Towards Patient-Centered CARE for Depression: Conjoint Methods to Tailor Treatment Based On PREFERENCES

BACKGROUND: Although effective depression treatments exist, non-treatment and under-treatment is common especially among the elderly and minorities. Depression treatments that incorporate what is valued by patients may improve treatment engagement, adherence and response. In this study we explicate methods that can contribute to the development of patient-centered depression treatment.

OBJECTIVE: To estimate the value individuals place on attributes of depression treatment as a first step towards developing tailored treatments.

DATA COLLECTION/EXTRACTION METHODS: Conjoint analysis to calculate group and individual utilities for treatment attributes and predict treatment choice. Participant comments about treatment features were correlated with individual utility scores.

PRINCIPLE FINDINGS: Group utility assessments revealed that side effect severity was most important in driving treatment choice (utility of 5.58). Individual utilities showed that 27 participants preferred counseling (utility -9) and 14 preferred medication (utility of 2). Respondents who preferred medication mentioned time, combining treatments, and the relationship with the provider, while those who preferred counseling brought up dependence on medications, long-term side effects, and treatment effectiveness.

CONCLUSIONS: We used conjoint analysis to determine the range of individual preferences for specific treatment characteristics and predict what modifications in treatment characteristics are associated with patients switching from desiring one treatment to another. Our finding suggest that individual level utilities may be helpful for determining who would most benefit from tailored depression treatment and the specific ways to tailor treatment interventions.