Parental Preferences for Vesicoureteral Reflux Treatment: a Crowd-sourced, Best-worst Scaling Study.
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2019-03-13
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Abstract
OBJECTIVE:To quantitatively evaluate parental preferences for the various treatments for vesicoureteral reflux using crowd-sourced best-worst scaling, a novel technique in urologic preference estimation. METHODS:Preference data were collected from a community sample of parents via two best-worst scaling survey instruments published to Amazon's Mechanical Turk online community. Attributes and attribute levels were selected following extensive review of the reflux literature. Respondents completed an object case best-worst scaling exercise to prioritize general aspects of reflux treatments and multi-profile case best-worst scaling to elicit their preferences for the specific differences in reflux treatments. Data were analyzed using multinomial logistic regression. Results from the object-case provided probability scaled values (PSV) that reflected the order of importance of attributes. RESULTS:We analyzed data for 248 and 228 respondents for object and multi-profile case BWS, respectively. When prioritizing general aspects of reflux treatment, effectiveness (PSV=20.37), risk of future urinary tract infection (PSV=14.85) and complication rate (PSV=14.55) were most important to parents. Societal cost (PSV=1.41), length of hospitalization (PSV=1.09), and cosmesis (PSV=0.91) were least important. Parents perceived no difference in preference for the cosmetic outcome of open versus minimally invasive surgery (p=0.791). Bundling attribute preference weights, parents in our study would choose open surgery 74.9% of the time. CONCLUSIONS:High treatment effectiveness was the most important and preferred attribute to parents. Alternatively, cost and cosmesis were among the least important. Our findings serve to inform shared parent-physician decision-making for vesicoureteral reflux.
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Dionise, Zachary R, Juan Marcos Gonzalez, Michael L Garcia-Roig, Andrew J Kirsch, Charles D Scales, John S Wiener, J Todd Purves, Jonathan C Routh, et al. (2019). Parental Preferences for Vesicoureteral Reflux Treatment: a Crowd-sourced, Best-worst Scaling Study. Urology. 10.1016/j.urology.2019.01.045 Retrieved from https://hdl.handle.net/10161/18193.
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Scholars@Duke
Juan Marcos Gonzalez
Dr. Gonzalez is an Associate Professor in the Department of Population Health Sciences. He is an expert in the design of stated-preference survey instruments and the use of advanced statistical tools to analyze stated-preference data. His research has focused on the transparency in benefit-risk evaluations of medical interventions, and the elicitation of health preferences from multiple stakeholders to support shared decision making.
Dr. Gonzalez co-led the first FDA-sponsored preference study which was highlighted in FDA’s recent precedent-setting guidance for submitting patient-preference evidence to inform regulatory benefit-risk evaluations of new medical devices. More recently, Dr. Gonzalez collaborated with the Medical Devices Innovation Consortium (MDIC) to prepare the first catalog of preference-elicitation methods (part of the Patient-Centered Benefit-Risk Assessment Framework) suitable for benefit-risk assessments of medical devices. As a core group member of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Conjoint Analysis Task Force, Dr. Gonzalez helped draft good-practice recommendations for statistical analysis, interpretation, and reporting of health preference data. Currently, he is working with the Center for Devices and Radiological Health at FDA to support the Center’s capabilities for the review of stated-preference data in regulatory decisions.
Areas of expertise: Clinical Decision Sciences and Health Measurement
Charles Scales
Charles D. Scales, Jr., MD MSHS FACS is Associate Dean for Clinical Research Initiatives and Associate Professor of Urology and Population Health Science. He completed medical school and residency training in urology at Duke University. After residency, Dr. Scales completed the Robert Wood Johnson Foundation Clinical Scholars Program at UCLA, where he received advanced training in health services research, health policy, and quality of care. He teaches these skills to future generations through the Duke Master of Management in Clinical Informatics (MMCi) degree program, and in 2025 will present his course, “Data, Information, and Health Care Transformation” for the 10th consecutive year.
From the research perspective, Dr. Scales has a longstanding interest in the epidemiology of and patient care for urinary stone disease. Recent studies have redefined the epidemiology of urinary stone disease in the United States, compared the effectiveness of dominant stone removal technologies, and identified new opportunities for improving patient-centered and policy-relevant outcomes, such as unplanned care after procedural interventions. His research and perspective on urinary stone disease has been highlighted in U.S. News & World Report, Reuters, NPR, and the Wall Street Journal, among other media outlets.
Currently, Dr. Scales leads a diverse health services and clinical research program at the Duke Clinical Research Institute, where he is the Principal Investigator for the Scientific Data and Research Center for the NIDDK Urinary Stone Disease Research Network (U01). Within the USDRN, he leads the multicenter Prevention of Urinary Stones with Hydration (PUSH) randomized clinical trial, which is the largest randomized controlled stone prevention trial to date, and the multicenter Study to Enhance Understanding of Stent-Associated Symptoms (STENTS) cohort study.
John Samuel Wiener
As a general pediatric urologist, Dr. Wiener is involved with all aspects of pediatric urology as a clinician and researcher. His research interests are most focused, however, on the urologic management of neurogenic bladder and spina bifida and the molecular biology involving development of the genitourinary tract and disorders.
Dr. Wiener is the principal investigator at Duke for The National Spina Bifida Patient Registry and Urologic Management of Young Children with Spina Bifida protocol administered by the Centers for Disease Control and Prevention. These projects began at Duke in 2011 and 2015, respectively.
Dr. Wiener was previously a project director for the P50 Center for Undiagnosed Pediatric and Urogenital Disorders.
Dr. Wiener has served in national leadership positions in pediatric urology including President of the Society of Fetal Urology, Executive Council of Society for Pediatric Urology, and the Examination Committee of the American Board of Urology. He is currently on the Board of Directors of the Spina Bifida Association
J Todd Purves
Jonathan Charles Routh
I am a pediatric urologist and health services researcher who is interested in caring for children with urological problems, conducting research on how to improve that care, and mentoring young researchers to ensure that the next generation does both better than I currently can.
My clinical interests include minimally-invasive surgery, neurogenic and non-neurogenic voiding dysfunction, complex urologic reconstruction (particularly in children with spina bifida), and pediatric urologic oncology (particularly Wilms tumor and rhabdomyosarcoma). My research has been funded by awards from the NIH, CDC, FDA, and multiple foundations and industry partners, and during my time on faculty at Duke I have had the pleasure of collaborating with many groups and individuals around the world on a number of projects. Over the past 15 years, I have formally mentored nearly 3 dozen undergraduates, medical students, urology residents, post-doctoral students, and junior faculty members across multiple disciplines (pediatrics, urogynecology, urology, and nursing).
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