Preferences for Prophylactic Oral Antibiotic Use in Dermatologic Surgery: A Multicenter Discrete Choice Experiment.

BACKGROUND: Antibiotics are often prescribed after dermatologic surgery for infection prophylaxis, but patient preferences about prophylactic antibiotics are not well understood. OBJECTIVE: To understand patient preferences about taking antibiotics to prevent surgical site infection (SSI) relative to antibiotic efficacy and antibiotic-associated adverse drug reactions. MATERIALS AND METHODS: Multi-center, prospective discrete choice experiment (DCE). RESULTS: Three hundred thirty-eight respondents completed the survey and DCE. 54.8% of respondents preferred to take an antibiotic if it reduced the SSI rate from 5% to 2.5% and if the risk of adverse drug reactions was low (1% risk gastrointestinal upset, 0.5% risk itchy skin rash, 0.01% risk emergency department visit). Even if an antibiotic could eliminate SSI risk (0% risk SSI) and had a low adverse drug reaction profile, 26.7% of respondents prefer not to take prophylactic oral antibiotics. CONCLUSION: Risk-benefit thresholds for taking antibiotics to prevent SSI vary widely. Clinical trials are needed to better characterize the effectiveness and risks of oral antibiotic SSI prophylaxis to guide decision-making. Future studies should also evaluate whether shared decision-making can improve the patient experience.

Patients prioritize local recurrence risk over other attributes for surgical treatment of facial melanomas-Results of a stated preference survey and choice-based conjoint analysis.

BACKGROUND: Surgical treatment options for facial melanomas include conventional excision with postoperative margin assessment, Mohs micrographic surgery (MMS) with immunostains (MMS-I), and slow MMS. Patient preferences for these surgical options have not been studied. OBJECTIVES: To evaluate patient preferences for surgical treatment of facial melanoma and to determine how patients value the relative importance of different surgical attributes. METHODS: Participants completed a 2-part study consisting of a stated preference survey and a choice-based conjoint analysis experiment. RESULTS: Patients overwhelmingly (94.3%) rated local recurrence risk as very important and ranked it as the most important attribute of surgical treatment for facial melanoma. Via choice-based conjoint analysis, patients ranked the following surgical attributes from highest to lowest in importance: local recurrence rate, out-of-pocket cost, chance of second surgical visit, timing of reconstruction, travel time, and time in office for the procedure. Consistent with their prioritization of low local recurrence rates, more than 73% of respondents selected MMS-I or slow MMS as their preferred treatment option for a facial melanoma. LIMITATIONS: Data were obtained from a single health system. CONCLUSION: Patients prefer surgical treatment options that minimize risk for local recurrence. Logistics for travel and treatment have less influence on patient preferences. Most survey participants chose MMS-I to maximize local cure and convenience of care.

Patient Preferences for the Treatment of Basal Cell Carcinoma: A Mapping Review of Discrete Choice Experiments.

BACKGROUND: Treatment options for skin cancer differ in several attributes including efficacy, convenience, cost, scarring, and side effects. Discrete choice experiments (DCEs) provide insight into how patients value the attributes of their treatment options. OBJECTIVE: To review published DCE data on skin cancer treatment. METHODS: PubMed database was systematically searched using predefined keyword combinations for articles pertaining to skin cancer treatment and DCEs through October 2017. Three hundred seventy unique article titles were evaluated, and titles that did not mention skin cancer treatment were excluded leaving 44 studies. Abstracts of 44 studies were examined, and studies that used DCEs to query preference for skin cancer treatment were included in this mapping review. RESULTS: Six articles that used DCEs to query patient preference for skin cancer treatment were reviewed. All DCE studies identified focused on basal cell carcinoma. CONCLUSION: Discrete choice experiments are a rigorous method of eliciting patient preference for skin cancer surgery. Recurrence was the most important attribute in 4 of the 6 studies reviewed. Appearance was the most important attribute in 1 study and the second most important in 3 studies. Comparisons between studies are limited by the heterogeneity of the treatment attributes and levels included in DCEs.