Preference Elicitation Tool for Abnormal Uterine Bleeding Treatment: A Randomized Controlled Trial

Background It is estimated that one-third of women will experience abnormal menstrual bleeding. The majority of these cases are not due to cancer or pregnancy complications and, as a result, women are faced with a variety of treatment alternatives, the selection of which is largely dependent on personal preferences for care rather than clinical outcomes.

This randomized trial was designed to evaluate a preference elicitation tool to promote physician–patient collaborative decision making for treatment of abnormal uterine bleeding (AUB).

Adaptive conjoint analysis (ACA) was used to create a preference elicitation tool in English and in Spanish. Women with AUB were enrolled to the study and randomly assigned to ACA or usual counseling at the initial clinic visit at four clinics (three in Indianapolis, IN, USA, and one in Southern Pines, NC, USA). The ACA tool elicited preferences across eight attributes: treatment efficacy; sexual function; medical care; cost; fertility; frequency of medication use; permanence; and recovery time. t tests were used to compare differences in the primary outcomes of decision regret and treatment satisfaction at the follow-up visit. The study was designed to have 80 % power to detect significant differences between groups for the primary outcomes of regret and satisfaction.

Women were enrolled in the study between September 2009 and March 2012. 183 participants were randomized to ACA and 191 to usual counseling. Overall, mean (standard deviation) treatment satisfaction was high at 35.71 (9.72) (scale of 0–44), and decision regret was low at 25.9 (21.0) (scale of 0–100), creating ceiling effects for the selected outcome variables; there were no significant differences between the ACA and control groups at the follow-up assessment. There was a strong inverse relationship between age and decision regret (p = 0.007). Exploratory subgroup analysis in the youngest quartile comprising 64 women aged 19–35 years showed a statistically non-significant difference in mean regret scores for the ACA group versus usual counseling (24.6 vs. 34.6, respectively; p = 0.08).

A preference elicitation tool at the initial consultation visit did not reduce decision regret or improve treatment satisfaction among patients with AUB; however, there is a need for additional research to further understand this tool’s potential role in promoting collaborative decision making, which may be particularly important among younger women. Similar content being viewed by others

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Satisfaction with ovarian carcinoma risk-reduction strategies among women at high risk for breast and ovarian carcinoma. Cancer. 2011;117(12):2659–67. Acknowledgment The authors would like to thank Indiana University and Southern Pines Women’s Health Center employees Ashley Bozell, MPH, Jane Cole, CMA, Bindu Dukka, MPH, Lynn Nall, RN, Andrea Priest, MPH, and Carol Wuestfeld, RN, for their dedication to the recruitment and follow-up of study participants. Conflict of interest The authors report no conflicts of interest. Financial support This study was funded by a grant to the investigators from the Ralph W. and Grace M. Showalter Research Trust Fund, which had no involvement in the study design, conduct, interpretation, or dissemination. Author contributions The authors each contributed to and approved the final manuscript for publication. The principal and co-investigators, Drs. Hess, Litwiller, Byron, Stutsman, Kasper, and Learman, were responsible for all aspects of the study, including obtaining funding, study design, and procedures patient enrollment, and writing the manuscript. Dr. Hess was the primary investigator responsible for grant writing to obtain support for the study, data analysis, Institutional Review Board (IRB), and regulatory responsibilities and led the work on the manuscript. All investigators were responsible for patient recruitment, enrollment, data collection, conduct of study visits, interpretation of data, and revisions and substantial contributions to the manuscript. Dr. Hess is guarantor of the study and accepts full responsibility for the content of this work. Author information Authors and Affiliations Corresponding author Additional information Clinicaltrials.gov identifier: NCT01721304; http://www.clinicaltrials.gov/ct2/show/NCT01721304. Electronic supplementary material Below is the link to the electronic supplementary material. Rights and permissions About this article Cite this article Hess, L.M., Litwiller, A., Byron, J. et al. Preference Elicitation Tool for Abnormal Uterine Bleeding Treatment: A Randomized Controlled Trial. Patient 8, 217–227 (2015). https://doi.org/10.1007/s40271-014-0078-8 Published: Issue date: DOI: https://doi.org/10.1007/s40271-014-0078-8