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Author Notes:

Jonathan C. Routh, Division of Urologic Surgery, Duke University Medical Center, DUMC Box 3831, Durham, NC 27710, Phone: 919-684-6994, Fax: 919-681-5507, jonathan.routh@duke.edu

Mr. Dionise conceptualized and designed the study, designed the data collection instrument, supervised data collection, carried out analysis, drafted the initial manuscript, and reviewed and revised the manuscript.

Dr. Gonzalez helped conceptualized the study, designed the data collection instrument, reviewed and revised the manuscript and analysis.

Drs. Garcia-Roig and Kirsch conceptualized the study, designed the data collection instrument, and reviewed and revised the manuscript.

Drs. Scales, Wiener, and Purvis conceptualized the study and reviewed and revised the manuscript.

Dr. Routh conceptualized and designed the study, designed the data collection instrument, supervised data collection, and reviewed and revised the manuscript.

All authors approved the final manuscript as submitted and agree to be accountable for the work.

The authors have no financial relationships relevant to this article to disclose.


Research Funding:

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.


  • Science & Technology
  • Life Sciences & Biomedicine
  • Urology & Nephrology

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

Journal Title:



Volume 128


, Pages 71-77

Type of Work:

Article | Post-print: After Peer Review


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.

Copyright information:


This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (https://creativecommons.org/licenses/by-nc-nd/4.0/).
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