title: The effect of information on preferences for treatments of metastatic renal cell carcinoma.
abstract: Limited information exists regarding the effect of uncertainty in outcomes on patient preferences for metastatic renal cell carcinoma (mRCC) treatments. This study tested the effect on patients' preferences and willingness to tolerate toxicities when patients were provided with information about possible correlations between treatment-related toxicities and efficacy.
  
  
  
  Patients with self-reported RCC diagnosis completed an online survey. Respondents were randomly assigned to the information treatment (i.e. information about the possible correlation). Medicines were defined by progression-free survival (PFS), three toxicities potentially correlated with PFS, and one toxicity uncorrelated with PFS. Direct-elicitation questions measured willingness to tolerate the toxicities, preferences for medicines with higher toxicity but a higher chance of longer PFS, and preferences for medicines with higher toxicity during treatment and a 2 week dosing schedule break. A discrete-choice experiment (DCE) tested the effect of information on relative preferences for medication attributes.
  
  
  
  A total of 378 RCC patients completed the survey. Respondents who received the information reported greater willingness to accept more severe toxicities and preferred treatment with a higher chance of longer PFS but more severe toxicities. The DCE results were consistent with the hypothesis that the information increased willingness to tolerate toxicities; however, the results were only statistically significant for changes in fatigue (none to severe; p < 0.05) and hypertension (none to manageable; p < 0.05).
  
  
  
  Online recruitment through patient support groups may limit generalizability to the population of patients with mRCC who would be candidates for the targeted therapies.
  
  
  
  The findings suggest that RCC patients have diverse preferences but may be willing to continue targeted therapies, even in the presence of severe toxicities, if there is a chance of improved clinical benefit. Physicians should provide patients with comprehensive information about medication features, including toxicities and efficacy (and their potential correlation), to improve compliance and optimize outcomes.
authors.affiliation: a RTI Health Solutions , Research Triangle Park , NC , USA.
authors.forename: Carol
authors.initials: C
authors.lastname: Mansfield
authors.affiliation: b Stanford University Medical Center , Stanford , CA , USA.
authors.forename: Sandy
authors.initials: S
authors.lastname: Srinivas
authors.affiliation: c Pfizer Oncology , New York , NY , USA.
authors.forename: Connie
authors.initials: C
authors.lastname: Chen
authors.affiliation: a RTI Health Solutions , Research Triangle Park , NC , USA.
authors.forename: A Brett
authors.initials: AB
authors.lastname: Hauber
authors.affiliation: c Pfizer Oncology , New York , NY , USA.
authors.forename: Subramanian
authors.initials: S
authors.lastname: Hariharan
authors.affiliation: c Pfizer Oncology , New York , NY , USA.
authors.forename: Ewa
authors.initials: E
authors.lastname: Matczak
authors.affiliation: d Pfizer , Sollentuna , Sweden.
authors.forename: Rickard
authors.initials: R
authors.lastname: Sandin
mesh_terms: D002292:Carcinoma, Renal Cell / Q000188:drug therapy* / Q000401:mortality / Q000556:secondary; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D008297:Male; D008875:Middle Aged; D057240:Patient Preference; D011795:Surveys and Questionnaires
keywords: Conjoint analysis; Patient preference; Renal cell carcinoma; Uncertainty