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Patient preferences for personalized (N-of-1) trials
A conjoint analysis
Moise, N., Wood, D., Kuen K Cheung, Y., Duan, N., Onge, T. S., Duer-Hefele, J., Pu, T., Davidson, K. W., Kronish, I. M., & members of the “Personalized Trial Collaboratory” (2018). Patient preferences for personalized (N-of-1) trials: A conjoint analysis. Journal of Clinical Epidemiology, 102, 12-22. https://doi.org/10.1016/j.jclinepi.2018.05.020
OBJECTIVE: Despite their promise for increasing treatment precision, Personalized Trials (i.e., N-of-1 trials) have not been widely adopted. We aimed to ascertain patient preferences for Personalized Trials.
STUDY DESIGN AND SETTING: We recruited 501 adults with ≥2 common chronic conditions from Harris Poll Online. We used Sawtooth Software to generate 45 plausible Personalized Trial designs comprising combinations of eight key attributes (treatment selection, treatment type, clinician involvement, blinding, time commitment, self-monitoring frequency, duration, and cost) at different levels. Conditional logistic regression was used to assess relative importance of different attributes using a random utility maximization model.
RESULTS: Overall, participants preferred Personalized Trials with no costs vs. $100 cost (utility difference 1.52 [standard error 0.07], P < 0.001) and with less vs. more time commitment/day (0.16 [0.07], P < 0.015) but did not hold preferences for the other six attributes. In subgroup analyses, participants ≥65 years, white, and with income ≤$50,000 were more averse to costs than their counterparts (P all <0.05).
CONCLUSION: To optimize dissemination, Personalized Trial designers should seek to minimize out-of-pocket costs and time burden of self-monitoring. They should also consider adaptive designs that can accommodate subgroup differences in design preferences.
