Measuring preferences for analgesic treatment for cancer pain: How do African-Americans and Whites perform on choice-based conjoint (CBC) analysis experiments?

BMC Medical Informatics and Decision Making

Research Article

Salimah H Meghani¹  Joseph Curry²  Jesse Chittams³  Alexandra L Hanlon³ 

[1] Department of Biobehavioral Health Sciences, NewCourtland Center for Transitions & Health, University of Pennsylvania School of Nursing, Claire M. Fagin Hall, 418 Curie Boulevard, Room 337, 19104-4217, Philadelphia, PA, USA;Sawtooth Technologies, Inc, 1500 Skokie Boulevard, 60062, Northbrook, IL, USA;University of Pennsylvania School of Nursing, 418 Curie Blvd. Room 492, 19104, Philadelphia, PA, USA;

关键词: Cancer Pain;    Conjoint Analysis;    Mean Absolute Error;    Preference Weight;    Analgesic Treatment;   

DOI  :  10.1186/1472-6947-13-118

 received in 2012-12-17, accepted in 2013-10-10,  发布年份 2013

来源: Springer

【 摘 要 】

BackgroundConjoint Analysis (CA) can serve as an important tool to study health disparities and unique factors underlying decision-making in diverse subgroups. However, methodological advancements are needed in exploiting this application of CA. We compared the internal and external predictive validity and inter-temporal stability of Choice-based-Conjoint (CBC) analysis between African-Americans and Whites in the clinical context of preferences for analgesic treatment for cancer pain.MethodsWe conducted a prospective study with repeated-measures at two time-points (T1 = baseline; T2 = 3-months). African-Americans (n = 102); and Whites (n = 139) with cancer-related pain were recruited from outpatient oncology clinics in Philadelphia. Informed by pilot work, a computer-assisted CBC experiment was developed using 5 attributes of analgesic treatment: type of analgesic; expected pain relief; type of side-effects; severity of side-effects; and out-of-pocket cost. The design included 2 choice alternatives, 12 random tasks, 2 holdout tasks, and maximum of 6 levels per attribute. The internal and external predictive validity of CBC was estimated using Root Likelihood (RLH) and Mean Absolute Error (MAE), respectively. Inter-temporal stability was assessed using Cohen’s kappa.ResultsWhites predominantly traded based on “pain relief” whereas African-Americans traded based on “type of side-effects”. At both time-points, the internal validity (RLH) was slightly higher for Whites than for African-Americans. The RLH for African-Americans improved at T2, possibly due to the learning effect. Lexicographic (dominant) behavior was observed in 29% of choice datasets; Whites were more likely than African-Americans to engage in a lexicographic behavior (60% vs. 40%). External validity (MAE) was slightly better for African-Americans than for Whites at both time-points (MAE: T1 = 3.04% for African-Americans and 4.02% for Whites; T2 = 8.04% for African-Americans; 10.24% for Whites). At T2, the MAE increased for both groups possibly reflecting an increase in the complexity of pain treatment decision-making based on expectations (T1) as opposed to reality (T2). The inter-temporal stability was fair for CBC attributes between T1 and T2 (kappa = 0.28, 95% CI: 0.24-0.32) and was not predicted by demographics including race.ConclusionsWhile we found slight group differences, overall the internal and external predictive validity of CBC was comparable between African-Americans and Whites. We discuss some areas to investigate and improve internal and external predictive validity of CBC experiments.

【 授权许可】

CC BY   
© Meghani et al.; licensee BioMed Central Ltd. 2013