Engaging patients and caregivers in prioritizing symptoms impacting quality of life for Duchenne and Becker muscular dystrophy

Hollin IL, Peay H, Fischer R, Janssen EM, Bridges JFP. Engaging patients and caregivers in prioritizing symptoms impacting quality of life for Duchenne and Becker muscular dystrophy. Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation  2018;27:2261-2273

Hollin_2018_Qual Life Res. Sep;27(9);2261-2273

Patients engagement is important in decision making and research prioritization. Therefore Duchenne/Becker patients and caregivers were asked what the most important symptoms are that should be addressed. Heart and pulmonary problems were considered most important, while attention problems were considered least important.



PURPOSE: Patient preference information (PPI) have an increasing role in regulatory decision-making, especially in benefit-risk assessment. PPI can also facilitate prioritization of symptoms to treat and inform meaningful selection of clinical trial endpoints. We engaged patients and caregivers to prioritize symptoms of Duchenne and Becker muscular dystrophy (DBMD) and explored preference heterogeneity.

METHODS: Best-worst scaling (object case) was used to assess priorities across 11 symptoms of DBMD that impact quality of life and for which there is unmet need. Respondents selected the most and least important symptoms to treat among a subset of five. Relative importance scores were estimated for each symptom, and preference heterogeneity was identified using mixed logit and latent class analysis.

RESULTS: Respondents included patients (n = 59) and caregivers (n = 96) affected by DBMD. Results indicated that respondents prioritized “weaker heart pumping” [score = 5.13; 95% CI (4.67, 5.59)] and pulmonary symptoms: “lung infections” [3.15; (2.80, 3.50)] and “weaker ability to cough” [2.65; (2.33, 2.97)] as the most important symptoms to treat and “poor attention span” as the least important symptom to treat [- 5.23; (- 5.93, – 4.54)]. Statistically significant preference heterogeneity existed (p value < 0.001). At least two classes existed with different priorities. Priorities of the majority latent class (80%) reflected the aggregate results, whereas the minority latent class (20%) did not distinguish among pulmonary and other symptoms.

CONCLUSIONS: Estimates of the relative importance for symptoms of Duchenne muscular dystrophy indicated that symptoms with direct links to morbidity and mortality were prioritized above other non-skeletal muscle symptoms. Findings suggested the existence of preference heterogeneity for symptoms, which may be related to symptom experience.

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