MAKING TREATMENT DECISIONS WITH HIV-INFECTION - A PILOT-STUDY OF PATIENT PREFERENCES

The importance of understanding patient preferences in making treatmen t decisions is widely recognized. This pilot study utilized a forced-c hoice paired-comparison method in which 28 ambulatory HIV-infected pat ients were given a computer-generated presentation of all possible pai rs of eight different treatment options for their disease (FDA-approve d medications, experimental and alternative treatments, no medication) . Preferences were analyzed using binary multidimensional scaling anal yses to determine the utility of paired-comparison models for the stud y of treatment-decision making and to identify factors influencing pat ient decision making. Results indicated that a three-dimensional model provided the best fit for the data. One dimension correlated with med ications that raise CD4+ lymphocyte counts (r = 0.92, p < 0.001) and a second dimension correlated with frequency of dosing (r = 0.97, p < 0 .0001). Patients' internal consistency of decision making was inversel y correlated with severity of AIDS dementia symptoms as measured by pe rformance on a neuropsychological test battery (r = -0.55, p < 0.0025) . This finding indicates that AIDS dementia may significantly hinder p atients' ability to use a rational (internally consistent) decision-ma king strategy in making treatment choices. Results also suggested that AIDS patients base treatment decisions primarily on the likelihood of raising CD4+ cell counts and restrictiveness of dosing regimens, but are not influenced by FDA approval status, volume of empirical support for the medications, or even possible harmful side effects. The impli cations of these findings for the treatment of patients with AIDS are discussed.