ஜர்னல் ஆஃப் ஹெல்த் & மெடிக்கல் இன்பர்மேட்டிக்ஸ்

Patient’s Preferences for Management Options in Relation to Preterm Birth

Abstract

van der Ven AJ,van Os M,van den Wijngaard L,Mochtar MH,de Bekker-Grob EW,Kazemier BM,de Groot CJM,Pajkrt E,Mol BWJ,van Wely M*

To explore pregnant women’s preferences regarding cervical length measurement by ultrasound and treatment with progesterone in relation to preterm birth prevention we performed a discrete choice experiment. Four hospitals, four ultrasound centers and ten midwifery practices spread over the country participated in this study and distributed questionnaires among pregnant women between 15-36 weeks of gestation. Each questionnaire contained 16 choice sets with two screening or treatment options and one opt-out ‘no screening or treatment’ option. Women were asked to consider the following screening/treatment options 1) transvaginal or abdominal cervical length measurement, 2) vaginal or oral administration of progesterone, 3) short-term health risk and 4) long-term health risk for the child. The relative importance of the choices and trade-offs patients were willing to make were analyzed with panel-based mixed logit regression in STATA. Of the 156 questionnaires that were actually handed out, 138 were returned. Overall most respondents made trade-offs between attributes and all screening/treatment characteristics proved important in their decision making. Transvaginal cervical length measurements were not preferred (p=0.01) and was traded only in exchange for an absolute decrease of 6.5% (95% CI 2.6 – 10.4) in long-term neonatal complication rate. Previous experience with adverse neonatal outcome affected the preferences of the women.