Patient Preferences for Lung Cancer Treatments: A Study Protocol for a Preference Survey Using Discrete Choice Experiment and Swing Weighting

Abstract

Background: Advanced treatment options for non-small cell lung cancer (NSCLC) consist of immunotherapy, chemotherapy, or a combination of both. Decisions surrounding NSCLC can be considered as preference-sensitive because multiple treatments exist that vary in terms of mode of administration, treatment schedules, and benefit–risk profiles. As part of the IMI PREFER project, we developed a protocol for an online preference survey for NSCLC patients exploring differences in preferences according to patient characteristics (preference heterogeneity). Moreover, this study will evaluate and compare the use of two different preference elicitation methods, the discrete choice experiment (DCE) and the swing weighting (SW) task. Finally, the study explores how demographic (i.e., age, gender, and educational level) and clinical (i.e., cancer stage and line of treatment) information, health literacy, health locus of control, and quality of life may influence or explain patient preferences and the usefulness of a digital interactive tool in providing information on preference elicitation tasks according to patients.Methods: An online survey will be implemented with the aim to recruit 510 NSCLC patients in Belgium and Italy. Participants will be randomized 50:50 to first receive either the DCE or the SW. The survey will also collect information on participants' disease-related status, health locus of control, health literacy, quality of life, and perception of the educational tool.Discussion: This protocol outlines methodological and practical steps to quantitatively elicit and study patient preferences for NSCLC treatment alternatives. Results from this study will increase the understanding of which treatment aspects are most valued by NSCLC patients to inform decision-making in drug development, regulatory approval, and reimbursement. Methodologically, the comparison between the DCE and the SW task will be valuable to gain information on how these preference methods perform against each other in eliciting patient preferences. Overall, this protocol may assist researchers, drug developers, and decision-makers in designing quantitative patient preferences into decision-making along the medical product life cycle.

Comparing Discrete Choice Experiment with Swing Weighting to Estimate Attribute Relative Importance: A Case Study in Lung Cancer Patient Preferences

“…Details on the study design have been published elsewhere. 39 , 40 This case study was identified as suitable for the comparison of DCE and SW-DR due to the potentially fragile physical state or diminished cognitive status of the patients. 41 – 44 The current study included DCE and SW exercises in the ways these methods typically would be applied to answer a particular clinical research question.…”

“…Respondents were selected and referred to the PREFER research team by the treating oncologists at cancer treatment centers in Belgium and in Italy. 40 To be eligible, patients had to understand Italian or Dutch, be 18 y or older, and have a histologic or cytologic diagnosis of NSCLC as evaluated by clinicians. Patients were not eligible if they (as evaluated by the clinician): 1) had cognitive impairments rendering the participant incapable of informed consent or 2) were unable to understand the study materials.…”

Balancing benefits and risks in lung cancer therapies: patient preferences for lung cancer treatment alternatives

“…Participants were selected and referred to the PREFER research team by the treating oncologists at the Thoracic Oncology Division of the European Institute of Oncology and the National Cancer Institute in Milan, and at the Respiratory Oncology Department of the KU Leuven University Hospital in Leuven. Patients were eligible if they were stage I to IV NSCLC patients, over 18 years of age, and able to read and speak Italian or Dutch ( Monzani et al, 2021 ). Patients were approached via phone or in the hospital waiting room before a visit, and if they agreed to participate, they received the information sheet and a consent form by email.…”

Opportunities and Challenges of Web-Based and Remotely Administered Surveys for Patient Preference Studies in a Vulnerable Population

“…This case study involved a large cohort of patients with NSCLC at stages from I to IV recruited from three cancer treatment centers across Italy and Belgium. 8 The clinical aim of this case study was to assess how patients trade-off benefits and risks related to treatment alternatives, by using both discrete choice experiment (DCE) and swing weighting (SW) methods. DCE asks respondents to make choices among sets of profiles in a series of choice questions, with different levels of benefits and risks associated with the choices.…”

“…Due to the SARS-CoV-2 pandemic, the original protocol of the PREFER lung cancer quantitative case study 8 had to be modified. Originally, the protocol specified that eligible NSCLC participants could be contacted either by phone or approached in the waiting room either before or after a medical visit, at which point the researcher would introduce the study.…”