title: Patient-centered Treatment Decisions for Urethral Stricture: Conjoint Analysis Improves Surgical Decision-making.
abstract: OBJECTIVE
  To determine whether the use of a choice-based conjoint analysis (CA) exercise decreased patients' decisional conflict about treatment preferences for surgical management of urethral stricture disease. Understanding patient preferences for treatment decisions assists in shared decision-making and emphasizes patient-centered outcomes. CA offers a method to understand what risks patients are willing to take for what gains.
  
  
  METHODS
  The CA methodology was used by providing participants with case-based choices to elucidate the relative importance that individuals place on various treatment aspects. Patients' decisional conflict regarding surgery for urethral stricture was assessed before and after the CA exercise to assess the impact the exercise had on their decisional conflict.
  
  
  RESULTS
  Completion of the CA exercise resulted in a significant decrease in decisional conflict (P < .001). The majority (59.5%) of participants with decisional conflict before the CA exercise experienced a decrease in decisional conflict afterwards, with only a minority (16.5%) experiencing new decisional conflict after the exercise. Participants felt the choice-based CA exercise was helpful in deciding what was important in making treatment decisions (70%) and in expressing their priorities and treatment preferences (82%). The number needed to counsel to achieve a decrease in decisional conflict was 1.69 and to achieve no decisional conflict was 3.65.
  
  
  CONCLUSIONS
  Choice-based CA improves patients' ability to express their treatment preferences and decreases decisional conflict. CA may be a new tool that physicians and patients can use to aid in shared decision-making with a focus on patient-centered outcomes.
authors.affiliation: Philip R. Lee Institute for Health Policy Studies, Department of Urology, UCSF School of Medicine, San Francisco, CA. Electronic address: Lindsay.Hampson@ucsf.edu.
authors.forename: Lindsay A
authors.initials: LA
authors.lastname: Hampson
authors.affiliation: Department of Epidemiology & Biostatistics, UCSF School of Medicine, San Francisco, CA.
authors.forename: Isabel E
authors.initials: IE
authors.lastname: Allen
authors.affiliation: UCSF School of Medicine, San Francisco, CA.
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Gaither
authors.affiliation: Department of Clinical Pharmacy, UCSF School of Pharmacy, San Francisco, CA.
authors.forename: Tracy
authors.initials: T
authors.lastname: Lin
authors.affiliation: Department of Clinical Pharmacy, UCSF School of Pharmacy, San Francisco, CA.
authors.forename: Jie
authors.initials: J
authors.lastname: Ting
authors.affiliation: Department of Urology, UCSF School of Medicine, San Francisco, CA.
authors.forename: E Charles
authors.initials: EC
authors.lastname: Osterberg
authors.affiliation: Department of Clinical Pharmacy, UCSF School of Pharmacy, San Francisco, CA.
authors.forename: Leslie
authors.initials: L
authors.lastname: Wilson
authors.affiliation: Department of Urology, UCSF School of Medicine, San Francisco, CA.
authors.forename: Benjamin N
authors.initials: BN
authors.lastname: Breyer
mesh_terms: D000066491:Clinical Decision-Making / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010358:Patient Participation / Q000706:statistics & numerical data*; D018802:Patient-Centered Care / Q000592:standards*; D011795:Surveys and Questionnaires; D014525:Urethral Stricture / Q000601:surgery*; D013521:Urologic Surgical Procedures, Male