title: Patient Preferences for Pain Management in Advanced Cancer: Results from a Discrete Choice Experiment.
abstract: BACKGROUND
  Pain from advanced cancer remains prevalent, severe and often under-treated.
  
  
  OBJECTIVE
  The aim of this study was to conduct a discrete choice experiment with patients to understand their preferences for pain management services and inform service development.
  
  
  METHODS
  Focus groups were used to develop the attributes and levels of the discrete choice experiment. The attributes were: waiting time, type of healthcare professional, out-of-pocket costs, side-effect control, quality of communication, quality of information and pain control. Patients completed the discrete choice experiment along with clinical and health-related quality of life questions. Conditional and mixed logit models were used to analyse the data.
  
  
  RESULTS
  Patients with cancer pain (n = 221) and within palliative care services completed the survey (45% were female, mean age 64.6 years; age range 21-92 years). The most important aspects of pain management were: good pain control, zero out-of-pocket costs and good side-effect control. Poor or moderate pain control and £30 costs drew the highest negative preferences. Respondents preferred control of side effects and provision of better information and communication, over access to certain healthcare professionals. Those with lower health-related quality of life were less willing to wait for treatment and willing to incur higher costs. The presence of a carer influenced preferences.
  
  
  CONCLUSIONS
  Outcome attributes were more important than process attributes but the latter were still valued. Thus, supporting self-management, for example by providing better information on pain may be a worthwhile endeavour. However, service provision may need to account for individual characteristics given the heterogeneity in preferences.
authors.affiliation: Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Charles Thackrah Building, 101 Clarendon Road, Leeds, UK. D.Meads@leeds.ac.uk.
authors.forename: David M
authors.initials: DM
authors.lastname: Meads
authors.affiliation: Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Charles Thackrah Building, 101 Clarendon Road, Leeds, UK.
authors.forename: John L
authors.initials: JL
authors.lastname: O'Dwyer
authors.affiliation: Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Charles Thackrah Building, 101 Clarendon Road, Leeds, UK.
authors.forename: Claire T
authors.initials: CT
authors.lastname: Hulme
authors.affiliation: Leeds University Business School and Leeds Institute for Data Analytics, University of Leeds, Leeds, UK.
authors.forename: Phani
authors.initials: P
authors.lastname: Chintakayala
authors.affiliation: Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Charles Thackrah Building, 101 Clarendon Road, Leeds, UK.|School of Dentistry, University of Leeds, Leeds, UK.
authors.forename: Karen
authors.initials: K
authors.lastname: Vinall-Collier
authors.affiliation: Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.
authors.forename: Michael I
authors.initials: MI
authors.lastname: Bennett
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000072716:Cancer Pain / Q000628:therapy*; D002755:Choice Behavior; D003142:Communication; D003661:Decision Support Techniques; D005260:Female; D017144:Focus Groups; D005102:Health Expenditures; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D059408:Pain Management / Q000379:methods*; D010166:Palliative Care / Q000379:methods*; D010353:Patient Education as Topic; D057240:Patient Preference / Q000523:psychology*; D011369:Professional-Patient Relations; D011788:Quality of Life; D013997:Time Factors; D055815:Young Adult
keywords: Cancer Pain; Discrete Choice Experiment; Pain Control; Pain Management; Palliative Care Service