Discrete choice experiment produced estimates of acceptable risks of therapeutic options in cancer patients with febrile neutropenia

J Clin Epidemiol. 2012 Jun;65(6):627-34. doi: 10.1016/j.jclinepi.2011.11.008. Epub 2012 Mar 15.

Abstract

Objective: To use a discrete choice experiment (DCE) to describe patient/proxy tolerance for the number of clinic visits, and chances of readmission, intensive care unit admission, and mortality to accept oral outpatient management of low-risk febrile neutropenia.

Study design and setting: Adults and children aged 12-18 years with cancer and parents of pediatric cancer patients were asked to choose between outpatient oral and inpatient intravenous management of low-risk febrile neutropenia. Using a DCE, we varied the attribute levels with the outpatient option and kept them constant for the inpatient option.

Results: Seventy-eight adults, 153 parents, and 43 children provided responses. All four attributes significantly affected choices. The mean tolerance (95% confidence interval) for the number of clinic visits per week was 3.6 (2.2-4.8), 2.1 (1.1-3.2), and 4.3 (2.5-6.0) to accept outpatient management among adults, parents, and children, respectively. With thrice weekly clinic visits and 7.5% chance of readmission, probabilities of accepting the outpatient strategy were 50% (44-54%) for adults, 43% (39-48%) for parents, and 53% (46-59%) for children.

Conclusion: Using a DCE, we determined that a 7.5% chance of readmission and clinic visits more frequently than thrice weekly are unlikely to be acceptable.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Oral
  • Adolescent
  • Adult
  • Aged
  • Algorithms
  • Ambulatory Care* / statistics & numerical data
  • Anti-Bacterial Agents / administration & dosage*
  • Antineoplastic Agents / administration & dosage
  • Antineoplastic Agents / adverse effects*
  • Child
  • Choice Behavior*
  • Female
  • Fever / drug therapy*
  • Follow-Up Studies
  • Humans
  • Infusions, Parenteral
  • Inpatients* / statistics & numerical data
  • Male
  • Middle Aged
  • Neoplasms / drug therapy*
  • Neoplasms / mortality
  • Neutropenia / chemically induced
  • Neutropenia / drug therapy*
  • Neutropenia / mortality
  • Ontario / epidemiology
  • Parents / psychology
  • Patient Preference / psychology
  • Retrospective Studies
  • Risk Assessment
  • Surveys and Questionnaires

Substances

  • Anti-Bacterial Agents
  • Antineoplastic Agents