Patientenpräferenzen: Ergebnisse einer deutschen Studie mittels Adaptive Choice-Based Conjoint (ACBC)-Analyse für Patientinnen mit fortgeschrittenem Brustkrebs (aBC) unter palliativer Behandlung

Introduction: Integration of patient preferences into shared decision making improves disease-related outcomes, but such data from patients with advanced breast cancer (aBC) are limited. The objective of this study was to demonstrate the relative importance of overall survival (OS) and progression-free survival (PFS) in relation to quality of life (QoL) and therapy-associated side effects from the perspective of patients with aBC. Methods: Postmenopausal patients with hormone receptor-positive, human epidermal growth factor receptor 2-negative aBC receiving first- or second-line treatment were recruited throughout Germany. Patient-relevant attributes for aBC therapy assessment were collected using a stepwise multimodal approach. A conjoint matrix was developed, resulting in 2 attributes for therapy goals (OS and PFS), 4 for QoL, and 6 for side effects. An online quantitative survey was then performed using adaptive choice-based conjoint (ACBC) methodology. Results: The quantitative survey included 104 patients: 67 (64.4%) receiving first-line treatment and 37 (35.6%) receiving second-line treatment. The QoL attribute “physical agility and mobility” received the highest utility score (19.4 of 100%), reflecting the greatest importance to patients, followed by treatment goals (OS [15.2%] and PFS [14.4%]). Therapy-related side effects were less important, with nausea/vomiting being the most important (9.3%), followed by infection (6.4%) and hair loss (5.0%). The McFadden pseudo R2 (0.805), the root likelihood (0.864), and the χ2 test (2,809.041; p < 0.0001) indicated a very good fit of the statistical model. Conclusion: Using ACBC analysis, it appears that QoL, OS, and PFS are most important to postmenopausal patients with aBC in relation to cancer treatment. Side effects seem to be less important if OS or PFS are prolonged and the QoL is maintained. Thus, QoL, OS, and PFS should be considered equally when making treatment decisions in aBC.

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A neuronal ensemble encoding adaptive choice during sensory conflict in Drosophila

Nature Communications ◽

10.1038/s41467-021-24423-y ◽

2021 ◽

Vol 12 (1) ◽

Author(s):

Preeti F. Sareen ◽

Li Yan McCurdy ◽

Michael N. Nitabach

Keyword(s):

Food Choice ◽

Internal State ◽

Relevant Information ◽

Food Choices ◽

Small Population ◽

Sensory Conflict ◽

Shaped Body ◽

Motor Circuits ◽

Specific Subset ◽

Adaptive Choice

AbstractFeeding decisions are fundamental to survival, and decision making is often disrupted in disease. Here, we show that neural activity in a small population of neurons projecting to the fan-shaped body higher-order central brain region of Drosophila represents food choice during sensory conflict. We found that food deprived flies made tradeoffs between appetitive and aversive values of food. We identified an upstream neuropeptidergic and dopaminergic network that relays internal state and other decision-relevant information to a specific subset of fan-shaped body neurons. These neurons were strongly inhibited by the taste of the rejected food choice, suggesting that they encode behavioral food choice. Our findings reveal that fan-shaped body taste responses to food choices are determined not only by taste quality, but also by previous experience (including choice outcome) and hunger state, which are integrated in the fan-shaped body to encode the decision before relay to downstream motor circuits for behavioral implementation.

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Salience-driven value construction for adaptive choice under risk

10.1101/506832 ◽

2018 ◽

Cited By ~ 1

Author(s):

Mehran Spitmaan ◽

Emily Chu ◽

Alireza Soltani

Keyword(s):

Reward Magnitude ◽

Human Subjects ◽

Real Life ◽

Individual Outcomes ◽

Single Piece ◽

Differential Weighting ◽

Adaptive Choice ◽

Plausible Mechanism ◽

Reward Information ◽

Adaptive Decision Making

Decisions we face in real life are inherently risky and can result in one of many possible outcomes. However, most of what we know about choice under risk is based on studies that use options with only two possible outcomes (simple gambles), so it remains unclear how the brain constructs reward values for more complex risky options faced in real life. To address this question, we combined experimental and modeling approaches to examine choice between pairs of simple gambles and pairs of three-outcome gambles in male and female human subjects. We found that subjects evaluated individual outcomes of three-outcome gambles by multiplying functions of reward magnitude and probability. To construct the overall value of each gamble, however, most subjects differentially weighted possible outcomes based on either reward magnitude or probability. These results reveal a novel dissociation between how reward information is processed when evaluating complex gambles: valuation of each outcome is based on an integrated value whereas combination of possible outcomes relies on a single piece of reward information. We show that differential weighting of possible outcomes enabled subjects to make decisions more easily and quickly. Together, these findings reveal a plausible mechanism for how salience, in terms of possible reward magnitude or probability, can influence the construction of subjective values for complex gambles. They also point to separable neural mechanisms for how reward value controls choice and attention in order to allow for more adaptive decision making.

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