Patient Perception, Preference and Participation Adaptive Conjoint Analysis as individual preference assessment tool: Feasibility through the internet and reliability of preferences Arwen H. Pieterse a, *, Frank Berkers b , Monique C.M. Baas-Thijssen a , Corrie A.M. Marijnen c , Anne M. Stiggelbout a a Department of Medical Decision Making, University Medical Center Leiden, Leiden, the Netherlands b TNO Information and Communication Technology, Delft, the Netherlands c Department of Clinical Oncology, Leiden University Medical Center, Leiden, the Netherlands 1. Introduction Clinicians often do not adequately judge the importance patients place on treatment aspects or outcomes [1–4]. Especially preference-sensitive decisions should incorporate patient values [5]. However, the latter are not routinely assessed in practice. Several methodologies have been developed to clarify personal values patients associate with treatment aspects. Often-used techniques such as decision boards [6,7], videotapes [8,9], and rating scales ask for treatment preference. They do not reveal how treatment aspects contribute to overall judgments [10], so results are limited to particular clinical contexts. Techniques such as Standard Gambles and Time TradeOffs, measure utilities for treatment aspects; their applicability at the individual level is questionable [11]. Balance scales ask individuals to nominate and value treatment aspects they consider relevant. These exercises are straightforward but a-theoretical. Adaptive Conjoint Analysis (ACA)-based exercises seem good candidates to implement in practice as values clarification tasks to aid individually tailored treatment decision-making. ACA origi- nates from traditional conjoint analysis and has a strong theoretical basis [12–14]. Using this decomposed methodology, the relative importance of treatment aspects may be investigated. The ACA-questionnaire is computer-administered and presents paired combinations of treatment aspects. The pairs are increas- ingly tailored to what participants consider relevant tradeoffs, thereby fostering involvement in the task [15] and possibly assisting patients’ thoughtful evaluation. ACA is increasingly applied in studies assessing preferences at a group-level, including studies among HIV [16,17], rheumatology [18–21], and oncology patients [22], patients with growth hormone deficiencies [23], and patients about to undergo major surgery [24]. In this study we Patient Education and Counseling 78 (2010) 224–233 ARTICLE INFO Article history: Received 5 December 2008 Received in revised form 11 March 2009 Accepted 6 May 2009 Keywords: Decision support Patient values Rectal cancer Treatment outcome Conjoint analysis ABSTRACT Objective: Patient values are not routinely assessed in clinical practice. Adaptive Conjoint Analysis (ACA) is increasingly applied in studies assessing treatment preferences, and could provide a means to routinely assess individual patients’ treatment preferences. Methods: An ACA-questionnaire was administered three times (7–10 days apart) to 98 long-term rectal cancer survivors either on a portable computer or through internet, to assess whether (a) responses differ according to administration mode, (b) relative importances of rectal cancer treatment outcomes (survival, local control, incontinence, sexual problems) consolidate over time, (c) ACA-outcomes are sufficiently reliable (ICC) for use in individual decision-making. We also evaluated patients’ acceptance of ACA. Results: Mode did not affect ACA-completion or evaluation. Importance scores did not consolidate over time. ICCs were poor for sexual problems and fair for the other outcomes, and were at least equal or higher from first to second retest. Most participants valued completing the ACA-questionnaire and learning their results. Conclusion: Values did not show consolidation over time. ACA-derived preferences should not determine which treatment patients should choose. Practice implications: Findings extend ACA-validation studies to the health care setting and suggest that ACA-questionnaires might be appreciated as adjuncts to treatment decision-making in newly diagnosed patients. ß 2009 Elsevier Ireland Ltd. All rights reserved. * Corresponding author at: Department of Medical Decision Making, University Medical Center Leiden, P.O. Box 9600, 2300 RC Leiden, the Netherlands. Tel.: +31 71 526 1203; fax: +31 71 526 6838. E-mail address: a.h.pieterse@lumc.nl (A.H. Pieterse). Contents lists available at ScienceDirect Patient Education and Counseling journal homepage: www.elsevier.com/locate/pateducou 0738-3991/$ – see front matter ß 2009 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.pec.2009.05.020