1 research outputs found
Quantifying patient preferences for symptomatic breast clinic referral: a decision analysis study
Objectives Decision analysis study that incorporates
patient preferences and probability estimates to
investigate the impact of women’s preferences for referral
or an alternative strategy of watchful waiting if faced with
symptoms that could be due to breast cancer.
Setting Community-based study.
Participants Asymptomatic women aged 30–60 years.
Interventions Participants were presented with 11 health
scenarios that represent the possible consequences
of symptomatic breast problems. Participants were
asked the risk of death that they were willing to take in
order to avoid the health scenario using the standard
gamble utility method. This process was repeated for
all 11 health scenarios. Formal decision analysis for the
preferred individual decision was then estimated for each
participant.
Primary outcome measure The preferred diagnostic
strategy was either watchful waiting or referral to a breast
clinic. Sensitivity analysis was used to examine how each
varied according to changes in the probabilities of the
health scenarios.
Results A total of 35 participants completed the
interviews, with a median age 41 years (IQR 35–47 years).
The majority of the study sample was employed (n=32,
91.4%), with a third-level (university) education (n=32,
91.4%) and with knowledge of someone with breast
cancer (n=30, 85.7%). When individual preferences were
accounted for, 25 (71.4%) patients preferred watchful
waiting to referral for triple assessment as their preferred
initial diagnostic strategy. Sensitivity analysis shows that
referral for triple assessment becomes the dominant
strategy at the upper probability estimate (18%) of breast
cancer in the community.
Conclusions Watchful waiting is an acceptable strategy
for most women who present to their general practitioner
(GP) with breast symptoms. These findings suggest that
current referral guidelines should take more explicit
account of women’s preferences in relation to their GPs
initial management strategy