Aims: Men with prostate cancer undergo monitoring of the prostate position during radiation therapy. Several options for real-time prostate monitoring exist including fiducial markers (FMs) and transperineal ultrasound (US). However, the patient experience for these distinct procedures is very different. This study investigated preferences around various aspects of prostate image-guidance, focusing on FMs and US.
Methods A discrete choice experiment (DCE) was conducted, with the attributes of: pain; out of pocket cost; accuracy, side effects; additional appointments; and additional time. Male participants were recruited from prostate cancer patients presenting to a regional cancer centre and the general Australian population. The DCE survey required participants to make hypothetical choices in each of 8 choice sets. Multinomial logit modelling and Latent Class Analysis were used to analyse the responses. Marginal willingness to pay (mWTP) was calculated.
Results: 476 respondents completed the survey (236 prostate cancer patients and 240 general population, mean age of 73.8 and 44.3 years respectively). The most important attributes were pain, cost and accuracy for both cohorts (p<0.01). Prostate cancer patients were more willing to pay a higher cost to avoid worst pain than the general population, and also more willing to pay a higher cost for increased accuracy. Latent Class Analysis revealed 3 groups: 2 were focused more on the process-related attributes of pain and cost, and the third was focused on the clinical efficacy attributes of accuracy and side effects. There was a tendency for those with higher education to be in the clinical efficacy group (p<0.01).
Conclusion: Both prostate cancer patients and the general population preferred less cost and pain, and improved accuracy. Radiation oncology centres should consider the preferences of patients when considering image-guidance techniques in addition to the clinical and technical evidence.