To determine patients' preferences for treatment options offered for shoulder pain in primary care.
A discrete choice experiment (DCE) was used to investigate these preferences. Adults with shoulder pain were asked to fill in a questionnaire including general questions and a DCE with 12 choice tasks. They had to choose between two treatment options or opt out entirely for each of the choice tasks. The following attributes with varying levels were included in the choice tasks: treatment effectiveness (50%, 70%, or 90%), risk of relapse (10%, 20%, or 30%), time to pain reduction (2 or 6 weeks), attention to the prevention of relapse (yes/no), treatment including an injection (yes/no), and treatment including physiotherapy (none, 6, or 12 sessions). A conditional logit model with latent class analysis was used for the analysis and a class assignment model.
A total of 312 participants completed the questionnaire, with an average age of 52 ±15.2 years and 46% identifying as men. Latent class analysis revealed three groups and each participant has a probability to belong to one of these classes. Group 1 preferred to opt-out, unless the attributes were highly favorable such as a 90% effectiveness. Group 2 preferred treatment, but not an injection. Group 3 preferred to-opt out and did not opt for treatment. The likelihood of a participant belonging to one of these groups was 68.8%, 9.3%, and 21.9%, respectively. The class assignment was related to having previously received injection or physiotherapy, as they did not prefer that same treatment again for their shoulder pain.
This study showed that participants tended to avoid treatment, unless the treatment offered favorable characteristics. However, there will also be a small group who will be hard to convince to have treatment. There is also reluctance among patients previously treated with physiotherapy or an injection to opt for such treatment again.
Future research could gather insights into the barriers participants encounter that led to their hesitancy in opting for treatment, as well as declining previously received treatments.
The results of this study show different groups of patients with shoulder pain with varying decision making patterns which you can encounter in the general practice. It also emphasizes the need to better inform patients about treatment options, since there seems to be hesitancy in opting for treatment.
Shoulder Pain
Decision Making
