Weighting (side)effects when dealing with endometriosis-associated pain.

What do clinicians prioritize while dealing with pain?

Key Points

Highlights:

• It is like solving puzzles when dealing with endometriosis therapies and their effects on the body.

Importance:

• The study reveals the views of clinicians when deciding on a therapy type for endometriosis patients.

What's done here:                                       

• A new method called the discrete-choice experiment methodology was used to show pain treatment preferences.
• A survey questioning the medicine preference and the reason for it has been sent to board-certified or equivalent obstetricians and/or gynecologists.
• 10 hypothetical cases have been presented and the attributes for choosing medicine for that case have been questioned with the following questions: Improvement in dysmenorrhea, improvement in nonmenstrual pelvic pain, improvement in dyspareunia, mode of administration, risk of pregnancy-related complications if pregnancy occurs during treatment, risk of bone fracture and hot flashes during the treatment.
• The aim of that medication has been quantified with a ratio called conditional relative importance.

Key Results:

• 250 responders have been reached out to.
• The most important attribute, conditional on the attributes and levels evaluated, was the risk of moderate-to-severe hot flashes (conditional relative importance, 3.34).
•  The conditional relative importance of the other attributes were 2.13 for improvement in nonmenstrual pelvic pain, 2.04 for improvement in dyspareunia, 1.88 for improvement in dysmenorrhea, 1.16 for risk of pregnancy-related complications if pregnancy occurs during treatment, 0.62 for increased risk of bone fracture later in life, and 0.48 for the mode of administration.

Limitations:

• The survey questioned hypothetical patients with hypothetical single medication preferences, but endometriosis is a disease that might require a multidisciplinary treatment approach. And this might cause obscurity while answering the questions in the survey.

Lay Summary

The treatment options for endometriosis-related pain are so many. And the guidelines leave the selection to the clinicians, which causes obscurity between preferences.

In the study by Christine Poulos et al, the authors analyzed the response of clinicians on the field and the underlying cause of their choice in different case scenarios. In the article published in "Expert Review of Pharmacoeconomics & Outcomes Research", a new method called the discrete-choice experiment methodology was used to show pain treatment preferences.

A survey questioning the medicine preference and the reason for it has been sent to board-certified or equivalent obstetricians and/or gynecologists.

Ten hypothetical cases have been presented and the attributes for choosing medicine for that case have been questioned with the following questions: Improvement in dysmenorrhea, improvement in nonmenstrual pelvic pain, improvement in dyspareunia, mode of administration, risk of pregnancy-related complications if pregnancy occurs during treatment, risk of bone fracture and hot flashes during the treatment. The aim of that medication has been quantified with a ratio called conditional relative importance.

Two hundred and fifty responders have been reached out to. The most important attribute, conditional on the attributes and levels evaluated, was the risk of moderate-to-severe hot flashes (conditional relative importance: 3.34). The conditional relative importance of the other attributes were 2.13 for improvement in nonmenstrual pelvic pain, 2.04 for improvement in dyspareunia, 1.88 for improvement in dysmenorrhea, 1.16 for risk of pregnancy-related complications if pregnancy occurs during treatment, 0.62 for increased risk of bone fracture later in life, and 0.48 for the mode of administration.

The results showed that clinicians choose the treatment modality according to their side effects but not the effects. While the study limited the answers to specific treatment choices for a disease that might require multiple treatments, the outcome was still interesting and should be evaluated in future surveys.

Research Source: https://pubmed.ncbi.nlm.nih.gov/36625547/