Using a Discrete Choice Experiment to Elicit Patient Preferences for Physical Therapist Services after Surgery for Breast Cancer.

Abstract

Importance: Patients often experience challenges accessing physical therapy for breast cancer-related impairments. Eliciting patient preferences for physical therapy can inform design of patient-centered, breast cancer-focused physical therapy programming.

Objective: A discrete choice experiment (DCE) was used to elicit patient preferences for physical therapy after breast cancer surgery.

Design: Sequential mixed methods identified 7 attributes of physical therapy: education timing; referral method; first appointment timing; physical therapist expertise level; treatment format; treatment frequency; and annual out-of-pocket cost. Respondents chose between 2 physical therapy programs and an opt-out option.

Settings: The DCE was administered online.

Participants: Participants were adults with breast cancer in Canada.

Main outcomes & measures: Responses were analyzed using a mixed logit model. Willingness-to-pay estimates were calculated as the marginal rate of substitution between each attribute level with respect to cost.

Results: The DCE was completed by 148 respondents (completion rate: 77.5%). Most were within 3 years post-diagnosis (54.1%), had completed post-secondary education (70.9%), and had annual family incomes over $40,000 (76.5%). Nearly half were referred to physical therapy (48.5%). Respondents preferred to be seen by a physical therapist with expertise in breast cancer (β = .368, SD = 0.091) and to receive more frequent appointments (β = -.011, SD = 0.025).

Conclusion: The DCE was capable of eliciting patient preferences for physical therapy after breast cancer surgery. Respondents exhibited preferences for physical therapist expertise level and treatment frequency. Findings from this study will be the first step in informing development of accessible physical therapy programming that is responsive to the needs and preferences of patients with breast cancer.

Relevance: This work can inform design of accessible, patient-centered physical therapist services for patients with breast cancer. Receiving timely physical therapy can improve patients' physical function, quality of life, and ability to engage in life roles and activities.