Data from: 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 (SG) 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, 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 median age 41 years (Interquartile range 35 to 47 years). The majority of the study sample were 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 GP with breast symptoms. These findings suggest that current referral guidelines should take more explicit account of women’s preferences in relation in terms of the initial diagnostic strategy for symptomatic breast problems.研究目标：本研究为一项纳入患者偏好与概率估计的决策分析研究，旨在探讨女性出现疑似乳腺癌症状时，其对转诊或密切观察等待这两种备选策略的偏好所产生的影响。 研究场景：基于社区的研究。 研究对象：年龄30~60岁的无症状女性。 干预措施：向研究对象展示11种可反映乳腺症状潜在结局的健康场景。采用标准博弈（standard gamble, SG）效用法，询问研究对象为规避该健康场景所愿意承担的死亡风险。针对全部11种健康场景重复上述流程。随后为每位参与者估算其偏好个体化决策的正式决策分析模型。 主要结局指标：偏好的初始诊断策略，包括密切观察等待或转诊至乳腺专科门诊。采用敏感性分析，探究各结局指标如何随健康场景发生概率的变化而发生改变。 研究结果：共计35名参与者完成访谈，中位年龄为41岁（四分位距35~47岁）。研究对象中绝大多数为在职状态（n=32，占比91.4%），均接受过高等教育（大学及以上学历，n=32，91.4%），且有亲友罹患乳腺癌（n=30，85.7%）。在纳入个体偏好因素后，25名（71.4%）参与者更倾向于选择密切观察等待，而非转诊接受三联评估（triple assessment）作为初始诊断策略。敏感性分析结果显示，当社区乳腺癌概率估计值达到上限（18%）时，转诊接受三联评估将成为最优策略。 研究结论：对于多数因乳腺症状就诊于全科医生（General Practitioner, GP）的女性而言，密切观察等待是一项可接受的诊疗策略。本研究结果提示，当前的转诊指南应更明确地将女性的偏好纳入考量，以制定针对乳腺症状患者的初始诊断策略。