OBJECTIVES

: Treatment of diabetic peripheral neuropathy (DPN) symptoms is challenging due to variable treatment effectiveness and side effects. This study evaluated best-worst scaling as a strategy for patient-centered tailoring of treatment choice.

METHODS

: We designed an object case best-worst scaling preference instrument to identify DPN treatment attributes of least and most importance to patients. An initial set of 9 attributes was identified through coding and analysis of transcripts from in-depth interviews with 42 patients with DPN symptoms in a large U.S. health system. We used Sawtooth Software to design a balanced incomplete block design of the survey instrument. We then conducted 2 rounds of iterative pilot testing with interviewers and patients (n=19), resulting in a refined instrument with 7 attributes with 2 levels each. The final survey instrument was limited to 4 choices per set and a total of 15 sets per patient. We fielded the survey among a random sample of 100 patients who were actively being treated for DPN symptoms. The importance score was then calculated for each patient.

RESULTS

: Preference assessments were conducted with 100 patients with an average age of 61. Most of the participants were female (52%) and were 34% White, 33% Black, 16% Asian, 14% Hispanic and 3% unknown race or ethnicity. The attribute identified by patients as being most important to decision-making was functioning “I can do the things that I usually do”. The second most important attribute was whether “my doctor and I discuss my concerns about this medication”. The attributes identified as least important were medication cost and whether they had to take more than one pill every day.

CONCLUSIONS

: This study provides real-world evidence regarding the treatment preferences of adults with DPN symptoms. Healthcare innovations in DPN are needed to foster patient-provider communication about treatment preferences, particularly related to functioning.