The elicitation of quality of life preferences for lung cancer treatment from the perspective of patients and treating physicians: results of two discrete choice experiments

PURPOSE: Maintaining or improving the health-related quality of life (QoL) of lung cancer patients is essential throughout treatment. To support shared decision-making and improve patient-physician communication, patients' preferences should be understood and considered in clinical decision-making; however, existing research indicates notable discrepancies between patient and physician priorities. This study therefore aims to elicit and compare their preferences regarding QoL dimensions in lung cancer care in Germany. METHODS: Based on systematic literature reviews as well as qualitative analysis, two discrete choice experiments (DCEs) were applied to elicit the preferences of patients and treating physicians. In the DCE scenarios, both groups chose between alternative QoL profiles reflecting different health states during lung cancer treatment. Data were analyzed using multinomial logit models. RESULTS: The final DCEs comprised five common attributes - activities of daily living, shortness of breath, anxiety, social life, and emotional impairment - and one group-specific attribute: financial difficulties in the patient DCE and severity of pain in the physician DCE. Overall, 162 patients (mean age: 60.39 years, SD 10.05) and 154 referring physicians (mean age: 51.26 years, SD 11.28) participated. All model coefficients were statistically significant (p < 0.001). Patients prioritized "Shortness of breath" (28.0%; level range of 1.417) and "Activities of daily living" (23.8%; level range of 1.207), while "Emotional impairment" (6.4%; level range of 0.323) ranked lowest. In contrast, treating physicians emphasized ''Shortness of breath" (26.0%; level range of 1.114) and "Severity of pain" (22.5%; level range of 0.962); again, "Emotional impairment" ranked lowest (4.8%; level range of 0.207). CONCLUSIONS: Overall, patients and treating physicians showed broad agreement regarding the importance of several central QoL dimensions, particularly shortness of breath and activities of daily living. At the same time, differences in the weighting of selected attributes suggest that individual QoL priorities should be addressed explicitly in patient-physician communication.