| Background:In 2020,breast cancer emerged as the most common cancer globally,with an incidence of 2.26 million cases,surpassing the 2.2 million cases of lung cancer.It also stood as the fifth leading cause of death worldwide.Chemotherapy is a primary treatment modality for breast cancer,yet it often gives rise to a multitude of adverse reactions.Given the shortened hospital stays,most of these reactions transpire outside the hospital environment,necessitating the implementation of transitional care for patients.Within the context of patient-centered healthcare,it becomes paramount to encourage patient participation in decision-making processes when devising transitional care strategies for breast cancer chemotherapy patients,duly considering their individual preferences.Objectives:This study leverages a discrete choice experiment to explore the stated preferences of breast cancer chemotherapy patients for various attributes and levels of transitional care.The study aims to gather data on these preferences;to quantify the relative importance and willingness-to-pay associated with each attribute;to simulate the acceptance likelihood of different transitional care strategies under varying scenarios;and to analyze the heterogeneity in transitional care preferences among different demographic groups.The findings are intended to guide the design of transitional care plans for breast cancer chemotherapy patients,thereby enhancing compliance,mitigating chemotherapyinduced complications,alleviating psychological burdens,promoting recovery,and ultimately,improving quality of life.Methods:Utilizing a convenience sampling approach,the study included breast cancer chemotherapy patients who received treatment at a tertiary-level hospital in Shanxi between October 2022 and February 2023.The characteristics and corresponding levels of preferences for transitional care were determined through literature review,qualitative interviews,and expert consultation.Using the D-Efficient Design method in SAS software,the choice sets were generated and divided into two versions of the questionnaire,each supplemented with a control item and warm-up questions to minimize research bias.Two uniformly trained investigators conducted the face-to-face questionnaire administration.The collected data were analyzed using mixed logit and conditional logit models in Stata 17.0 software.The model selection was based on the comparative fit,using the Akaike Information Criterion(AIC)and the Bayesian Information Criterion(BIC).Results from the regression analysis,including parameter estimates,95% confidence intervals(CI),and P-values,were reported,with P < 0.05 indicating statistical significance.Results:1.A total of 310 questionnaires were disseminated for this study,after discarding the invalid ones,261 questionnaires were ultimately incorporated into the research,yielding a valid response rate of 84.19%.2.This investigation considered six distinct attributes: health education modality during hospitalization,service frequency,service provider,service content,service delivery method,and personal out-of-pocket expenses.3.This research generated 17 choice sets in total,each comprising two alternatives,with one choice set being incorporated repetitively into the questionnaire.4.As the conditional logit model yielded smaller values for both the Akaike Information Criterion(AIC)and Bayesian Information Criterion(BIC)compared to the mixed logit model,and as the preference utility results of the two models did not demonstrate anypronounced discrepancies after sensitivity analysis,the conditional logit model was selected preferentially for data analysis and interpretation.5.Patients exhibited significant statistical preferences for four attributes: service provider,service content,service delivery method,and out-of-pocket expenses.However,the health education modality during hospitalization and the service frequency did not possess significant statistical relevance.6.In terms of service providers,patients demonstrated a stronger preference for specialist doctors and nurses over community doctors and nurses(β=0.925;p < 0.001).Concerning service content,patients preferred a multidimensional service that encompassed symptom management,psychological care,and rehabilitation guidance over mere symptom management(β=0.286;p < 0.001).In the case of service delivery,patients preferred faceto-face outpatient services over remote delivery(β=0.239;p < 0.001).7.Regarding willingness to pay,breast cancer chemotherapy patients demonstrated the highest payment willingness for the service provider attribute.Patients were willing to pay approximately ￥105.381 more for services offered by specialist doctors and nurses compared to community doctors and nurses.As for service content,breast cancer patients were willing to pay an extra ￥29.623 for multidimensional care services encompassing symptom management,psychological care,and rehabilitation guidance over simple symptom management.8.Various population characteristics influenced preferences for transitional care options.The preference for multidimensional services encompassing symptom management,psychological care,and rehabilitation guidance was statistically insignificant among patients aged 45-55 years.Patients residing outside of Taiyuan were willing to pay 1.5times more to shift from community doctors and nurses to specialist doctors and nurses.Patients experiencing severe adverse reactions to chemotherapy displayed a higher preference for home service delivery.Conclusion:1.Breast cancer chemotherapy patients exhibit a stronger preference for transitional careplans that include symptom management,psychological treatment,and rehabilitation guidance,provided by specialized doctors and nurses in an outpatient setting,with minimal out-of-pocket costs.2.The design of transitional care plans must consider individual patient factors due to inconsistent attribute preferences across different population characteristics.3.The choice preference for transitional care among breast cancer chemotherapy patients is influenced by a myriad of factors.Along with individual factors,considerations should be made for the national and regional economic conditions,and policy context when developing transitional care programs. |
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