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Purpose: Evidence on treatment preferences of patients with moderate-to-severe atopic dermatitis (AD) in the United States (US) is limited and an assessment of treatment preferences in this group is warranted. Materials and methods: An online discrete choice experiment survey was conducted (June 2023) among US adults with self-reported moderate-to-severe AD or experience with systemic therapy who had inadequate response to topical treatments. Preference weights estimated from conditional logistic regression models were used to calculate willingness to trade off and attributes’ relative importance (RI). Results: Participants (N=300; mean age: 45years; 70% females; 52% systemic therapy experienced) preferred treatments with higher efficacy, lower risk of adverse events (AEs), and less frequent blood tests (p<.05). Treatment attributes, from high to low RI, were itch control (38%), risk of cancer (23%), risk of respiratory infections (18%), risk of heart problems (11%), sustained improvement in skin appearance (5%), blood test frequency (3%), and frequency and mode of administration (2%); together, AE attributes accounted for more than half of the RI. Conclusions: Participants preferred AD treatments that maximize itch control while minimizing AE risks, whereas mode of administration had little impact on preferences. Understanding patients’ preferences may help improve shared decision-making, potentially leading to enhanced patient satisfaction with treatment, increased engagement, and better clinical outcomes. [ABSTRACT FROM AUTHOR]

Background: When people are ill, the options for health-seeking behavior are shaped by several factors. Understanding these options is likely to contribute to early treatment and better outcomes. The objective of this study was to investigate the utilization and preferred places for treating common health problems in Lagos, Nigeria. Methods: A cross-sectional survey was conducted using both an interviewer administered questionnaire and focus group discussions to obtain data. Participants were recruited through multi- stage sampling methods from four local government areas in Lagos State. Conditions of interest included fever in children, cough, diarrhoea and vomiting and pregnancy care. The Statistical Package for Social Sciences (SPSS) version 22 software was used for analysis while the qualitative data was analyzed with ATLAS.ti software version 7. The level of significance was set at p < 0.05 Results: Two thousand participants were recruited. The mean age was 37.6±10.21years. Government hospitals were the most frequent usual source of health care (41%). Perceived effectiveness of treatment, speed of service and low cost were main reasons for these choices. Other sources of care such as drug store, nursing homes and trado-medical facilities were preferred more frequently by more than a third of respondents for most conditions except for pregnancy care. Primary Health Care centers were the least preferred sources of care. Conclusion: Primary Health Care centres were the least utilized sources of care. Increased advocacy is a recommended strategy to improve early presentation to health facilities.

Abstract Background Informal care plays an essential role in managing the COVID-19 pandemic. Expanding health insurance packages that reimburse caregivers' services through cost-sharing policies could increase financial resources. Predicting payers' willingness to contribute financially accurately is essential for implementing such a policy. This study aimed to identify the key variables related to WTP/WTA of COVID-19 patients for informal care in Sanandaj city, Iran. Methods This cross-sectional study involved 425 COVID-19 patients in Sanandaj city, Iran, and 23 potential risk factors. We compared the performance of three classifiers based on total accuracy, specificity, sensitivity, negative likelihood ratio, and positive likelihood ratio. Results Findings showed that the average total accuracy of all models was over 70%. Random trees had the most incredible total accuracy for both patient WTA and patient WTP(0.95 and 0.92). Also, the most significant specificity (0.93 and 0.94), sensitivity (0.91 and 0.87), and the lowest negative likelihood ratio (0.193 and 0.19) belonged to this model. According to the random tree model, the most critical factor in patient WTA were patient difficulty in personal activities, dependency on the caregiver, number of caregivers, patient employment, and education, caregiver employment and patient hospitalization history. Also, for WTP were history of COVID-19 death of patient's relatives, and patient employment status. Conclusion Implementing of a more flexible work schedule, encouraging employer to support employee to provide informal care, implementing educational programs to increase patients' efficacy, and providing accurate information could lead to increased patients' willingness to contribute and finally promote health outcomes in the population.

Background. This study explored the layperson’s perception of comfort, satisfaction, and willingness to use various accessories in clear aligner therapy. Methods. A total of 267 people analyzed standardized intraoral photographs of a female model in orthodontic treatment using: 1) only clear aligner (CA), the control group; 2) clear aligner+attachments (AT); 3) clear aligners+Cl II elastics (EL); 4) clear aligner+hybrid treatment with esthetic braces (HEB); 5) Clear aligner+hybrid treatment with metallic braces (HMB); 6) clear aligner+mini-implants (MI); 7) clear aligner+mini-implants and elastics for intrusion (MIE). In addition, a social media questionnaire was distributed to assess the willingness to undergo orthodontic treatment with various accessories. Results. There was a significant difference between CA and all the other groups (P

Abstract Colorectal cancer (CRC) is a frequent cause of cancer-related mortality in the Palestinian population. This cross-sectional study was conducted from July 2019 to March 2020 and examined attitudes toward CRC and colonoscopy, as well as the interplay between both. Participants were recruited using convenience sampling from public spaces, governmental hospitals, and primary healthcare centers across 11 governorates in Palestine. Displaying a positive attitude was defined as agreeing on at least the median number of questions related to CRC (5 of 11 questions) or colonoscopy (6 of 10 questions). A total of 4623 participants were included. Most participants agreed that ‘early detection of CRC increases the possibility of more effective treatment’ (n = 4161, 89.7%). Similarly, the majority of participants agreed on ‘preferring a physician with a gender similar to the participants to perform the colonoscopy’ (n = 3738, 80.9%) and ‘willingness to have colonoscopy even if the participant had to pay for it’ (n = 3727, 80.6%). Furthermore, 3115 participants (67.4%) demonstrated positive attitudes toward CRC, while 2540 participants (55.0%) displayed similar attitudes toward colonoscopy. Participants from the West Bank and Jerusalem were more likely than those from the Gaza Strip to display positive attitudes toward colonoscopy (59.2% vs. 48.9%). Participants with positive attitudes toward CRC were more likely to also display positive attitudes toward colonoscopy and vice versa. About two thirds of study participants exhibited positive attitudes toward CRC, and 55.0% displayed positive attitudes toward colonoscopy. There was a reciprocal relationship between having positive attitudes toward CRC and colonoscopy.

Elizabeth H Golembiewski,1 Montserrat Leon-Garcia,1– 3 Derek Loy Gravholt,1 Juan P Brito,1 Erica S Spatz,4 Markus A Bendel,5 Victor M Montori,1 Andrea P Maraboto,1 Sandra A Hartasanchez,1 Ian G Hargraves1 1Knowledge and Evaluation (KER) Unit, Mayo Clinic, Rochester, MN, USA; 2Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain; 3Department of Pediatrics, Obstetrics, Gynaecology and Preventive Medicine, Universidad Autónoma de Barcelona, Barcelona, Spain; 4Division of Cardiovascular Medicine, School of Medicine, Yale University, New Haven, CT, USA; 5Division of Pain Medicine, Mayo Clinic, Rochester, MN, USACorrespondence: Ian G Hargraves, Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA, Email hargraves.ian@mayo.eduPurpose: To compare three methods for identifying patient preferences (MIPPs) at the point of decision-making: analysis of video-recorded patient-clinician encounters, post-encounter interviews, and post-encounter surveys.Patients and Methods: For the decision of whether to use a spinal cord stimulator device (SCS), a video coding scheme, interview guide, and patient survey were iteratively developed with 30 SCS decision-making encounters in a tertiary academic medical center pain clinic. Burke’s grammar of motives was used to classify the attributed source or justification for a potential preference for each preference block. To compare the MIPPs, 13 patients’ encounters with their clinician were video recorded and subsequently analyzed by 4 coders using the final video coding scheme. Six of these patients were interviewed, and 7 surveyed, immediately following their encounters.Results: For videos, an average of 66 (range 33– 106) sets of utterances potentially indicating a patient preference (a preference block), surveys 33 (range 32– 34), and interviews 25 (range 18– 30) were identified. Thirty-eight unique themes (75 subthemes), each a preference topic, were identified from videos, surveys 19 themes (12 subthemes), and interviews 39 themes (54 subthemes). The proportion of preference blocks that were judged as expressing a preference that was clearly important to the patient or affected their decision was highest for interviews (72.8%), surveys (68.0%), and videos (27.0%). Videos mostly attributed preferences to the patient’s situation (scene) (65%); interviews, the act of receiving or living with SCS (43%); surveys, the purpose of SCS (40%).Conclusion: MIPPs vary in the type of preferences identified and the clarity of expressed preferences in their data sets. The choice of which MIPP to use depends on projects’ goals and resources, recognizing that the choice of MIPP may affect which preferences are found.Keywords: patient preferences, decision making, regulatory, preference identification, preference elicitation

David John Mott,1 Jake Hitch,1,2 Samantha Nier,3 Zack Pemberton-Whiteley,3,4 Chris Skedgel1 1Office of Health Economics, London, UK; 2Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK; 3Acute Leukemia Advocates Network, Bern, Switzerland; 4Leukemia Care, Worcester, UKCorrespondence: David John Mott, Email dmott@ohe.orgBackground: Acute leukemia is a cancer of the white blood cells which progresses rapidly and aggressively. There are two types: acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML). The latter has a rare subtype: acute promyelocytic leukemia (APL). For some patients, following first-line treatment, remission is not achieved (“refractory disease”), and for others the leukemia returns after achieving remission (“relapse”). For these individuals, outcomes are typically poor. It is, therefore, important to understand patients’ treatment priorities in this context.Methods: Building upon formative qualitative research, an online survey containing a discrete choice experiment (DCE) was designed to explore patients’ treatment preferences in the relapsed/refractory setting. The DCE attributes were mode of administration; quality of life during treatment; chance of response; duration of response; and quality of life during response. Each respondent completed twelve scenarios containing two hypothetical treatments. Participants were eligible if they lived in the United Kingdom and had a diagnosis of acute leukemia. The data were analysed using a latent class model.Results: A total of 95 patients completed the survey. The latent class analysis identified two classes. For both, chance of response was the most important attribute. For class 1, every attribute was important, whereas for class 2, the only important attributes were quality of life (during treatment and response) and chance of response. A greater proportion of respondents would fall into class 1 overall, and those with ALL or APL and those more recently diagnosed were more likely to be in class 2.Conclusion: Our results indicate that patients are strongly concerned about the chance of response, as well as quality of life (to a lesser extent), when faced with different treatment options in the relapsed/refractory setting. However, there is significant preference heterogeneity within the patient population, and other treatment characteristics also matter to many.Keywords: acute leukemia, hematology, oncology, patient preferences, discrete choice experiment

Abstract Background In response to climate change (CC), medicine needs to consider new aspects in health counselling of patients. Such climate-sensitive health counselling (CSHC) may include counselling patients on preventing and coping with climate-sensitive diseases or on leading healthy and climate-friendly lifestyles. This study aimed to identify previous participation in and preferences for CSHC as well as associated sociodemographic and attitudinal factors among the general public in Germany. Methods We conducted a cross-sectional study in a population-based online panel in five German federal states (04–06/2022). We performed descriptive statistics and multivariable regression analysis to assess prior participation in CSHC and content preferences regarding CSHC, as well as associations between sociodemographic variables and general preference for CSHC. Results Among 1491 participants (response rate 47.1%), 8.7% explicitly reported having participated in CSHC, while 39.9% had discussed at least one CSHC-related topic with physicians. In the studied sample, 46.7% of participants would like CSHC to be part of the consultation with their physician, while 33.9% rejected this idea. Participants aged 21 to 40 years (versus 51 to 60), individuals alarmed about CC (versus concerned/cautious/disengaged/doubtful/dismissive), and those politically oriented to the left (vs. centre or right) showed greater preference for CSHC in the multivariable regression model. Most participants wanted to talk about links to their personal health (65.1%) as opposed to links to the health of all people (33.2%). Conclusions Almost half of the participants in this sample would like to receive CSHC, especially those who are younger, more alarmed about CC and more politically oriented to the left. More research and training on patient-centred implementation of CSHC is needed.

PURPOSE: Despite increasing evidence of benefit supporting complex genomic sequencing (CGS) in personalizing cancer therapy, its widespread uptake remains limited. METHODS: This mixed-methods, prospective cross-institutional demonstration study was designed to evaluate implementation of CGS in the care of patients with advanced cancer. DNA sequencing was undertaken on formalin-fixed paraffin-embedded tumor and matched blood was completed with the Peter MacCallum Cancer Centre Comprehensive Cancer Panel; 391 genes via central laboratory. Oncologists performed consent and result delivery. Patients completed pre- and post-test surveys, including validated and study-specific questions and, if eligible, semistructured interviews. Qualitative interviews were undertaken with study clinicians to evaluate processes. RESULTS: One hundred ninety-nine (63%) had ≥1 finding with the potential to affect management, including 172 (55%) whose finding could affect their treatment options, 25 (8%) whose test led to the resolution of diagnostic ambiguity, and 49 (16%) with a pathogenic germline variant. In 6-month follow-up, 50 (16%) participants had their subsequent therapy changed on the basis of their CGS results. Two hundred ninety-three (88% of adult patients) completed surveys at three time points. At consent, patients cited multifaceted value in testing, showed good understanding of basic concepts, but most (69%) overestimated the likelihood of result-led change. Post-test patients remained consistently satisfied with accessing CGS. 21% struggled with understanding results but there were low levels of decisional regret after participation (89% had nil/mild regret). Clinicians cited collaboration and communication as critical to delivery. CONCLUSION: Patients undergoing CGS are generally satisfied and place value on its use beyond potential therapeutic benefit. Our results suggest that to improve test utility and delivery of CGS with value to patients and investing institutions, focus must be placed on addressing the additional barriers to its wider implications including efforts to improve process efficiencies, clinician genomic literacy, and decision-making support. [ABSTRACT FROM AUTHOR]

Rationale Aims and Objectives Method Results and Conclusion Patients with advanced dementia experience multifaceted vulnerabilities because of their diminished capacities for decision making. The dominant versions of person‐centred care (PCC) emphasise patient preferences and autonomy, which often undermines a recognition of their distinct unfulfilled needs. Determining whether an individual autonomy conception of personhood applies to patients with advanced dementia is morally problematic from various theoretical perspectives and leads to the one‐approach‐fits‐all problem when caring for this patient population.The availability of patients' advanced directives varies depending on their cultural backgrounds. The goal of the study is to argue that PCC, with a focus on relational autonomy, should be the first step for caring for patients with advanced dementia.The study engages in a critical exploration of inclusivity and diversity in ethical thinking within a framework of PCC and uses philosophical argumentation to assess the viability of a relational autonomy conception of PCC.By taking relationality seriously, especially in caring for patients with advanced dementia in a multicultural society, and by considering the moral nexus of unmet needs through the perspective of PCC, we can resolve the problem of one‐approach‐fits‐all in dementia care. [ABSTRACT FROM AUTHOR]

Follicular lymphoma (FL) is an indolent, germinal center B cell–derived lymphoid neoplasm, for which recent advances in treatment have substantially improved patient survival. However, FL remains an incurable and heterogeneous disease, with groups of patients experiencing early disease progression, histologic transformation, or a high risk of treatment-related toxicity. Additionally, FL is a continually relapsing disease, and response rates and disease-control intervals decrease with each subsequent line of therapy. In this review, we explore the current treatment landscape for relapsed or refractory FL and promising therapies in development, highlighting the efficacy and potential risks of each treatment. We provide a real-world perspective on the unmet needs of patients with FL. Novel therapeutic approaches in development offer a wide array of options for clinicians when treating relapsed or refractory FL. A nuanced approach is required to address the needs of individual patients, taking into consideration both the risks and benefits of each treatment option, as well as patient preferences. [ABSTRACT FROM AUTHOR]

Purpose: Multidisciplinary care (MDC) meetings improve the quality of cancer care by providing a space for interdisciplinary communication. The Pediatric Oncology Facility Integrated Local Evaluation (PrOFILE) tool assesses MDC meetings as part of the Service Integration module. We aimed to evaluate the characteristics of MDC meetings at institutions that completed PrOFILE. Methods: From 2019 to 2021, 112 institutions from 23 countries collected data by utilizing the abbreviated version of PrOFILE. Within a secondary data analysis, we descriptively analyzed the characteristics of MDC meetings stratified by income level. Results: Participating institutions were located in low‐income countries (LICs) (n = 6), lower‐middle‐income countries (LMICs) (n = 34), upper‐middle‐income countries (UMICs) (n = 55), and high‐income countries (HICs) (n = 17). Of the 112 participating facilities, 79% reported having MDC meetings. The existence of an MDC varied with income, with 50% of LICs and 100% of HICs hosting MDCs. The frequency of MDC meetings also differed, with 100% of MDCs in LICs occurring weekly, while 53% of MDCs in HICs occurred monthly. Specialties regularly represented at MDC meetings across all participating institutions were hematology/oncology (93%), pathology (52%), radiology (60%), general surgery (57%), and radiation oncology (51%). All MDC meetings in LICs reported representation from these specialties. Availability of test results and discussion of new cases did not vary with income. Residual disparities were identified for the following characteristics: discussion of new and interesting cases, inclusion of patient preferences, and ability to meet urgently. Conclusions: The existence and components of a functional MDC meeting may vary between countries' income levels. Variation in certain components, such as access to tests, may be due to differences in resource distribution, but other factors such as inclusion of patient preferences and ability to meet urgently can be optimized in all settings to foster high‐quality teamwork and communication. [ABSTRACT FROM AUTHOR]

Breast reconstruction surgery is continualladvancing, significantly enhancing patient well-being. Current surgical techniques prioritize minimizing donor site morbidity while achieving a more natural breast appearance. Increasing patient preferences for avoiding prosthetic materials in reconstruction, along with advancements in oncological safety and heightened aesthetic expectations, are driving the exploration and development of innovative approaches. Today's reconstructive options range from straightforward oncoplastic glandular remodeling to intricate microsurgical procedures. This narrative review, titled "Breast reconstruction: the oncoplastic approach," provides a comprehensive overview of contemporary trends in breast-conserving treatment. It evaluates the indications for these techniques and offers guidance to plastic surgeons in crafting personalized treatment plans. This approach presents a valuable single-stage alternative or adjunct to traditional prosthetic or microsurgical reconstruction methods. [ABSTRACT FROM AUTHOR]

Allergic rhinitis (AR) is a prevalent disease in Canada that affects both children and adults. Several guidelines for the management of AR have been published by professional allergy societies worldwide. However, there are regional differences in the clinical management of AR, and regulatory approval of some AR pharmacotherapies varies among countries. Thus, six research questions specific to the treatment of AR in Canada were identified for this focused practice parameter. Reviews of the literature published since 2016 were conducted to obtain evidence-based support for the responses of the Work Group to each research question. In response to research question 1 "In patients with symptoms indicative of AR, is serum-specific IgE sufficient to identify candidates for immunotherapy or is a skin prick test mandatory?" the Work Group concluded that either sIgE testing or skin prick test are acceptable for diagnosing AR and guiding immunotherapy. In response to research question 2 "When taking into account the preferences of the patient and the prescriber (stakeholder engagement) should second-generation oral antihistamine (OAH) or intranasal corticosteroid (INCS) be first line?" the Work Group concluded that existing guidelines generally agree on the use of INCS as a first-line therapy used for AR, however, patient and provider preferences and considerations can easily shift the first choice to a second-generation OAH. In response to research question 3 "Is a combination intranasal antihistamine (INAH)/INCS formulation superior to INCS plus OAH? Do they become equivalent after prolonged use?" the Work Group concluded that that the combination INAH/INCS is superior to an INCS plus OAH. However, there was insufficient evidence to answer the second question. In response to research question 4 "Do leukotriene receptor antagonists (LTRA) have a greater benefit than OAH in AR for some symptoms to justify a therapeutic trial in those who cannot tolerate INCS?" the Work Group concluded that LTRAs have inferior, or at best equivalent, daytime or overall symptom control compared with OAH, but LTRAs may improve nighttime symptom control and provide benefits in patients with AR and concomitant asthma. In response to research question 5 "Should sublingual immunotherapy (SLIT) tablets be considered first-line immunotherapeutic options over subcutaneous immunotherapy (SCIT) based on the evidence of efficacy?" the Work Group concluded that the choice of SLIT or SCIT cannot be made on efficacy alone, and differences in other factors outweigh any differences in efficacy. In response to research question 6 "Based on efficacy data, should ALL patients seen by an allergist be offered SLIT or SCIT as a treatment option?" the Work Group concluded that the efficacy data suggests that SLIT or SCIT should be used broadly in patients with AR, but other clinical concerns also need to be taken into consideration. [ABSTRACT FROM AUTHOR]

PURPOSE: In Canada, health data are siloed, slowing bioinnovation and evidence generation for personalized cancer care. Secured data-sharing platforms (SDSPs) can enable data analysis across silos through rapid concatenation across trial and real-world settings and timely researcher access. To motivate patient participation and trust in research, it is critical to ensure that SDSP design and oversight align with patients' values and address their concerns. We sought to qualitatively characterize patient preferences for the design of a pan-Canadian SDSP. METHODS: Between January 2022 and July 2023, we conducted pan-Canadian virtual focus groups with individuals who had a personal history of cancer. Following each focus group, participants were invited to provide feedback on early-phase analysis results via a member-checking survey. Three trained qualitative researchers analyzed data using thematic analysis. RESULTS: Twenty-eight individuals participated across five focus groups. Four focus groups were conducted in English and one in French. Thematic analysis generated two major and five minor themes. Analytic themes spanned personal and population implications of data sharing and willingness to manage perceived risks. Participants were supportive of increasing access to health data for precision oncology research, while voicing concerns about unintended data use, reidentification, and inequitable access to costly therapeutics. To mitigate perceived risks, participants highlighted the value of data access oversight and governance and informational transparency. CONCLUSION: Strategies for secured data sharing should anticipate and mitigate the risks that patients perceive. Participants supported enhancing timely research capability while ensuring safeguards to protect patient autonomy and privacy. Our study informs the development of data-governance and data-sharing frameworks that integrate real-world and trial data, informed by evidence from direct patient input. @CLEONetwork researchers identify patient priorities for enhanced precision oncology data sharing initiatives [ABSTRACT FROM AUTHOR]

Current healthcare systems are like living creatures. They are highly complex, multi-faceted, and dynamic. They must constantly change and adapt; they are like a melting pot, brimming with both rich and diverse cultures from all corners of the world. Beyond just nationality, these systems can include many languages, religious beliefs, socioeconomic backgrounds, and unique health practices. The tides of globalization, multicultural societies, migration, and international collaboration are continuously reshaping how healthcare providers are educated and how healthcare is delivered in an equitable, inclusive, and fair manner. To keep pace with, and within, these highly vibrant socio-cultural frameworks, Cross-Cultural Medical Education is needed to educate healthcare professionals. This education is essential to create professionals who are not just skilled, but who are also culturally savvy and able provide fair and equal care to patients from all sorts of backgrounds. It provides professionals with foundational knowledge to navigate the complex landscape of diverse patient populations. Cross-Cultural Medical Education is thus of paramount importance to satisfy the need for effective cross-cultural communication and understanding in patient care preferences, ultimately leading to improved health outcomes. [ABSTRACT FROM AUTHOR]

Treatment patterns and preferences for patients with Graves' disease (GD) vary across countries. In this study, we assessed the initial therapies and subsequent treatment modalities employed for GD in real-world clinical practice in Korea. We analyzed 452,001 patients with GD from 2004 to 2020, obtained from the Korean National Health Insurance Service database. Initial treatments included antithyroid drug (ATD) therapy (98% of cases), thyroidectomy (1.3%), and radioactive iodine (RAI) therapy (0.7%). The rates of initial treatment failure were 58.5% for ATDs, 21.3% for RAI, and 2.1% for thyroidectomy. Even among cases of ATD treatment failure or recurrence, the rates of RAI therapy remained low. Regarding initial treatment, the 5-year remission rate was 46.8% among patients administered ATDs versus 91.0% among recipients of RAI therapy; at 10 years, these rates were 59.2% and 94.0%, respectively. Our findings highlight a marked disparity in the use of RAI therapy in Korea compared to Western countries. Further research is required to understand the reasons for these differences in treatment patterns. [ABSTRACT FROM AUTHOR]

Background Prognostic uncertainty is a recurring theme among patients with chronic kidney disease (CKD). We developed a survey to explore whether CKD patients want to know more about their future, and if so, which topics they prioritize. In addition, we explored differences between several subgroups. Methods A survey was constructed and tested in collaboration with the Dutch Kidney Patients Association. The survey consisted of three parts: (i) demographics, (ii) considerations about the future, and (iii) prognostic information. The survey was distributed among CKD patients (all stages) through patient associations and via healthcare professionals in two Dutch hospitals. Descriptive statistics were used to summarize the results. All results were stratified by population, sex, and age. Results A total of 163 patients (45 CKD, 26 dialysis, and 92 kidney transplantation) participated in the survey. The mean age was 63.9 (SD 12.0) and 48.5% was male. Most patients think about their future with CKD occasionally (56.4%) or often (35.0%). Nearly half of the patients (49.7%) discuss the future with their nephrologist, some (19.6%) do not but would like to, and 20 (15.3%) prefer not to. Most patients (73.6%) want more prognostic information, regardless of it being positive or negative. Key topics to receive prognostic information about were laboratory values, symptoms, and physical well-being. Dialysis patients prioritized mental over physical well-being. CKD patients without kidney replacement therapy (KRT) indicated thinking about, and discussing their future more regularly than KRT patients. Conclusions Patients with CKD contemplate their future regularly and express interest in receiving prognostic information on a variety of topics. One in five patients currently do not discuss their future with CKD with their nephrologist, despite wanting to do so. These findings underline the need to tailor prognostic information provision to patients' preferences, advocating more attention to this subject both in research and clinical practice. [ABSTRACT FROM AUTHOR]

Background: Understanding patient preferences for treatments may facilitate shared decision-making. This study assessed adult patient preferences for attention-deficit/hyperactivity disorder (ADHD) treatments in a sample of 600 patients in the United States (US). Methods: A web-based discrete choice experiment (DCE) survey was conducted among treated adults with ADHD. Participants were recruited from Dynata's US panel (06/22/2023-07/06/2023). Attributes and levels, identified based on clinical inputs and published data, included efficacy and safety. Participants' preferences were estimated using conditional logistic regression. Willingness to trade-off and attributes' relative importance were calculated. Overall preferences for treatment profiles approximating centanafadine, lisdexamfetamine, atomoxetine, and viloxazine were estimated using adjusted total utilities. Results were stratified by current treatment status. Sensitivity analyses including participants who passed validity tests were conducted. Results: Among the 600 participants (mean age 37.9 years; 66.2% female; 50.8% treated), all attributes had a statistically significant impact on preferences for ADHD treatments (p < 0.001); the most important attribute was improvement in ADHD symptoms (36%), followed by risks of nausea (25%), insomnia (20%), anxiety (8%), dry mouth (6%), and feeling jittery (5%). Together, safety attributes accounted for > 60% of relative importance in decision-making. Participants were willing to forgo 0.59, 0.57, 0.49, 0.32, and 0.17 percentage points of symptom improvement to achieve one-percentage-point reduced risk of insomnia, nausea, anxiety, feeling jittery, and dry mouth, respectively. Centanafadine profile had consistently higher adjusted total utilities than its comparators. Similar results were obtained in the subgroup and sensitivity analyses. Conclusion: Efficacy was the most important attribute for patients when making treatment decision, but taken together, AEs had greater relative importance than efficacy alone. Accordingly, a profile resembling that of centanafadine would be preferred by an average patient compared to key competitors due to its favorable safety profile. These findings may help improve treatment decision-making, enhance treatment satisfaction, and foster adherence. [ABSTRACT FROM AUTHOR]

Objective response rate (ORR), and duration of response (DOR) were of lesser importance. Conclusion: In this study, patients highlighted that improving survival time was the most important and that QoL is also an important consideration. Discussions during treatment decision-making may benefit from broader conversations around treatment characteristics, including impacts on QoL and convenience of the regimen. [ABSTRACT FROM AUTHOR]

Background: COVID-19 spurred rapid adoption and expansion of telemedicine. We investigated the factors driving visit modality (telemedicine vs. in-person) for outpatient visits at a large cardiovascular center. Methods: We used electronic health record data from March 2020 to February 2021 from four cardiology subspecialties (general cardiology, electrophysiology, heart failure, and interventional cardiology) at a large academic health system in Northern California. There were 21,912 new and return visits with 69% delivered by telemedicine. We used hierarchical logistic regression and cross-validation methods to estimate the variation in visit modality explained by patient, clinician, and visit factors as measured by the mean area under the curve. Results: Across all subspecialties, the clinician seen was the strongest predictor of telemedicine usage, while primary visit diagnosis was the next most predictive. In general cardiology, the model based on clinician seen had a mean area under the curve of 0.83, the model based on the primary diagnosis had a mean area under the curve of 0.69, and the model based on all patient characteristics combined had a mean area under the curve of 0.56. There was significant variation in telemedicine use across clinicians within each subspecialty, even for visits with the same primary visit diagnosis. Conclusion: Individual clinician practice patterns had the largest influence on visit modality across subspecialties in a large cardiovascular medicine practice, while primary diagnosis was less predictive, and patient characteristics even less so. Cardiovascular clinics should reduce variability in visit modality selection through standardized processes that integrate clinical factors and patient preference. [ABSTRACT FROM AUTHOR]

Purpose: Investigate patient preferences in embryo selection for transfer regarding quality versus sex in IVF/ICSI cycles with PGT-A and assess associated clinical implications. Methods: Retrospective cohort study at a university fertility practice from January 2012 to December 2021. Included were patients undergoing single frozen euploid transfers with at least one embryo of each sex available. Primary outcomes were preference for embryo selection (quality vs. sex) and sex preference (male vs. female). Trends over 10 years were evaluated and clinical outcomes, including clinical pregnancy rate (CPR), sustained implantation rate (SIR), and live birth rate (LBR), were compared. Results: A total of 5,145 embryo transfer cycles were included; 54.5% chose the best-quality embryo, while 45.5% selected based on sex. Among those choosing based on sex, 56.5% chose male embryos and 43.5% chose female. Preference for quality remained consistent over the decade (p = 0.30), while male embryos were consistently favored (p = 0.64). Best-quality embryos had higher grades (p < 0.001). Clinical outcomes were similar between groups (CPR: 74.4% vs. 71.9%, p = 0.05; SIR: 64.9% vs. 63.4%, p = 0.26; LBR: 58.8% vs. 56.7%, p = 0.13), and between male and female embryo selections. Conclusions: Sex selection remains common, with 45.5% selecting embryos based on sex, predominantly favoring males. This trend persisted over 10 years, with comparable clinical outcomes regardless of selection criteria. [ABSTRACT FROM AUTHOR]

• Female patients strongly prefer female primary care physicians. • Female primary care physicians have less appointment availability than males. • Compared to males, Black and Hispanic women have less access to female physicians. Patient preferences for physicians may be influenced by shared characteristics such as gender. We analyzed experimental data from a survey of US adults in which respondents were asked to choose between physician profiles that on average varied only by gender. We find that female patients prefer female physicians to male physicians by 51.8 percentage points (95 % CI: 0.470 to 0.566, p < 0.01), and that result holds across Black, White, and Hispanic sub-groups. With no countervailing preference among male patients, this result holds in the overall sample at 26.8 percentage points (95 % CI: 0.228 to 0.307, p < 0.01). We also analyzed data from a simulated patient field experiment concerning access to primary care appointments and find that female physicians, on average, offer appointments 7.1 days later than male physicians (95 % CI: 5.1 to 9.1, p < 0.01), consistent with the finding that female physicians are preferred. Female physicians' offices appear to favor female patients, offering appointments to them 2.6 days earlier compared to male patients (95 % CI: -5.3 to 0.195, p = 0.07). However, Hispanic female patients were offered 4.2-percentage-points fewer appointments compared to Hispanic males (95 % CI: -0.069 to -0.014, p < 0.01) by female physicians' offices. Similarly, Black female patients were told that the physician is "not taking new patients" 3.5 percentage points more often (95 % CI: -0.004 to 0.073, p = 0.08) and were offered appointments that were 2.6 minutes shorter compared to Black males (95 % CI: -4.8 to -0.44, p = 0.02). Overall, our analysis suggests that female primary care physicians are in high demand relative to their supply, and that access to scarce female physicians is mediated by race and ethnicity. [ABSTRACT FROM AUTHOR]

Evidence-based practice (EBP) has been defined as the integration of best available scientific evidence, patient preferences, and individual clinical expertise. A range of barriers for implementing EBP in physiotherapy practice have been identified, but little is known about the underlying causes. The objective was to explore how physiotherapists in private practice perceive EBP, how they use, and what their main challenges are. This study used a convergent parallel mixed-methods design. It consisted of a 28-item questionnaire informed by systematic reviews with a deductive approach and semi-structured interviews with a phenomenological and inductive approach. The results from the questionnaire (n = 216) and the interviews (n = 9) showed that physiotherapists are more likely to implement EBP if they have sufficient flexibility in time allocation to facilitate shared decision-making and increase the integration of patient preferences. Support from colleagues and the workplace culture were identified as both a challenge and a potential facilitator for increased use of EBP. Participants in this study experienced several modifiable challenges, including lack of flexibility in time allocation and insufficient time to build rapport with the patient. Physiotherapists show inconsistency in their understanding of what EBP is – this ultimately becomes an additional and yet undescribed barrier for implementation of EBP. [ABSTRACT FROM AUTHOR]

Rectal cancer management has evolved significantly, particularly with neoadjuvant treatment strategies. This narrative review examines the development and effectiveness of these therapies for locally advanced rectal cancer (LARC), highlighting the historical quest that led to current neoadjuvant alternatives. Initially, trials showed the benefits of adding radiotherapy (RT) and chemotherapy (CT) to surgery, reducing local recurrence (LR). The addition of oxaliplatin to chemoradiotherapy (CRT) further improved outcomes. TNT integrates chemotherapy and radiotherapy preoperatively to enhance adherence, timing, and systemic control. Key trials, including PRODIGE 23, CAO/ARO/AIO 12, OPRA, RAPIDO, and STELLAR, are analyzed to compare short-course and long-course RT with systemic chemotherapy. The heterogeneity and difficulty in comparing TNT trials due to different designs and outcomes are acknowledged, along with their promising long-term results. On the other hand, it briefly discusses the potential for non-operative management (NOM) in select patients, a strategy gaining traction due to favorable outcomes in specific trials. As a conclusion, this review underscores the complexity of rectal cancer treatment, emphasizing individualized approaches considering patient preferences and healthcare resources. It also highlights the importance of interpreting impressive positive or negative results with caution due to the variability in study designs and patient populations. [ABSTRACT FROM AUTHOR]

Treatment of advanced-stage ovarian cancer contains cytoreductive surgery (CRS) and chemotherapy. Achieving successful CRS (≤ 1 cm residual disease) is prognostically important, but may not be feasible peri-operatively while still risking complications. Therefore, patients' treatment expectations are important to discuss. We investigated patient considerations for interval CRS. Patients with advanced-stage ovarian cancer planned for interval CRS completed a questionnaire about the impact of chance of successful CRS, survival benefit and becoming care-dependent on decision-making regarding CRS. The questionnaire included a vignette study, in which patients repeatedly chose between two treatment scenarios with varying levels for chance of successful CRS, survival benefit and risk of complications including stoma. Patient preferences were analyzed, including differences between patients aged < 70 and ≥ 70 years. Among 85 included patients, 31 (37%) patients considered interval CRS worthwhile irrespective of survival benefit and 33 (39%) irrespective of chance of successful surgery. However, 34 patients (41%) considered interval CRS only worthwhile if survival benefit was > 12 months, while 41 (49%) thought so if chance of successful surgery was ≥ 25%. Older patients considered these factors more important. Overall, 27% considered becoming permanently dependent of home care unacceptable. In the vignette study (n = 72) risk of complications and stoma were considered less important than chance of successful CRS and survival benefit. Survival benefit, chance of successful surgery and becoming care-dependent are important factors in patient's decision for interval CRS, while risk of complications and stoma are less important. Our results are useful in shared decision-making for interval CRS in ovarian cancer. • For one-third of the patients, chance of successful surgery or survival gain did not influence decision-making for surgery. • Forty-one percent of the patients considered interval cytoreductive surgery worthwhile if survival gain was > 12 months. • Approximately half of the patients considered cytoreductive surgery worthwhile if chance of successful surgery was ≥ 25%. • Older patients (aged ≥ 70 years) consider these factors of greater importance compared to younger patients. • Risk of complications and stoma were considered less important than chance of successful surgery or survival gain. [ABSTRACT FROM AUTHOR]

Outcomes following vagus nerve stimulation (VNS) improve over years after implantation in children with drug‐resistant epilepsy. The added value of deep brain stimulation (DBS) instead of continued VNS optimization is unknown. In a prospective, non‐blinded, randomized patient preference trial of 18 children (aged 8–17 years) who did not respond to VNS after at least 1 year, add‐on DBS resulted in greater seizure reduction compared with an additional year of VNS optimization (51.9% vs. 12.3%, p = 0.047). Add‐on DBS also resulted in less bothersome seizures (p = 0.03), but no change in quality of life. DBS may be considered earlier for childhood epilepsy after non‐response to VNS. ANN NEUROL 2024;96:405–411 [ABSTRACT FROM AUTHOR]

Purpose: To assess preferences and outcome expectations for vagus nerve stimulation (VNS) and corpus callosotomy (CC) surgeries in the treatment of atonic seizure in Lennox-Gastaut syndrome (LGS). Methods: A total of 260 surveys were collected from patients are caregivers of LGS patients via Research Electronic Data Capture (REDCap). Results: Respondents reported an average acceptable atonic seizure reduction rate of 55.9% following VNS and 74.7% following CC. 21.3% (n = 50) were willing to be randomized. Respondents reported low willingness for randomization and a higher seizure reduction expectation with CC. Conclusion: Our findings guide surgical approaches for clinicians to consider patient preference in order to design future studies comparing effectiveness between these two procedures. [ABSTRACT FROM AUTHOR]

In this study, we explore optimal service allocation within the Chinese hierarchical healthcare system with green channels, providing valuable insights for practitioners to understand how optimal service allocation is affected by various realistic factors. These green channels are designed to streamline referrals from community healthcare centers to comprehensive hospitals. We aim to determine the optimal capacity allocation for these green channels within comprehensive hospitals. Our research employs techniques from queuing theory and stochastic processes, e.g., diffusion analysis, to develop a mathematical model that approximates the optimal allocation of resources. We uncover both closed-form and numerical solutions for this optimal capacity allocation. By analyzing the impact of various cost factors, we find that an increase in costs within the green channel results in a lower optimal service rate. Additionally, patient preferences for specific treatments influence allocation, reducing the optimal share of services provided by general hospitals. The optimal solution is also affected by the proportions of different patient types. Through extensive simulations, we validate the accuracy of our model approximations under heavy traffic conditions, further examining sources of error to ensure robustness. Our findings provide valuable insights into optimizing resource allocation in hierarchical healthcare systems, ensuring efficient and cost-effective patient care. [ABSTRACT FROM AUTHOR]

Urgency urinary incontinence (UUI) refractory to medical treatment poses significant challenges despite advancements. This study evaluates the efficacy of intravesical botulinum toxin for UUI and identifies factors influencing treatment outcomes. Among 368 women receiving botulinum toxin injections, 74.5% achieved a complete discontinuation of pad usage. Predictors of efficacy included lower pre-treatment pad usage and the absence of prior sling placement. Patients often required repeat injections (60.3%), with younger age and satisfaction correlating with treatment repetition. The interval between injections averaged 18 months, influenced by logistical challenges and patient preferences. Despite concerns about diminishing efficacy, subjective perceptions did not align with objective findings. Limitations include retrospective analysis and heterogeneous clinical records. In conclusion, intravesical botulinum toxin is effective for UUI, with pre-treatment pad usage and sling placement history influencing outcomes and patient characteristics influencing treatment repetition. [ABSTRACT FROM AUTHOR]

Purpose: Chiari Malformation Type I (CM1) is characterized by the downward displacement of the cerebellar tonsils below the foramen magnum. The standard surgical treatment for CM1 is foramen magnum decompression and atlas laminectomy (FMD-AL). However, there is a growing interest in exploring minimally invasive techniques, such as neuroendoscopically assisted FMD-AL, to optimize surgical outcomes. The aim is to present the results of the less invasive neuroendoscopic-assisted system application as an alternative to decompression surgery in patients with CM-1 with/without syringomyelia. Patients and methods: A retrospective analysis was conducted on 76 patients with CMI who underwent either neuroendoscopic-assisted FMD-AL (n = 23) or open surgery (n = 53). Preoperative and postoperative assessments were performed, including pain levels, functional assessment, outcome and serum creatinine kinase (CK) levels. Surgical parameters and radiological imaging were also evaluated and compared. Results: Both surgical groups showed improvements in pain levels and increase in postoperative CK levels. There were no statistically significant differences between the groups in terms of postoperative JOA scores, VAS scores, CCOS, or syrinx resolution. However, the neuroendoscopic group had significantly lower CK levels, shorter hospital stays, less blood loss, and shorter operation times compared to the open surgery group, indicating reduced muscle damage and potential benefits of the neuroendoscopic assisted approach. Conclusion: Both neuroendoscopy and open surgery groups can effectively alleviate symptoms and improve outcomes in patients with CM1. The neuroendoscopic assisted technique offers the advantage of reduced muscle damage and shorter hospital stays. The choice of surgical technique should be based on individual patient characteristics and preferences. Level of evidence: 3 (Retrospective case–control study) according to using the Oxford Centre for Evidence-Based Medicine (CEBM) Table. [ABSTRACT FROM AUTHOR]

Background Biologic therapies have led to increasing numbers of patients with psoriasis who have clear or nearly clear skin. It is current practice to continue biologic therapy indefinitely in these patients, which contributes to a substantial long-term drug and healthcare burden. 'As needed' biologic therapy in psoriasis may address this; however, our understanding of patient and clinician perceptions of this strategy is limited. Objectives The aim of this mixed-methods study was to gain insight into the perspectives of both patients and clinicians regarding the acceptability of an 'as needed' approach to biologic therapy in psoriasis, including potential barriers and enablers to implementation in routine care. Methods We first conducted UK-wide online scoping surveys of patients with psoriasis and dermatology clinicians to explore their views on 'as needed' biologic therapy. Using topic guides informed by these survey findings, we then carried out qualitative focus groups with patients and clinicians. Themes were identified using reflexive thematic analysis. Results Of 67 patients and 27 clinicians completing the scoping surveys, 67% (43 of 64 patients) and 78% (21 of 27 clinicians) supported the use of 'as needed' biologic therapy, respectively. Respondents highlighted advantages such as a reduction in healthcare burden and greater ownership of care. Challenges included logistics of 'as needed' drug provision and potential risks of disease flare and drug immunogenicity. Focus groups comprised 15 patients with psoriasis [9 female patients (60%), average disease duration 32 years (range 9–64)] and 9 dermatology clinicians [8 female clinicians (89%), average dermatology experience 20 years (range 8–33)]. Both patients and clinicians felt that an 'as needed' treatment approach will deliver a reduction in treatment burden and present an opportunity for patient-led ownership of care. Both groups highlighted the importance of ensuring ongoing access to medication and discussing the potential impact of psoriasis recurrence. Patient preferences were influenced by their lived experiences, particularly previous difficulties with medication delivery logistics and establishing disease control. Clinician perspectives were informed by personal experience of their patients adapting their own dosing schedules. Clinicians highlighted the importance of targeted patient selection for an 'as needed' approach, ongoing disease monitoring, and prompt reaccess to medications upon psoriasis recurrence. Conclusions These data indicate that 'as needed' biologic therapy in psoriasis is acceptable for both patients and clinicians. Formal assessment of clinical effectiveness and cost-effectiveness is warranted to enable the real-world potential of this approach to be realized. [ABSTRACT FROM AUTHOR]

Background: Bromhidrosis, characterized by foul‐smelling sweat, is a prevalent condition that significantly affects patients' social and psychological well‐being. Methods: This review presents novel treatment approaches and discusses the pros and cons of various treatment options for axillary bromhidrosis. Results: Extensive research has explored numerous treatment modalities for bromhidrosis. This article systematically reviews both surgical and nonsurgical interventions utilized in clinical practice. Conclusion: By synthesizing available evidence, this review aims to offer evidence‐based recommendations for effectively managing bromhidrosis, considering factors such as treatment efficacy, safety profiles, patient preferences, and clinical outcomes. [ABSTRACT FROM AUTHOR]

Background: Individuals with high risk for lung cancer may benefit from lung cancer screening, but there are associated risks as well as benefits. Shared decision‐making (SDM) tools with personalized information may provide key support for patients. Understanding patient perspectives on educational tools to facilitate SDM for lung cancer screening may support tool development. Aim: This study aimed to explore patient perspectives related to a SDM tool for lung cancer screening using a qualitative approach. Methods: We elicited patient perspectives by showing a provider‐facing SDM tool. Focus group interviews that ranged in duration from 1.5 to 2 h were conducted with 23 individuals with high risk for lung cancer. Data were interpreted inductively using thematic analysis to identify patients' thoughts on and desires for a patient‐facing SDM tool. Results: The findings highlight that patients would like to have educational information related to lung cancer screening. We identified several key themes to be considered in the future development of patient‐facing tools: barriers to acceptance, preference against screening and seeking empowerment. One further theme illustrated effects of patient–provider relationship as a limitation to meeting lung cancer screening information needs. Participants also noted several suggestions for the design of technology decision aids. Conclusion: These findings suggest that patients desire additional information on lung cancer screening in advance of clinical visits. However, there are several issues that must be considered in the design and development of technology to meet the information needs of patients for lung cancer screening decisions. Patient or Public Contribution: Patients, service users, caregivers or members of the public were not involved in the study design, conduct, analysis or interpretation of the data. However, clinical experts in health communication provided detailed feedback on the study protocol, including the focus group approach. The study findings contribute to a better understanding of patient expectations for lung cancer screening decisions and may inform future development of tools for SDM. [ABSTRACT FROM AUTHOR]

Background: Older adults should be supported to make informed decisions about cancer screening. However, it is unknown how general practitioners (GPs) in Australia communicate about cancer screening with older people.Aim: To investigate GPs' views and experiences of communicating about cancer screening (breast, cervical, prostate, and bowel) with older people (≥70 years).Design and Setting: Qualitative, semi-structured interviews, Australia.Method: Interviews were conducted with GPs practising in Australia (n = 28), recruited through practice-based research networks, primary health networks, social media, and email invitation. Interviews were audio-recorded and analysed thematically using Framework Analysis.Results: Findings across GPs were organized into 3 themes: (i) varied motivation to initiate cancer screening discussions; some GPs reported that they only initiated screening within recommended ages (<75 years), others described initiating discussions beyond recommended ages, and some experienced older patient-initiated discussions; (ii) GPs described the role they played in providing screening information, whereby detailed discussions about the benefits/risks of prostate screening were more likely than other nationally funded screening types (breast, cervical, and bowel); however, some GPs had limited knowledge of recommendations and found it challenging to explain why screening recommendations have upper ages; (iii) GPs reported providing tailored advice and discussion based on personal patient preferences, overall health/function, risk of cancer, and previous screening.Conclusions: Strategies to support conversations between GPs and older people about the potential benefits and harms of screening in older age and rationale for upper age limits to screening programmes may be helpful. Further research in this area is needed. [ABSTRACT FROM AUTHOR]

This article explores the effects of uncontrolled symptoms on the quality of life of patients with allergic rhinitis (AR). The study used a questionnaire to assess the impact of individual symptoms on quality of life. The results showed that poorly controlled eye, nose, and asthma symptoms were consistently associated with lower quality of life measures. The study emphasizes the importance of symptom control in improving the quality of life for patients with AR. However, it is important to note that the findings may not apply to all patients. [Extracted from the article]

Introduction: Understanding individual patient preferences for chronic low back pain (cLBP) outcomes is essential for targeting available therapeutic options; yet tools to elicit patient outcome preferences are limited. Objective: To develop and test a choice‐based conjoint (CBC) measure, commonly used in behavioral economics research, to elicit what outcomes patients with cLBP want to achieve and avoid. Design: We developed a survey‐based CBC measure to allow patients to make risk/benefit trade‐off choices between possible treatment outcomes. After extensive literature, clinician, and patient input, our measure included seven attributes: fatigue, anxiety/depression, difficulty thinking/making decisions, pain intensity, physical abilities, change in pain, and ability to enjoy life despite pain. Random‐parameters logit models were used to estimate strength of preferences, and latent class analysis was used to identify patient characteristics associated with distinct preference. Setting: Online study using the Sawtooth web‐based platform. Participants: Two hundred eleven individuals with cLBP recruited from online advertising as well as at clinical sites across multiple academic and private institutions. Interventions: Not applicable. Results: The most valued outcome was the highest level of physical activity (β = 1.6–1.98; p <.001), followed by avoiding cognitive difficulties (β = −1.48; p <.001). Avoidance of severe pain was comparable to avoiding constant fatigue and near‐constant depression/anxiety (β = −0.99, −1.02); p <.001). There was an association between preferences and current pain/disability status; patients with higher pain had a stronger preference to avoid severe pain, whereas those with higher disability have stronger preferences for achieving physical activity. The latent class analysis identified two distinct groups: (1) more risk‐seeking and willing to accept worse outcomes (56%); and (2) more risk‐averse with a stronger preference for achieving maximum benefits (44%). Conclusions: Our study illuminated cLBP patient preferences for treatment outcomes and heterogeneity in these preferences. Patients stressed the importance of reaching high physical activity and avoiding cognitive declines, even over a desire to avoid pain. More work is needed to understand patient preferences to aid informed, shared decisions. [ABSTRACT FROM AUTHOR]

Introduction: There is a growing interest in personalized decision-making in oncology. According to the Integrated Oncological Decision-Making Model (IODM), decisions should be based on information from three domains: (1) medical technical information, (2) patients' general health status and (3) patients' preferences and goals. Little is known about what kind of tool/strategy is used to collect the information, by whom this is collected (nurse, clinician) when this is collected (moment in the care pathway), and how this information should be collected and integrated within decision-making in oncological care pathways, and what its impact is. Methods: We searched PUBMED, Embase and Web of Science in October 2023 for studies looking at tools to collect and integrate information from the three domains of the IODM. We extracted data on the content and implementation of these tools, and on decision and patient outcomes. Results: The search yielded 2576 publications, of which only seven studies described collection of information from all three domains (inclusion criteria). In the seven included studies, information on the three domains was collected through dialogue, questionnaires, and assessments (what) by a nurse (2 out of 7 studies) or by other members of the Multi-Disciplinary Team (by whom) (5 out of 7 studies). Members of the Multi-Disciplinary Team subsequently integrated the information (5 out 7 studies) during their meeting (when), with patients and family attending this meeting in 2 studies (how). In terms of decision outcomes, 5 out of 7 studies compared the treatment recommendations before and after implementation of the tools, showing a modification of the treatment plan in 3% to 53% of cases. The limited data on patient outcomes suggest positive effects on well-being and fewer complications (3 out of 7 studies). Conclusion: The seven studies identified that integrated information from the three IODM domains into treatment decision-making lacked comprehensive information regarding the strategies, process, timing and individuals involved in implementing the tools. Nevertheless, the few studies that looked at patient outcomes showed promising findings. [ABSTRACT FROM AUTHOR]

Background: Clinical acupuncture decisions are highly operator-dependent and require physician-patient interactions. The Delphi method allows subjective factors such as expert experience and preference of patients to be taken into account in clinical decision making, which is particularly applicable to acupuncture. Currently, the Delphi method is widely used to support clinical decisions in acupuncture. Therefore, it is necessary to provide high-quality and complete descriptions of the Delphi process when making clinical decisions. This study aims to evaluate the quality of the Delphi process in acupuncture, facilitate its standardization and rigor for further clinical decision making in acupuncture. Methods: Articles sourced from six databases were searched systematically to assess the quality of the Delphi consensus process based on the standards for conducting and reporting Delphi studies (CREDES). Descriptive statistics and analysis were presented according to the percentage of each item. Five-score Likert scale was used to evaluate the reporting quality of four domains as well as each item in CREDES by two independent researchers, combined with ICC-value to assess the consistency. Results: A total of 37 qualified articles were included according to eligibility criteria. As for the low reporting rate, the item "External validation" was reported as the lowest positive rate at 32.43% and the item "Prevention of bias" was 48.65%. The item "Adequacy of conclusions", "Definition and attainment of consensus", and "Discussion of limitations" were reported at a positive ratio of 62.16%, 64.86%, and 67.57% individually. The average scores of the four domains based on CREDES from highest to lowest were, respectively, as follows: planning and design (68.75%), reporting (66.07%), rationale for the choice of the Delphi technique (65.54%), study conduct (45.10%). Conclusion: The reporting quality of the Delphi consensus process in acupuncture is acceptable currently, but the reporting rate on some items is still low. Further standardization, including either clearer checklists or study reports, should be developed and strengthened to guide clinical decisions in acupuncture. [ABSTRACT FROM AUTHOR]

Purpose: The calculation of aggregated composite measures is a widely used strategy to reduce the amount of data on hospital report cards. Therefore, this study aims to elicit and compare preferences of both patients as well as referring physicians regarding publicly available hospital quality information Methods: Based on systematic literature reviews as well as qualitative analysis, two discrete choice experiments (DCEs) were applied to elicit patients' and referring physicians' preferences. The DCEs were conducted using a fractional factorial design. Statistical data analysis was performed using multinomial logit models Results: Apart from five identical attributes, one specific attribute was identified for each study group, respectively. Overall, 322 patients (mean age 68.99) and 187 referring physicians (mean age 53.60) were included. Our models displayed significant coefficients for all attributes (p < 0.001 each). Among patients, "Postoperative complication rate" (20.6%; level range of 1.164) was rated highest, followed by "Mobility at hospital discharge" (19.9%; level range of 1.127), and "The number of cases treated" (18.5%; level range of 1.045). In contrast, referring physicians valued most the "One-year revision surgery rate" (30.4%; level range of 1.989), followed by "The number of cases treated" (21.0%; level range of 1.372), and "Postoperative complication rate" (17.2%; level range of 1.123) Conclusion: We determined considerable differences between both study groups when calculating the relative value of publicly available hospital quality information. This may have an impact when calculating aggregated composite measures based on consumer-based weighting. [ABSTRACT FROM AUTHOR]

Background: A fixed 10-year lead-time in composite time-trade-off (C-TTO) tasks might compromise the precision of utility values below − 1. This study explored how alternative lead-times (ALTs) influence EQ-5D-5L value sets and their implications in economic evaluations. Methods: Leveraging data from Taiwan's EQ-5D-5L valuation and capitalizing on its exploratory willingness-to-accept question, we explored participants' quantification of "worse-than-dead (WTD)" health states with ALTs up to 50 years. We then derived alternative value sets incorporating these ALTs through interval regression and compared them against those from conventional models. To evaluate their impact on health change valuation, we simulated utility differences for all possible EQ-5D-5L health-state-pairs using each value set. Results: With a salient floor effect observed in the C-TTO values, the model with ALT led to a wider range of predicted utilities (– 2.3897 ~ 1), compared with those of conventional models (generalized least squares (GLS): – 0.7773 ~ 1; Tobit-GLS: – 0.9583 ~ 1). Compared to the Tobit-GLS model, the model with ALT increased the numerical distance in 80% of health-state-pairs, with 11% decreasing and 9% altering direction (e.g., positive to negative) in utility differences. Conclusions: While ALTs offer insights into patient preferences, their integration into economic evaluations might require rescaling. Future research should prioritize advanced rescaling methods or enhanced elicitation strategies for populations with substantial censoring. This is pivotal for improving the elicitation of extreme WTD states and accurately discerning the relative distances between health states. Countries developing EQ-5D-5L value sets should consider pilot studies and incorporating region-specific questions on social determinants, especially where pronounced floor effects are suspected. [ABSTRACT FROM AUTHOR]

To identify the preferences and perceptions of migraine patients for acute and preventive treatment options and to investigate which treatment outcomes are the most important. The authors performed a choice-format survey in a cohort of migraine patients from Greece and Cyprus. A self-administered questionnaire developed in collaboration with the Greek Society of Migraine Patients was used. Questionnaires were collected from 617 migraine patients. Efficacy was preferred over safety as the single most important parameter, both in acute and preventive treatment. When analyzing single outcomes, patients prioritized a complete pain remission at 1-hour post-dose for acute therapies. Regarding migraine prevention, a 75% reduction in frequency, intensity of pain, accompanying symptoms and acute medication intake were considered as most important. Conversely, outcomes routinely used in clinical trials, namely complete or partial pain remission at 2-hours post-dose for acute treatment and 50% or 30% reduction in migraine frequency for prevention, were not deemed particularly relevant. Tablet formulation was mostly preferred, both in acute and preventive treatment. Conclusion: Listening to patients' needs may add a piece of the puzzle that is generally missing in clinical practice and often explains the lack of adherence in both acute and preventative anti-migraine therapies. [ABSTRACT FROM AUTHOR]

Purpose: To support the development and implementation of exercise programming for people with prostate cancer (PC), we investigated their views on exercise. Methods: Online survey with open recruitment. We collected data on clinical and sociodemographic variables, experiences with exercise advice, outcome expectations, and preferences. We explored determinants of (1) having been counselled about exercise and (2) preferring supervised exercise. Results: The survey was completed by 171 patients (mean age = 70 years, SD = 6.5) from all PC treatment pathways. Sixty-three percent of the respondents reported never having been informed about the potential benefits of exercise. Forty-nine percent preferred exercise to be supervised. Respondents generally reported a positive attitude towards exercise. Seventy-four percent indicated barriers to exercising, including fatigue and lack of access to specific programmes. Outcome expectations were generally positive but moderately strong. Receiving hormonal therapy and younger age were significantly associated with having received exercise advice. Being insured and having higher fatigue levels contributed significantly to the preference for supervised exercise. Conclusion: Dutch people with PC report receiving insufficient effective exercise counselling. Yet, they are open to exercise and expect exercise to improve their health, although they experience various barriers that limit their ability to exercise. Implications for Cancer Survivors: The moderate outcome expectations for exercise of people with PC and their limited recall of exercise counselling highlight the need for better integration of exercise in clinical pathways. The lack of access to specific programming limits the use of evidence-based exercise programmes for people with PC. [ABSTRACT FROM AUTHOR]

Endometriosis, an inflammatory disease primarily affecting the pelvis and peritoneum, manifests with pelvic pain, dysmenorrhea, dyschezia, dyspareunia, and infertility. Despite its ubiquity, the management of endometriosis is challenging due to its heterogeneous presentation, limitations in diagnostic methods, variable therapeutic responses, and personal and socio-cultural impact on quality of life. This review attempts to consolidate the current literature on endometriosis occurring during and beyond menopause, and to present details regarding management strategies that take into account individual outcomes and goals when managing this condition. The topics included in this review are the clinical features and differential diagnosis of pelvic pain in postmenopausal patients, imaging considerations, serum and laboratory biomarkers, indications for surgery, the principles of hormone replacement therapy, the de novo development of endometriosis after menopause, and malignant transformation. Each topic includes a summary of the current literature, utilizing clinical research, case reports, and expert opinion. Despite a better understanding of the impact of endometriosis beyond menopause, there are many limitations to this condition, specifically with regard to cancer risk and indications for surgery. The existing evidence supports the use of shared decision making and the incorporation of patient preferences in guiding clinical management. Future research endeavors must shed light on the natural history of postmenopausal endometriosis through longitudinal studies in order to foster a deeper understanding of its complicated disease course across women's lifespans. [ABSTRACT FROM AUTHOR]

Background: Striking the right balance between early cancer diagnosis and the risk of excessive testing for low-risk symptoms is of paramount importance. Patient-centred care must also consider patient preferences for testing. Aim: To investigate the diagnostic testing preferences of the Australian public for symptoms associated with oesophagogastric (OG), bowel, or lung cancer. Design and setting: One of three discrete-choice experiments (DCEs) related to either OG, bowel, or lung cancer were administered to a nationally representative sample of Australians aged ≥40 years. Method: Each DCE comprised three scenarios with symptom positive predictive values (PPVs) for undiagnosed cancer ranging from 1% to 3%. The numerical risk was concealed from participants. DCE attributes encompassed the testing strategy, GP familiarity, test and result waiting times, travel duration, and test cost. Preferences were estimated using conditional and mixed logit models. Results: A total of 3013 individuals participated in one of three DCEs: OG (n = 1004), bowel (n = 1006), and lung (n = 1003). Preferences were chiefly driven by waiting time and test cost, followed by the test type. There was a preference for more invasive tests. When confronted with symptoms carrying an extremely low risk (symptom PPV of ≤1%), participants were more inclined to abstain from testing. Conclusion: Access-related factors, particularly waiting times and testing costs, emerged as the most pivotal elements influencing preferences, underscoring the substantial impact of these systemic factors on patient choices regarding investigations. [ABSTRACT FROM AUTHOR]

This case report aims to present the successful restoration of the atrophic partially edentulous posterior mandible using custom-made subperiosteal implants. The fixed prosthesis restoration was achieved using computer-aided design and computer-aided manufacturing technologies and 3D metal printing methods. The partially edentulous 58-year-old patient expressed a preference not to undergo bone augmentation procedures. The patient with teeth in the anterior mandible was treated with 2 separate custom-made subperiosteal implants. A custom-made implant was fabricated from sintered titanium using machined subperiosteal implants with a universal external connection. Subperiosteal implants offer several advantages over conventional bone grafting plus intraosseous implant placement techniques, such as the simple, 1-step procedure for atrophic jaws, streamlining the treatment process and reducing the overall time involved. Treatments using subperiosteal implants can be an alternative solution for individuals with severely atrophic jaws. Longer term studies in a larger sample are warranted to corroborate previous reports. [ABSTRACT FROM AUTHOR]

Background: The current literature supports the effectiveness of exercise, education, and self-management interventions for the long-term management of persistent low back pain. However, there is significant uncertainty about the implementation of interventions related to barriers, facilitators, and patient's preferences. This study will evaluate the Back to Living Well program implementation from a participant and organizational perspective. More specifically we address the following objectives: 1) identify program barriers and facilitators from participants' perspectives, 2) identify factors related to program, personal and contextual factors that contribute to negative and positive outcomes, and outcome trajectories, 3) identify factors influencing participants' selection of an in-person or e-health program, and 4) evaluate program specific barriers and facilitators from the organization and care delivery perspectives. Methods: This study will utilize a mixed-method convergent design including a longitudinal cohort strand and a longitudinal qualitative interview strand. The RE-AIM framework will be used to assess program implementation. Participants (n = 90, 1:1: in person or virtual) who choose to register in the program as well as staff (n = 10 to 15) involved in the delivery of the program will be invited to participate. Participants will participate in a 12-week physical activity, education, and self-management program. Implementation outcomes will be measured at 3-, 6-, 12-months, and six months after the end of the follow-ups. Interview scripts and directed content analysis will be constructed based on the Theoretical Domains Framework and the Neuromatrix Model of Pain, Theoretical Domains Framework. Staff interviews will be constructed and analyzed using the Consolidated Framework for Implementation Research. Participants will also complete pain, disability, quality of life and psychological questionnaires, wear an activity tracker at all time points, and complete weekly pain and activity limitation questions using a mobile application. Discussion: The study results will provide evidence to inform potential future implementation of the program. An effective, appropriately targeted, and well implemented exercise program for the long-term management (i.e., tertiary prevention) of LBP could minimize the burden of the condition on patients, the health care system and society. Trial registration: ClinicalTrials.gov NCT05929846. This (Registration Date: July 3 2023) study has been approved by the Hamilton Integrated Research Ethics Board Project ID#15,354. [ABSTRACT FROM AUTHOR]

Background and Aims Design Setting Participants Measurements Findings Conclusions Clinical trials support injectable opioid agonist treatment (iOAT) for individuals with opioid use disorder (OUD) for whom other pharmacological management approaches are not well‐suited. However, despite substantial research indicating that person‐centered care improves engagement, retention and health outcomes for individuals with OUD, structural requirements (e.g. drug policies) often dictate how iOAT must be delivered, regardless of client preferences. This study aimed to quantify clients' iOAT delivery preferences to improve client engagement and retention.Cross‐sectional preference elicitation survey.Metro Vancouver, British Columbia, Canada.124 current and former iOAT clients.Participants completed a demographic questionnaire package and an interviewer‐led preference elicitation survey (case 2 best–worst scaling task). Latent class analysis was used to identify distinct preference groups and explore demographic differences between preference groups.Most participants (n = 100; 81%) were current iOAT clients. Latent class analysis identified two distinct groups of client preferences: (1) autonomous decision‐makers (n = 73; 59%) and (2) shared decision‐makers (n = 51; 41%). These groups had different preferences for how medication type and dosage were selected. Both groups prioritized access to take‐home medication (i.e. carries), the ability to set their own schedule, receiving iOAT in a space they like and having other services available at iOAT clinics. Compared with shared decision‐makers, fewer autonomous decision‐makers identified as a cis‐male/man and reported flexible preferences.Injectable opioid agonist treatment (iOAT) clients surveyed in Vancouver, Canada, appear to prefer greater autonomy than they currently have in choosing OAT medication type, dosage and treatment schedule. [ABSTRACT FROM AUTHOR]

ARTESiA (Apixaban for the Reduction of Thrombo-Embolism in Patients With Device-Detected Sub-Clinical Atrial Fibrillation) demonstrated that apixaban, compared with aspirin, significantly reduced stroke and systemic embolism (SE) but increased major bleeding in patients with subclinical atrial fibrillation. To help inform decision making, the authors evaluated the efficacy and safety of apixaban according to baseline CHA 2 DS 2 -VASc score. We performed a subgroup analysis according to baseline CHA 2 DS 2 -VASc score and assessed both the relative and absolute differences in stroke/SE and major bleeding. Baseline CHA 2 DS 2 -VASc scores were <4 in 1,578 (39.4%) patients, 4 in 1,349 (33.6%), and >4 in 1,085 (27.0%). For patients with CHA 2 DS 2 -VASc >4, the rate of stroke was 0.98%/year with apixaban and 2.25%/year with aspirin; compared with aspirin, apixaban prevented 1.28 (95% CI: 0.43-2.12) strokes/SE per 100 patient-years and caused 0.68 (95% CI: −0.23 to 1.57) major bleeds. For CHA 2 DS 2 -VASc <4, the stroke/SE rate was 0.85%/year with apixaban and 0.97%/year with aspirin. Apixaban prevented 0.12 (95% CI: −0.38 to 0.62) strokes/SE per 100 patient-years and caused 0.33 (95% CI: −0.27 to 0.92) major bleeds. For patients with CHA 2 DS 2 -VASc =4, apixaban prevented 0.32 (95% CI: −0.16 to 0.79) strokes/SE per 100 patient-years and caused 0.28 (95% CI: −0.30 to 0.86) major bleeds. One in 4 patients in ARTESiA with subclinical atrial fibrillation had a CHA 2 DS 2 -VASc score >4 and a stroke/SE risk of 2.2% per year. For these patients, the benefits of treatment with apixaban in preventing stroke/SE are greater than the risks. The opposite is true for patients with CHA 2 DS 2 -VASc score <4. A substantial intermediate group (CHA 2 DS 2 -VASc =4) exists in which patient preferences will inform treatment decisions. (Apixaban for the Reduction of Thrombo-Embolism in Patients With Device-Detected Sub-Clinical Atrial Fibrillation; NCT01938248) [ABSTRACT FROM AUTHOR]

Rationale Aims Method Results Conclusion Patient participation should encapsulate the individual's resources and needs, though such standards remain rationed for people living with a long‐term health concern like kidney failure.To illustrate what patient participation signified to patients and staff in kidney care, and whether an agreed or disagreed conceptualisation occurred over time, evaluating the influence of two study‐specific interventions to facilitate more person‐centred participation.By convergent mixed methods design across 9 units in Sweden, we repeated the following data collection at 3 time points over 18 months: semistructured interviews with patients and staff (n = 72), and structured reviews for accounts of participation in patient records (n = 240). Data were subjected to content analysis and descriptive statistics, respectively. The outcomes were appraised for changes over time besides the interventions to enhance attention to patients' participation: a clinical tool and guidance distributed to management, and additional local support, respectively.Both patients and staff described patient participation as a comprehension of the disease and its management in everyday life. Yet, patients accentuated participation as one's experiences being recognised, and mutual knowledge exchange. Instead, staff emphasised the patients managing their treatment. The health records primarily represented what staff do to support their notion of patient participation. No influence of the interventions was noted, but what signified patient participation was maintained over time.Both patients and staff stress the importance of patient participation, although they focus on different elements. Further person‐centred conduct warrants a shared conceptualisation and strategies addressing and scaffolding patients' preferences and means. [ABSTRACT FROM AUTHOR]