Objective To study the preferences and risk tolerance of women suffering
from deep endometriosis (DE) with bowel involvement when they have to
choose between conservative or surgical. Design Labelled Discrete Choice
Experiment (DCE). Setting Dutch academic and non-academic hospitals and
online recruitment. Population or Sample A total of 169 patients
diagnosed with DE of the bowel. Methods Baseline characteristics and the
fear for surgery were collected. Women were asked to rank attributes and
choose between hypothetical conservative (medication) or surgical
treatment in different choice sets (scenarios). Each choice set offered
different levels of all treatment attributes. Data were analysed by
using multinomial logistic regression. Main Outcome Measures The
following attributes; effect/or risk on pain, fatigue, pregnancy,
endometriosis lesions, mood swings, osteoporosis, temporary stoma and
permanent intestinal symptoms were used in this DCE. Results In the
ranking osteoporosis is the least important attribute, while in the DCE,
a lower chance of osteoporosis is one of the most important drivers when
choosing a conservative treatment. Women with previous surgery show less
fear for surgery compared to women without surgery. The low anterior
resection syndrome is almost equally important for patients as the
chance of pain reduction. Pain reduction has higher importance than
improving fertility chances even in women with a future child wish.
Conclusions The risk of suffering from LARS as a result of treatment is
almost equally important as the reduction of pain symptoms. Women with
previous surgery experience less fear for surgery compared to women
without a surgical history.
Treatment preferences for medication or surgery in patients with deep endometriosis and bowel involvement – A Discrete Choice Experiment
