MEDICAL DECISION-MAKING AND THE PATIENT - UNDERSTANDING PREFERENCE PATTERNS FOR GROWTH-HORMONE THERAPY USING CONJOINT-ANALYSIS

OBJECTIVES. This study examines two questions that relate to patients' role in medical decision making: (1) Do patients utilize multiple att ributes in evaluating different treatment options?, and (2) Do patient treatment preferences evidence heterogeneity and disparate patterns? Although research has examined these questions by using either individ ual- or aggregate-level approaches, the authors demonstrate an interme diate level approach (ie, relating to patient subgroups). METHODS. The authors utilize growth augmentation therapy (GAT) as a context for an alyzing these questions because GAT reflects a class of nonemergency t reatments that (1) are based on genetic technology, (2) aim to improve the quality (rather than quantity) of life, and (3) offer useful insi ghts for the patient's role in medical decision making. Using conjoint analysis, a methodology especially suited for the study of patient-co nsumer preferences but largely unexplored in the medical field, data w ere obtained from 154 parents for their decision to pursue GAT far the ir child. RESULTS. In all, six attributes were utilized to study GAT, including risk of long-term side effects (1:10,000 or 1:100,000), cert ainty of effect (50% or 100% of cases), amount of effect (1-2 inches o r 4-5 inches in adult height), out-of-pocket cost ($100, $2,000, or $1 0,000/year) and child's attitude (likes or not likes therapy). An expe rimental design using conjoint analysis procedures revealed five prefe rence patterns that reflect clear disparities in the importance that p arents attach to the different attributes of growth therapy. These pre ference patterns are (1) child-focused (23%), (2) risk-conscious (36%) , (3) balanced (23%), (4) cost-conscious (14%), and (5) ease-of-use (4 %) oriented. Additional tests provided evidence for the validity of th ese preference patterns. Finally, this preference heterogeneity relate d systematically to parental characteristics (eg, demographic, psychol ogic). CONCLUSIONS. The study results offer additional insights into m edical decision making with the consumer as the focal point and extend previous work that has tended to emphasize either an individual- or a ggregate-based analysis. Implications for researchers and health care delivery in general and growth hormone management in particular are pr ovided.