OBJECTIVES: This study is currently being undertaken to identify the preferences of people diagnosed with HER2 positive breast for delivery of subcutaneous trastuzumab (Herceptin) therapy. The introduction of a product with a less invasive administration method holds out the prospect of delivering care in non hospital based environments. The design of care pathways that incorporate patient preferences is a key stage in achieving the best clinical outcomes from available resources.

METHODS: Important attributes for the delivery of trastuzumab therapy have been identified through two focus groups undertaken with breast cancer survivors attending a cancer support centre. The group will act as a steering group for the implementation of a discrete choice experiment: confirming the delivery of attribute levels; piloting of the questionnaire and commenting on choice sets; providing feedback on the interpretation of data achieved from respondent participation. Given the number of attributes and levels, the number of combinations is 128. A series of 16 choices will be employed using a D-efficient main effects design. The model will be assessed using conditional logistic regression and mixed logit regression in Stata. If possible, latent class modelling will be performed.

A community pharmacy pathway will be implemented using data generated from the study and the feasibility of treatment delivery assessed using a realist evaluation approach. Predicted uptake will be estimated and compared to the current situation.

RESULTS: Attributes identifed by the patient group for delivery of treatment are: travel time; travel cost; identity of provider; treatment site; "They know your name".

CONCLUSIONS: The potential to deliver cancer care in primary care settings is large, given the rise in cancer prevalence due to an ageing population and increasing survivorship amongst cancer sufferers. Design of care pathways that explicitly meet patients' preferences for care delivery is therefore a key step to successful service redesign.