Parental Preferences for Vesicoureteral Reflux Treatment: A Crowd-sourced, Best-worst Scaling Study

• Type of Material: Article
• Authors: Zachary R. Dionise, Duke University; Juan Marcos Gonzalez, Duke University; Michael Garcia-Roig, Emory University; Andrew Kirsch, Emory University; Charles D. Scales Jr., Duke University; John S. Wiener, Duke University; J. Todd Purves, Duke University; Jonathan C. Routh, Duke University
• Language: English
• Date: 2019-06-01
• Publisher: ELSEVIER SCIENCE INC
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: ELSEVIER SCIENCE INC
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.urology.2019.01.045
• Title of Journal or Parent Work: UROLOGY
• Volume: 128
• Start Page: 71
• End Page: 77
• Grant/Funding Information: Mr. Dionise is supported in part by a Urology Care Foundation Summer Medical Student Fellowship from the American Urological Association (AUA). Dr. Routh is supported in part by grant K08-DK100534 from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Neither funding source had any role in the collection, analysis, and interpretation of data; in the writing of the manuscript; or in the decision to submit the manuscript for publication.
• Keywords: Science & Technology; DEXTRANOMER/HYALURONIC ACID; CHILDREN; Urology & Nephrology; SURGERY; PATIENT; Life Sciences & Biomedicine; MANAGEMENT; OUTCOMES; PROPHYLAXIS
• Research Categories: Health Sciences, Health Care Management; Health Sciences, Medicine and Surgery; Sociology, Public and Social Welfare

Abstract

Objective: To quantitatively evaluate parental preferences for the various treatments for vesicoureteral reflux using crowd-sourced best-worst scaling, a novel technique in urologic preference estimation. Methods: Preference data were collected from a community sample of parents via 2 best-worst scaling survey instruments published to Amazon's Mechanical Turk online community. Attributes and attribute levels were selected following extensive review of the reflux literature. Respondents completed an object case best-worst scaling exercise to prioritize general aspects of reflux treatments and multiprofile case best-worst scaling to elicit their preferences for the specific differences in reflux treatments. Data were analyzed using multinomial logistic regression. Results from the object-case provided probability scaled values (PSV) that reflected the order of importance of attributes. Results: We analyzed data for 248 and 228 respondents for object and multiprofile case BWS, respectively. When prioritizing general aspects of reflux treatment, effectiveness (PSV = 20.37), risk of future urinary tract infection (PSV = 14.85), and complication rate (PSV = 14.55) were most important to parents. Societal cost (PSV = 1.41), length of hospitalization (PSV = 1.09), and cosmesis (PSV = 0.91) were least important. Parents perceived no difference in preference for the cosmetic outcome of open vs minimally invasive surgery (P = .791). Bundling attribute preference weights, parents in our study would choose open surgery 74.9% of the time. Conclusion: High treatment effectiveness was the most important and preferred attribute to parents. Alternatively, cost and cosmesis were among the least important. Our findings serve to inform shared parent-physician decision-making for vesicoureteral reflux.