial design. Clinical, sociodemographic, and psychological characteristics (decisional conflict and locus of control) of the participants were assessed using a self-administered questionnaire.
  
  
  RESULTS
  For 196 subjects, MARI varied by type of adverse effect, level of pain relief, and baseline risk. Mean MARI ranged from 3% to 5% for heart attack/stroke, 5% to 8% for stomach bleed, 13% to 21% for hypertension, 22% to 33% for fluid retention, and 23% to 35% for dyspepsia. Age, gender, education, physical and mental health, pain, disability, and locus of control were not associated with MARI.
  
  
  CONCLUSIONS
  Participants varied widely in the level of risk they would accept, but their clinical, sociodemographic, and psychological characteristics did not explain this variation. These observations are important for the development of practice guidelines for physicians and patients' decision aids that can foster individualized, evidence-based yet preference-sensitive care for patients with OA.
authors: Department of Health Care and Epidemiology, University of British Columbia, Vancouver, BC, Canada. jkopec@arthritisresearch.ca
authors: Jacek A
authors: JA
authors: Kopec
authors: Chris G
authors: CG
authors: Richardson
authors: Hilary
authors: H
authors: Llewellyn-Thomas
authors: Alice
authors: A
authors: Klinkhoff
authors: Anne
authors: A
authors: Carswell
authors: Andrew
authors: A
authors: Chalmers
mesh_terms: D000368:Aged; D000700:Analgesics / Q000009:adverse effects* / Q000627:therapeutic use; D004415:Dyspepsia / Q000139:chemically induced / Q000523:psychology; D005163:Factor Analysis, Statistical; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced / Q000523:psychology; D006801:Humans; D006973:Hypertension / Q000139:chemically induced / Q000523:psychology; D007389:Internal-External Control; D007674:Kidney Diseases / Q000139:chemically induced / Q000523:psychology; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000188:drug therapy / Q000523:psychology*; D017288:Pain Threshold; D017060:Patient Satisfaction; D011336:Probability; D012044:Regression Analysis; D018570:Risk Assessment; D020521:Stroke / Q000139:chemically induced / Q000523:psychology; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D000700:Analgesics