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Patient and Caregiver Preferences for RRMM Treatment Using Discrete-Choice Experiment and Best–Worst Scaling

Patients with relapsed/refractory multiple myeloma (RRMM) typically have significant symptom burdens and many have impaired health-related quality of life (HRQOL). Patients and their caregivers are faced with many therapeutic options that vary in terms of efficacy, tolerability, and other HRQOL considerations, yet research exploring patient and caregiver preferences in treatments is scant, however.

A recent study aimed to describe patient and caregiver preferences for treatments for RRMM. To accomplish this, a survey using discrete-choice experiment (DCE) and best–worst scaling (BWS) models was completed by patients with RRMM and their caregivers to quantify preferences for a set of MM treatment attributes. The DCE consisted of 6 attributes, which included progression-free survival (PFS), toxicity, and mode and frequency of administration, and the BWS model included 18 attributes. Treatment cost was assessed using a fixed-choice question.

The study included 94 patients with RRMM and 32 caregivers of patients. Researchers determined that the most important attributes to both patients and caregivers were avoiding severe nerve damage and prolonging PFS. The relative importance of the 2 attributes differed between patients and caregivers: patients favored the avoidance of severe nerve damage as the most relevant attribute, whereas caregivers ranked increased PFS as most important. However, both patients and caregivers were willing to make tradeoffs when it came to treatment decisions: both groups placed more importance on increasing in PFS from 6 to 12 months over avoiding mild-to-moderate nerve damage. The least important attribute to patients was risk of heart failure, whereas the least important attribute to caregivers was gastrointestinal problems. The 3 most bothersome treatment-related risks for patients were kidney damage, reduced white blood cell counts, and a weakened immune system. For caregivers, kidney damage, weakened bones, and reduced white blood cell counts were the 3 most bothersome features. Both patients and caregivers considered modes of administration to be among the least bothersome attributes. A clear trend emerged that cost-influenced the decision of some patients, although it did not seem to affect the decision of caregivers.

Consideration of treatment-related factors deemed meaningful to caregivers and patients is important when making treatment decisions, and these factors should be discussed between physicians and patients and their caregivers. Although larger, well-controlled studies are needed, this research highlights the need for shared decision-making to help improve treatment satisfaction.


Auclair D, Mansfield C, Fiala MA, et al. Preferences and priorities for relapsed multiple myeloma treatments among patients and caregivers in the United States. Patient Prefer Adherence. 2022;16:573-585.

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