Patient Preferences for Long-Term Implant Care in Cochlear, Glaucoma and Cardiovascular Diseases
Abstract
:1. Introduction
2. Materials and Methods
2.1. Discrete Choice Experiments
2.1.1. Attributes and Levels
2.1.2. Experimental Design
2.2. Data Collection
2.3. Analysis
2.3.1. Model of Utility
β4*infoCLINIC + β5* futureoptionPRESERVE + β6* technCOMPATIBLE + β7*
aftercareVARYING + β8* educationCOMPR + εi
2.3.2. Statistical Analysis
3. Results
3.1. Patient Preferences for Sustainable Implant Care in the Context of Cochlear Implants
3.2. Patient Preferences for Sustainable Implant Care in the Context of Glaucoma Implants
3.3. Patient Preferences for Sustainable Implant Care in the Context of Cardiovascular Implants
4. Discussion
4.1. Study Implications for Future Developments in Long-Term Implant Care
4.2. Strengths and Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Appendix A. Models of Utility
Appendix A.1. Model of Utility in Cochlear-DCE
+ β5* futureoptionPRESERVE + β6* technCOMPATIBLE + β7* aftercareVARYING +
β8* educationCOMPR + εi
Appendix A.2. Model of Utility in Glaucoma-DCE
β4*failureREMOVAL + β5*chancesofsuccessHIGHER +
β6*infosourceINDEPENDENT + β7*dataAVAILABLE + β8*infoexchangeAUTOM + εi
Appendix A.3. Model of Utility in Cardiovascular-DCE
+ β4*dataAVAILABL + β5*infoexchangeAUTOM + β6*successREIMPL + β7*
invasivenessSURGERY + εi
Appendix B. Overview of Model Effects
Wald Chi-Square | df | Sig. | |
---|---|---|---|
(Intercept) | 0.896 | 1 | 0.344 |
decision making | 39.045 | 2 | <0.001 ** |
information source | 26.590 | 2 | <0.001 ** |
preserving access to alternative treatments | 34.666 | 1 | <0.001 ** |
technological compatibility | 74.130 | 1 | <0.001 ** |
care relationship in aftercare | 2.211 | 1 | 0.137 |
education | 25.501 | 1 | <0.001 ** |
sex | 0.934 | 1 | 0.334 |
age | 0.023 | 1 | 0.880 |
Wald Chi-Square | df | Sig. | |
---|---|---|---|
(Intercept) | 0.563 | 1 | 0.453 |
decision making | 7.328 | 2 | 0.026 * |
corrective measure in case of implant failure | 7.001 | 2 | 0.030 * |
probability of treatment effect | 15.167 | 1 | <0.001 ** |
information source | 6.684 | 1 | 0.010 * |
data transparency | 13.382 | 1 | <0.001 ** |
information exchange between health professionals | 0.056 | 1 | 0.814 |
sex | 0.256 | 1 | 0.613 |
age | 1.373 | 1 | 0.241 |
Wald Chi-Square | df | Sig. | |
---|---|---|---|
(Intercept) | 1.610 | 1 | 0.204 |
decision making | 6.296 | 2 | 0.043 * |
information source | 0.132 | 1 | 0.716 |
sex | 0.340 | 1 | 0.560 |
data transparency | 7.787 | 1 | 0.005 * |
information exchange between health professionals | 0.053 | 1 | 0.818 |
means of maintaining treatment success | 24.946 | 1 | <0.001 ** |
invasiveness of intervention | 2.519 | 1 | 0.113 |
age | 1.886 | 1 | 0.170 |
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COCHLEAR-DCE | ||||
Attribute | Attribute Description | Level 1 (Reference) | Level 2 | Level 3 |
Decision making | Final decision on the implantation of a specific manufacturer’s CI model lies… | Only with your doctor [decisionDOC] | With you and your doctor [decisionSHARED, β1] | Only with you [decisionPAT, β2] |
Information source | Obtaining information about developments regarding the CI and care context: | Through own research [infoRESEARCH] | Automatically by the manufacturer [infoMANU, β3] | Automatically by the clinic or audiologist [infoCLINIC, β4] |
Access to alternative treatments in the future | Other treatment options after CI implantation, which are still being researched and may be available in the future... | Are excluded [futureoptionEXCLUDED] | Remain available [futureoptionPRESERVE, β5] | - |
Technological compatibility | Compatibility with newer CI models and accessories or devices from other manufacturers | Not compatible [technUNCOMPATIBLE] | Compatible [technCOMPATIBLE, β6] | - |
Care relationship in aftercare | Carrying out aftercare: | Fixed staff of professionals who are in exchange [aftercareFIXED] | Varying professionals according to specific needs [aftercareVARYING, β7] | - |
Education | Education regarding adjustments, decisions and innovations regarding your CI is... | Not very comprehensive [educationLITTLE] | Very comprehensive [educationCOMPR, β8] | - |
GLAUCOMA-DCE | ||||
Attribute | Attribute description | Level 1 (Reference) | Level 2 | Level 3 |
Decision making | Final decision on the implantation of a specific manufacturer’s CI model lies… | Only with your doctor [decisionDOC] | With you and your doctor [decisionSHARED, β1] | Only with you [decisionPAT, β2] |
Means in case of implant failure | Corrective measure in the event that the implant does not (or no longer) work | Implant stays in the eye [failureSTAY] | Correction by means of intervention [failureCORRECTION, β3] | Implant removal [failureREMOVAL, β4] |
Probability of treatment success | Chances of success of still not needing glaucoma medication 2 years after implantation are: | Over 50% [chancesofsuccessLOWER] | Over 75% [chancesofsuccessHIGHER, β5] | - |
Information source | Information that goes beyond implantation and aftercare (e.g., on nutrition, drops for dry eyes, glasses, etc.) will be provided… | In the context of implant care from the medical side [infosourceMEDICAL] | From independent information sources (e.g., glaucoma forum) [infosourceINDEPENDENT, β6] | - |
Data transparency | Statistics and empirical values on implantation in the treating clinic… | Are not available [dataNONAVAILABLE] | Are available [dataAVAILABLE, β7] | - |
Information exchange between health professionals | Exchange of information between different health professionals (e.g., resident ophthalmologist, family doctor and clinic) | You coordinate yourself [infoexchangePAT] | Takes place automatically [infoexchangeAUTOM, β8] | - |
CARDIOVASCULAR-DCE | ||||
Attribute | Attribute description | Level 1 (Reference) | Level 2 | Level 3 |
Decision making | Final decision on the implantation of a specific manufacturer’s CI model lies… | Only with your doctor [decisionDOC] | With you and your doctor [decisionSHARED, β1] | Only with you [decisionPAT, β2] |
Information source | Information that goes beyond implantation and aftercare (e.g., on nutrition, lifestyle, etc.) will be provided… | In the context of implant care from the medical side [infoMEDICAL] | From independent information sources (e.g., German Heart Foundation) [infosourceINDEPENDENT, β3] | - |
Data transparency | Statistics and empirical values on stent implantation in the treating heart clinic… | Are not available [dataNONAVAILABLE] | Are available [dataAVAILABLE, β4] | - |
Information exchange between health professionals | Exchange of information between different health professionals (e.g., family doctor, clinic and other health professionals) | You coordinate yourself [infoexchangePAT] | Takes place automatically [infoexchangeAUTOM, β5] | - |
Means of maintaining treatment success | The long-term success of the treatment can be secured by… | Lifelong medication (e.g., blood thinners) [successMEDICATION] | New implant every 10 years [successREIMPL, β6] | - |
Invasiveness of intervention | The implant is inserted… | Minimally invasive (without opening the chest) [invasivenessMIN] | Surgical (chest opening) [invasivenessSURGERY, β7] | - |
Inclusion | Exclusion |
---|---|
(prospective) Implant wearer of respective implants | Not an (prospective) implant wearer of respective implants |
Minimum age: 18 years | Age < 18 years |
Consent | Does not consent to voluntary study participation or data processing |
Attribute Levels (Ref: Reference Category) | Term in Model Equation | B | SE | Wald | df | Sig. | OR | 95% Confidence Interval for OR | |
---|---|---|---|---|---|---|---|---|---|
Lower | Upper | ||||||||
Final decision on the implantation of a specific manufacturer’s CI model lies with the patient and their doctors (ref: only doctor) | decisionSHARED | 1.010 | 0.165 | 37.690 | 1 | <0.001 ** | 2.745 | 1.989 | 3.789 |
Final decision on the implantation of a specific manufacturer’s CI model lies with the patient only (ref: only doctor) | decisionPAT | 0.627 | 0.146 | 18.396 | 1 | <0.001 ** | 1.872 | 1.406 | 2.494 |
Obtaining information about the developments regarding the CI and care context automatically by the clinic or audiologist (ref: own research) | infoCLINIC | 0.569 | 0.110 | 26.576 | 1 | <0.001 ** | 1.767 | 1.423 | 2.194 |
Obtaining information about the developments regarding the CI and care context automatically by the manufacturer (ref: own research) | infoMANU | 0.340 | 0.128 | 7.084 | 1 | 0.008 * | 1.404 | 1.094 | 1.803 |
Other treatment options after CI implantation, which are still being researched and may be available in the future remain available (ref: are excluded) | futureoptionPRESERVE | 0.881 | 0.15 | 34.666 | 1 | <0.001 ** | 2.414 | 1.800 | 3.237 |
CI is compatible with newer CI models and accessories or devices from other manufacturers (ref: no technological compatibility) | technCOMPATIBLE | 1.569 | 0.182 | 74.130 | 1 | <0.001 ** | 4.800 | 3.358 | 6.859 |
Aftercare is carried out by a variety of professionals according to specific needs (ref: fixed staff of professionals who are in exchange) | aftercareVARYING | −0.172 | 0.116 | 2.211 | 1 | 0.137 | 0.842 | 0.672 | 1.056 |
Education regarding adjustments, decisions and innovations regarding your CI is very comprehensive (ref: little comprehensive) | educationCOMPR | 0.781 | 0.155 | 25.501 | 1 | <0.001 ** | 2.185 | 1.613 | 2.958 |
sex | −0.005 | 0.005 | 0.934 | 1 | 0.334 | 0.995 | 0.984 | 1.005 | |
age | 0.000 | 0.000 | 0.023 | 1 | 0.880 | 1.000 | 1.000 | 1.000 | |
(intercept) | −2.366 | 0.1830 | 167.151 | 1 | <0.001 ** | 0.094 | 0.066 | 0.134 |
Attribute Levels (Ref: Reference Category) | Term in Model Equation | B | SE | Wald | df | Sig. | OR | 95% Wald Confidence Interval for OR | |
---|---|---|---|---|---|---|---|---|---|
Lower | Upper | ||||||||
Final decision on the implantation of a specific manufacturer’s GI model lies with the patient and their doctors (ref: only doctor) | decisionSHARED | 0.681 | 0.327 | 4.334 | 1 | 0.037 * | 1.976 | 1.041 | 3.752 |
Final decision on the implantation of a specific manufacturer’s GI model lies with the patient only (ref: only doctor) | decisionPAT | 0.192 | 0.38 | 0.256 | 1 | 0.613 | 1.212 | 0.576 | 2.549 |
Corrective measure in the event that the implant does not (or no longer) work: correction by means of intervention (ref: implant stays in the eye) | failureCORRECTION | 0.762 | 0.311 | 6.003 | 1 | 0.014 * | 2.142 | 1.165 | 3.938 |
Corrective measure in the event that the implant does not (or no longer) work: implant removal (ref: implant stays in the eye) | failureREMOVAL | 0.250 | 0.273 | 0.843 | 1 | 0.358 | 1.285 | 0.753 | 2.192 |
Chances of success of still not needing glaucoma medication 2 years after implantation is over 75% (ref: over 50%) | chancesofsuccessHIGHER | 1.714 | 0.440 | 15.167 | 1 | <0.001 ** | 5.551 | 2.343 | 13,152 |
Information that goes beyond implantation and aftercare (e.g., on nutrition, drops for dry eyes, glasses, etc.) will be provided from independent information sources (e.g., glaucoma forum) (ref: in the context of implant care from the medical side) | infosourceINDEPENDENT | −0.814 | 0.315 | 6.684 | 1 | 0.010 * | 0.443 (2.257) 1 | 0.239 (1.218) 1 | 0.821 (4.184) 1 |
Statistics and empirical values on implantation in the treating clinic are available (ref: not available) | dataAVAILABLE | 0.932 | 0.255 | 13.382 | 1 | <0.001 ** | 2.540 | 1.541 | 4.185 |
Exchange of information between different health professionals (e.g., resident ophthalmologist, family doctor and clinic): takes places automatically (ref: you coordinate yourself) | infoexchangeAUTOM | −0.053 | 0.227 | 0.056 | 1 | 0.814 | 0.948 | 0.608 | 1.478 |
sex | −0.003 | 0.007 | 0.256 | 1 | 0.613 | 0.997 | 0.984 | 1.010 | |
age | 0.001 | 0.000 | 1.373 | 1 | 0.241 | 1.001 | 1.000 | 1.001 | |
(Intercept) | −1.537 | 0.463 | 11.047 | 1 | <0.001 ** | 0.215 | 0.087 | 0.532 |
Attribute Levels (Ref: Reference Category) | Term in Model Equation | B | SE | Wald | df | Sig. | OR | 95% Wald Confidence Interval for OR | |
---|---|---|---|---|---|---|---|---|---|
Lower | Upper | ||||||||
Final decision on the implantation of a specific manufacturer’s CVI model lies with the patient and their doctors (ref: only doctor) | decisionSHARED | 0.994 | 0.396 | 6.294 | 1 | 0.012 * | 2.702 | 1.243 | 5.874 |
Final decision on the implantation of a specific manufacturer’s CVI model lies with the patient only (ref: only doctor) | decisionPAT | 0.579 | 0.289 | 4.021 | 1 | 0.045 * | 1.784 | 1.013 | 3.142 |
Information that goes beyond implantation and aftercare (e.g., on nutrition, lifestyle, etc.) will be provided by independent information sources (ref: in the context of implant care from the medical side) | infosourceINDEPENDENT | −0.123 | 0.340 | 0.132 | 1 | 0.716 | 0.884 | 0.454 | 1.721 |
Statistics and empirical values on implantation in the treating heart clinic are available (ref: not available) | dataAVAILABLE | 0.450 | 0.161 | 7.787 | 1 | 0.005 * | 1.568 | 1.143 | 2.150 |
Exchange of information between different practitioners (e.g., family doctor, clinic and other practitioners) | infoexchangeAUTOM | −0.057 | 0.248 | 0.053 | 1 | 0.818 | 0.945 | 0.581 | 1.536 |
The long-term success of the treatment can be secured with a new implant every 10 years (ref: lifelong medication) | successREIMPL | −2.473 | 0.495 | 24.946 | 1 | <0.001 ** | 0.084 (11.9) 1 | 0.032 (4.484) 1 | 0.223 (31.25) 1 |
The implant is inserted surgically (chest opening) (ref: minimally invasive) | invasivenessSURGERY | −0.738 | 0.465 | 2.519 | 1 | 0.113 | 0.478 | 0.192 | 1.189 |
sex | 0.003 | 0.006 | 0.340 | 1 | 0.560 | 1.003 | 0.992 | 1.015 | |
age | 0.000 | 0.000 | 1.886 | 1 | 0.170 | 1.000 | 1.000 | 1.001 | |
(Intercept) | 0.915 | 0.5089 | 3.236 | 1 | 0.072 | 2.498 | 0.921 | 6.772 |
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Schulz, S.; Harzheim, L.; Hübner, C.; Lorke, M.; Jünger, S.; Buchholz, A.; Frech, S.; Steffens, M.; Woopen, C. Patient Preferences for Long-Term Implant Care in Cochlear, Glaucoma and Cardiovascular Diseases. Int. J. Environ. Res. Public Health 2023, 20, 6358. https://doi.org/10.3390/ijerph20146358
Schulz S, Harzheim L, Hübner C, Lorke M, Jünger S, Buchholz A, Frech S, Steffens M, Woopen C. Patient Preferences for Long-Term Implant Care in Cochlear, Glaucoma and Cardiovascular Diseases. International Journal of Environmental Research and Public Health. 2023; 20(14):6358. https://doi.org/10.3390/ijerph20146358
Chicago/Turabian StyleSchulz, Sabine, Laura Harzheim, Constanze Hübner, Mariya Lorke, Saskia Jünger, Annika Buchholz, Stefanie Frech, Melanie Steffens, and Christiane Woopen. 2023. "Patient Preferences for Long-Term Implant Care in Cochlear, Glaucoma and Cardiovascular Diseases" International Journal of Environmental Research and Public Health 20, no. 14: 6358. https://doi.org/10.3390/ijerph20146358