Bertrand, Thomas (2018). Patient and physician preferences for non-invasive diagnostic cardiac imaging technologies: a discrete choice experiment. McGill Family Medicine Studies Online, 13: e13 

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Abstract

BACKGROUND: The use of non-invasive cardiovascular imaging tests for diagnosing coronary artery disease (CAD) has risen dramatically over the last decade. However, guidelines for the diagnosis and management of patients with stable ischemic heart disease reported a lack of attention devoted to users' satisfaction, and repeatedly documented the importance of patient-oriented research to guide clinical decision-making. In this context, this study aims to contribute to the understanding of patient and physician preference in relation to the choice of cardiovascular imaging tests.

METHODS: A discrete choice experiment (DCE) questionnaire on a convenience sample from the Royal Victoria cardiology clinic was used to systematically elicit patient and physician preference toward diagnostic imaging tests. Tests were differentiated using 6 attributes (patient out-of-pocket cost, risks and side effects, type of procedures, diagnostic accuracy, type of scanner and test duration). A choice-based conjoint analysis with hierarchical Bayes estimation was performed with Sawtooth Software.

RESULTS: One hundred and forty-eight cardiac patients and 63 physicians completed the DCE. Risks and side effects had the highest impact on patients' preference (30%). Patients assigned notably high utility to tests with milder side effects (+97.7), while avoiding exposure to ionizing radiation (-36.7) and risks associated with exercise and the use of pharmacological agents inducing direct coronary arteriolar vasodilation (-61.0). Physicians attributed more importance to costs for patients (29%).

CONCLUSIONS: Patients' preference was most determined by the risks and side effects associated with cardiovascular imaging tests, while physicians preferred less costly alternatives. When engaging in shared decision-making with patients, physicians should discuss the risks and side effects associated with cardiovascular imaging tests. In aiming for the best possible care, the clinical implementation of safer, more accurate and cost-effective imaging tests for diagnosing CAD may improve users' satisfaction and health outcomes.