title: Eliciting patients' preferences for epilepsy diagnostics: a discrete choice experiment.
abstract: BACKGROUND
  Diagnosing epilepsy is a lengthy and burdensome process for patients and their family. Although the need for a more patient-centered approach in clinical practice is widely acknowledged, empirical evidence regarding patient preferences for diagnostic modalities in epilepsy is missing. The objectives of this study were 1) to identify to what extent important attributes of diagnostic procedures in epilepsy affect preferences for a procedure, 2) to determine the relative importance of these attributes, and 3) to calculate overall utility scores for routine electroencephalography (EEG) and magnetoencephalography (MEG) recordings.
  
  
  METHODS
  A discrete choice experiment was performed to determine patients' preferences, which involved presentation of pairwise choice tasks regarding hypothetical scenarios. Scenarios varied along six attributes: "way of measuring brain activity", "duration", "freedom of movement", "travel time", "type of additional examination", and "chance of additional examination". Choice tasks were constructed using a statistically efficient design, and the questionnaire contained 15 unique unlabeled choice tasks. Mixed multinomial logistic regression was used to estimate patients' preferences.
  
  
  RESULTS
  A total of 289 questionnaires were included in the analysis. McFadden's pseudo R(2) showed a model fit of 0.28, and all attributes were statistically significant. Heterogeneity in preferences was present for all attributes. "Freedom of movement" and "Chance of additional examination" were perceived as the most important attributes. Overall utility scores did not substantially differ between routine EEG and MEG.
  
  
  CONCLUSIONS
  This study suggests that the identified attributes are important in determining patients' preference for epilepsy diagnostics. It can be concluded that MEG is not necessarily more patient-friendly than a routine EEG in primary diagnostics and, regarding additional diagnostics, patients have a strong preference for long-term 24-h EEG over EEG after sleep deprivation. Furthermore, barring substantial heterogeneity within the parameters in mind, our study suggests that it is important to take individual preferences into account in medical decision-making.
authors.affiliation: CAPHRI, Research School for Public Health and Primary Care, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands; Department of Health Services Research, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands; Department of Research & Development, Epilepsy Centre Kempenhaeghe, PO Box 61, 5590 AB Heeze, The Netherlands. Electronic address: bfm.wijnen@student.maastrichtuniversity.nl.
authors.forename: B F M
authors.initials: BF
authors.lastname: Wijnen
authors.affiliation: CAPHRI, Research School for Public Health and Primary Care, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands; Department of Health Services Research, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands; Department of Research & Development, Epilepsy Centre Kempenhaeghe, PO Box 61, 5590 AB Heeze, The Netherlands. Electronic address: reina.dekinderen@maastrichtuniversity.nl.
authors.forename: R J A
authors.initials: RJ
authors.lastname: de Kinderen
authors.affiliation: Department of Clinical Neurophysiology, Epilepsy Centre Kempenhaeghe, PO Box 61, 5590 AB Heeze, The Netherlands; Department of Neurology, Epilepsy Centre Kempenhaeghe, PO Box 61, 5590 AB Heeze, The Netherlands. Electronic address: colona@kempenhaeghe.nl.
authors.forename: A J
authors.initials: AJ
authors.lastname: Colon
authors.affiliation: CAPHRI, Research School for Public Health and Primary Care, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands; Department of Clinical Epidemiology and Medical Technology Assessment, University Hospital Maastricht, PO Box 5800, 6202 AZ Maastricht, The Netherlands. Electronic address: c.dirksen@mumc.nl.
authors.forename: C D
authors.initials: CD
authors.lastname: Dirksen
authors.affiliation: Department of Clinical Epidemiology and Medical Technology Assessment, University Hospital Maastricht, PO Box 5800, 6202 AZ Maastricht, The Netherlands. Electronic address: Brigitte.essers@mumc.nl.
authors.forename: B A B
authors.initials: BA
authors.lastname: Essers
authors.affiliation: CAPHRI, Research School for Public Health and Primary Care, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands; Department of Health Services Research, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands. Electronic address: m.hiligsmann@maastrichtuniversity.nl.
authors.forename: M
authors.initials: M
authors.lastname: Hiligsmann
authors.affiliation: Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Centre Utrecht, 3584 CG Utrecht, The Netherlands. Electronic address: f.s.s.leijten@umcutrecht.nl.
authors.forename: F S S
authors.initials: FS
authors.lastname: Leijten
authors.affiliation: Department of Neurology, Epilepsy Centre Kempenhaeghe, PO Box 61, 5590 AB Heeze, The Netherlands. Electronic address: ossenblokp@kempenhaeghe.nl.
authors.forename: P P W
authors.initials: PP
authors.lastname: Ossenblok
authors.affiliation: CAPHRI, Research School for Public Health and Primary Care, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands; Department of Health Services Research, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands. Electronic address: s.evers@maastrichtuniversity.nl.
authors.forename: S M A A
authors.initials: SM
authors.lastname: Evers
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002755:Choice Behavior / Q000502:physiology*; D004569:Electroencephalography; D004827:Epilepsy / Q000175:diagnosis* / Q000523:psychology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D015225:Magnetoencephalography; D008297:Male; D008875:Middle Aged; D057240:Patient Preference; D011795:Surveys and Questionnaires; D013997:Time Factors; D055815:Young Adult
keywords: Diagnostics; Discrete choice experiment; Electroencephalography; Epilepsy; Magnetoencephalography; Preferences