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A protocol for a discrete choice experiment: understanding patient medicine preferences for managing chronic non-cancer pain
  1. Marian Shanahan1,
  2. Briony Larance1,2,
  3. Suzanne Nielsen1,3,
  4. Milton Cohen4,
  5. Maria Schaffer1,
  6. Gabrielle Campbell1
  1. 1 National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, New South Wales, Australia
  2. 2 School of Psychology, University of Wollongong, Wollongong, New South Wales, Australia
  3. 3 Monash Addiction Research Centre, Monash University, Melbourne, Victoria, Australia
  4. 4 Vincent’s Clinical School, UNSW Medicine, University of New South Wales, Sydney, New South Wales, Australia
  1. Correspondence to Dr Marian Shanahan; m.shanahan{at}unsw.edu.au

Abstract

Introduction High rates of chronic non-cancer pain (CNCP), concerns about adverse effects including dependence among those prescribed potent pain medicines, the recent evidence supporting active rather than passive management strategies and a lack of funding for holistic programme have resulted in challenges around decision making for treatment among clinicians and their patients. Discrete choice experiments (DCEs) are one way of assessing and valuing treatment preferences. Here, we outline a protocol for a study that assesses patient preferences for CNCP treatment.

Methods and analysis A final list of attributes (and their levels) for the DCE was generated using a detailed iterative process. This included a literature review, a focus group and individual interviews with those with CNCP and clinicians who treat people with CNCP. From this process a list of attributes was obtained. Following a review by study investigators including pain and addiction specialists, pharmacists and epidemiologists, the final list of attributes was selected (number of medications, risk of addiction, side effects, pain interference, activity goals, source of information on pain, provider of pain care and out-of-pocket costs). Specialised software was used to construct an experimental design for the survey. The survey will be administered to two groups of participants, those from a longitudinal cohort of patients receiving opioids for CNCP and a convenience sample of patients recruited through Australia’s leading pain advocacy body (Painaustralia) and their social media and website. The data from the two participant groups will be initially analysed separately, as their demographic and clinical characteristics may differ substantially (in terms of age, duration of pain and current treatment modality). Mixed logit and latent class analysis will be used to explore heterogeneity of responses.

Ethics and dissemination Ethics approval was obtained from the University of New South Wales Sydney Human Ethics committee HC16511 (for the focus group discussions, the one-on-one interviews and online survey) and HC16916 (for the cohort). A lay summary will be made available on the National Drug and Alcohol Research Centre website and Painaustralia’s website. Peer review papers will be submitted, and it is expected the results will be presented at relevant pain management conferences nationally and internationally. These results will also be used to improve understanding of treatment goals between clinicians and those with CNCP.

  • discrete choice experiment
  • chronic non-cancer pain
  • preferences

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Footnotes

  • Contributors MSh was lead author and responsible for the study design, conducted the qualitative interviews and analysis, and the writing of the paper. GC and BL were involved qualitative interviews and its analysis. Msc contributed to the survey development and administration of the survey. MSh, BL, SN, MC and GC were involved in defining and selecting the attributes and levels. All authors provided detailed input to the paper.

  • Funding This was supported by the Australian National Health and Medical Research Council (NHMRC) (APP 1100822) and the Australian Government. The National Drug and Alcohol Research Centre, University of New South Wales Sydney is supported by funding from the Australian Government, under the Substance Misuse Prevention and Service Improvements Grant Fund. SN and GC are the recipients of an NHMRC Research Fellowship (#1132433 and #1119992).

  • Competing interests BL and SN report investigator-driven untied educational grants from Reckitt Benckiser/Indivior for studies of buprenorphine-naloxone and buprenorphine depot, the development of an opioid-related behaviour scale and a study of opioid substitution therapy uptake among chronic non-cancer pain patients. BL has also received investigator-initiated untied educational grants for post-marketing surveillance studies of opioids from Mundipharma Limited (a tamper-resistant oxycodone formulation) and Seqirus (tapentadol). These funders had no role in the design, conduct or interpretation of these studies. These studies were unrelated to the current discrete choice experiment protocol or broader pain and opioids in treatment study. SN has provided training around treatment of codeine dependence for which her institution received funding from Indivior. GC reports investigator-driven untied educational grants from Reckitt Benckiser for the development of an opioid-related behaviour scale. MC reports receiving fees from Mundipharma Limited for preparation and presentation of educational material.

  • Patient consent for publication Obtained.

  • Ethics approval Ethics approval was obtained from the UNSW Human Ethics committee HC16511 (for the focus group discussions, the one-on-one interviews and online survey) and HC16916 (for the cohort).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No additional data are available.