Details

Autor(en) / Beteiligte

• Kravitz, Richard L.
• Marois, Maria
• Sim, Ida
• Ward, Deborah
• Kanekar, Samika S.
• Yu, Allison
• Dounias, Peach
• Yang, Jiabei
• Wang, Youdan
• Schmid, Christopher H.

Titel

Chronic pain treatment preferences change following participation in N-of-1 trials, but not always in the expected direction

Ist Teil von

• Journal of clinical epidemiology, 2021-11, Vol.139, p.167-176

Ort / Verlag

United States: Elsevier Inc

Erscheinungsjahr

2021

Link zum Volltext

Quelle

MEDLINE

Beschreibungen/Notizen

• •Treatment preferences are “sticky”: only a minority of patients change their minds about treatment based on N-of-1 trials.•Different schemes for defining treatment success lead to different conclusions about whether patients’ treatment choices are concordant with their own data.•Patients and clinicians need more help interpreting personalized results. To examine pain treatment preferences before and after participation in an N-of-1 trial. In this observational study nested within a randomized trial, we examined chronic pain patients’ preferences before and after treatment in relation to N-of-1 trial results; assessed the influence of different schemes for defining comparative “superiority” on potential conclusions; and generated classification trees illustrating the relationship between pre-treatment preferences, N-of-1 trial results, and post-treatment preferences. Treatment preferences differed pre- and post-trial for 40% of participants. The proportion of patients whose N-of-1 trials demonstrated “superiority” of one treatment regimen over the other varied depending on how superiority was defined and ranged from 24% (using criteria that required statistically significant differences between regimens) to 62% (when relying only on differences in point estimates). Regardless of criteria for declaring treatment superiority, nearly three-fourths of patients with equivocal N-of-1 trial results nevertheless expressed definite preferences post-trial. A large segment of patients undergoing N-of-1 trials for chronic pain altered their treatment preferences. However, the direction of preference change did not necessarily correspond to the N-of-1 results. More research is needed to understand how patients use N-of-1 trial results, why preferences are “sticky” even in the face of personalized data, and how patients and clinicians might be educated to use N-of-1 trial results more informatively.