BMC Med Inform Decis Mak - Measuring preferences for analgesic treatment for cancer pain: how do African-Americans and Whites perform on choice-based conjoint (CBC) analysis experiments?


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CKGROUND: Conjoint 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.METHODS: We 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.RESULTS: Whites 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.CONCLUSIONS: While 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.

Resumo Limpo

ckground conjoint analysi ca can serv import tool studi health dispar uniqu factor under decisionmak divers subgroup howev methodolog advanc need exploit applic ca compar intern extern predict valid intertempor stabil choicebasedconjoint cbc analysi africanamerican white clinic context prefer analges treatment cancer painmethod conduct prospect studi repeatedmeasur two timepoint t baselin t month africanamerican n white n cancerrel pain recruit outpati oncolog clinic philadelphia inform pilot work computerassist cbc experi develop use attribut analges treatment type analges expect pain relief type sideeffect sever sideeffect outofpocket cost design includ choic altern random task holdout task maximum level per attribut intern extern predict valid cbc estim use root likelihood rlh mean absolut error mae respect intertempor stabil assess use cohen kapparesult white predomin trade base pain relief wherea africanamerican trade base type sideeffect timepoint intern valid rlh slight higher white africanamerican rlh africanamerican improv t possibl due learn effect lexicograph domin behavior observ choic dataset white like africanamerican engag lexicograph behavior vs extern valid mae slight better africanamerican white timepoint mae t africanamerican white t africanamerican white t mae increas group possibl reflect increas complex pain treatment decisionmak base expect t oppos realiti t intertempor stabil fair cbc attribut t t kappa ci predict demograph includ raceconclus found slight group differ overal intern extern predict valid cbc compar africanamerican white discuss area investig improv intern extern predict valid cbc experi

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