Patient Preferences for Pain Management Services in Advanced Cancer: Results from a Discrete Choice Experiment

Pain from advanced cancer remains prevalent, severe and often under-treated. New services are required to improve quality of life for patients with cancer pain. A discrete choice experiment (DCE) was conducted with patients to understand their preferences for pain management services to inform service development. Focus groups were used to develop the DCE ‘attributes’ and ‘levels’. The attributes were waiting time, type of healthcare professional, out-of-pocket costs, side-effect control, quality of communication, quality of information, and pain control. Patients from 13 English palliative care services completed the DCE along with clinical and health-related quality of life (HRQoL) questions. A conditional logit model was used to analyse the data. 221 patients completed the survey (45% female; mean age=64.6, range 21.6-92.2). The most important aspects of services were: good pain control, zero out-of-pocket costs and good side-effect control. Poor/ moderate pain control and £30 costs drew the highest negative preferences. Respondents were willing to incur costs ranging £10.26-£12.51 to reduce waiting time by 2 days, receive good information, good communication or to see a specialist pain doctor. Those with lower HRQoL were less willing to wait for treatment and willing to incur higher costs. Outcomes attributes (good pain control, few side effects) were more important than process attributes (waiting times, type of healthcare professional). However, the preference for good information and communication was greater than that to see some types of healthcare professional. Patients were willing to incur small costs (£10) and wait times to receive their preferred level of service.