The Needs And Preferences Of Gastric Cancer Patients For Follow-up After Surgery

Objectives:Carry out a discrete choice experiment to quantify the needs and preferences of gastric cancer patients for follow-up after surgery,and determine the impact of key attributes and corresponding levels on the postoperative follow-up strategies for gastric cancer patients,so as to provide references for optimizing the postoperative follow-up strategies for gastric cancer patients,and then improve patient follow-up compliance,prevent corresponding complications,reduce the psychological burden of gastric cancer patients,and improve the their quality of life.Method:This study is a discrete choice experiment.A total of 12 hospitals in eastern China,central China and western China were selected as survey sites to investigate the follow-up preferences of gastric cancer patients after surgery from September 2019 to September 2020.First,based on literature review,in-depth interviews,focus group discussions,and expert consultation,the attributes and corresponding levels of follow-up related were determined.Then,in the Ngene software,the D-Efficient Design was used to generate 36 choice sets,and these choice sets were randomly divided into four versions(4×9).In order to check the consistency and ensure the quality of the study,the second choice set of each version was repeatedly included as the tenth choice set.After the pilot test,the survey was carried out,with face-to-face survey as the main method and online survey as the auxiliary method.Finally,in STATA 15.0 software,a mixed Logit model was used to quantitatively analyze the gastric cancer patients’ preferences for follow-up after surgery.Results:1.In this study,a total of 440 gastric cancer patients were surveyed.After excluding invalid responses,the postoperative follow-up preference of 376 gastric cancer patients was analyzed;2.The six attributes included in this study have a significant influence on the gastric cancer patients’ preferences for follow-up after surgery.The attribute-level that has the greatest influence on the gastric cancer patients’ preference for follow-up is“comprehensive follow-up-very comprehensive”(coefficient: 1.995).“Provider-specialist doctor” and “provider-specialist nurse” are the second and third attribute levels that are most valued by patients after gastric cancer surgery respectively(coefficients are 1.111 and 0.909,respectively);3.Cost is the only attribute that has a negative impact on the gastric cancer patients’ preferences for postoperative follow-up(coefficient:-0.0014019),but its impact is not as important as other attributes;4.The results of willingness to pay showed that gastric cancer patients are willing to spend 1,423 yuan to obtain follow-up with a very comprehensive content.Face-to-face follow-up has the least impact on the gastric cancer patients’ preferences for follow-up after surgery,and gastric cancer patients are willing to pay 229.76437 yuan for this;5.In a series of simulated follow-up scenarios,from the perspective of changes in the single attribute-level,the change of comprehensiveness from general comprehensive to very comprehensive had the greatest impact on the gastric cancer patients’ preferences for follow-up after surgery,and the probability of their receiving the follow-up programme increased by 76.01% compared with the probability of receiving the baseline programme.The change of follow-up providers to specialist doctor and specialist nurse had similar influence on the probability of patients receiving follow-up programma,which increased 50.50% and 42.55%,respectively.For comprehensive factors,the probability of receiving follow-up was increased by95.82%(94.90%)if "the follow-up content was very comprehensive + the provider was a specialist doctor(specialist nurse)+ the same provider for each follow-up".Conclusion:1.The more preferred follow-up for patients with gastric cancer has the following characteristics: comprehensive content,provided by professional medical staff,low cost,face-to-face follow-up combined with remote follow-up,good continuity,main supplementary service with treatment of complications;2.The postoperative follow-up of patients with gastric cancer is affected by many factors.When developing the attribute level of follow-up,in addition to considering individual factors,national economic conditions and policy background should also be considered;3.Cost,comprehensiveness,providers,methods,continuity,and supplementary services have a significant impact on the postoperative follow-up preferences of gastric cancer patients,but the degree of impact is inconsistent.Therefore,patient preferences should be combined with regional characteristics,and comprehensive measures should be taken in accordance with local conditions to improve patient follow-up compliance.