{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T18:11:40Z","timestamp":1789236700395,"version":"build-2803163510"},"reference-count":19,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2025,5,30]],"date-time":"2025-05-30T00:00:00Z","timestamp":1748563200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Institute of Health","award":["1R34AR084146-01"],"award-info":[{"award-number":["1R34AR084146-01"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Current Oncology"],"abstract":"<jats:p>The proximal femur represents the most frequent site in the appendicular skeleton for metastatic bone disease (MBD) to occur, with a high risk for pathologic fracture. While surgical stabilization is typically used to manage fractures, reconstruction approaches are gaining popularity due to improved survival. Previous studies have focused on clinical outcomes, but patient-centered outcomes remain underexplored. This study aims to develop a patient-centered primary outcome for the Proximal FEmur Reconstruction or Internal Fixation fOR Metastases (PERFORM) Randomized Controlled Trial, employing a mixed-methods approach. First, a focus group with advanced cancer patients and caregivers identified relevant outcomes. Next, a discrete choice experiment (DCE) assessed the importance of these outcomes among stakeholders, including surgeons, patients and caregivers. The most important components for the primary outcome were identified: mortality within twelve months, physical function assessed at four months using the PROMIS\u00ae Global Physical Function score, and the number of days at home within twelve months. The DCE further confirmed that survival and physical function were most prioritized. The PERFORM trial\u2019s primary outcome, developed through extensive stakeholder engagement, will guide the evaluation of surgical approaches for MBD of the proximal femur and has the potential to influence patient-centered practice.<\/jats:p>","DOI":"10.3390\/curroncol32060318","type":"journal-article","created":{"date-parts":[[2025,5,30]],"date-time":"2025-05-30T06:14:27Z","timestamp":1748585667000},"page":"318","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["The Design of a Patient-Centered Hierarchal Composite Outcome for a Multi-Center Randomized Controlled Trial in Metastatic Bone Disease"],"prefix":"10.3390","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-3826-8689","authenticated-orcid":false,"given":"Hadia","family":"Farrukh","sequence":"first","affiliation":[{"name":"Department of Surgery, McMaster University, Hamilton, ON L8S 4K1, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abbey","family":"Kunzli","sequence":"additional","affiliation":[{"name":"Department of Surgery, McMaster University, Hamilton, ON L8S 4K1, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-0194-6105","authenticated-orcid":false,"given":"Olivia","family":"Virag","sequence":"additional","affiliation":[{"name":"Department of Surgery, McMaster University, Hamilton, ON L8S 4K1, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathan","family":"O\u2019Hara","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, University of Maryland, Baltimore, MD 21201, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1466-8063","authenticated-orcid":false,"given":"Sheila","family":"Sprague","sequence":"additional","affiliation":[{"name":"Department of Surgery, McMaster University, Hamilton, ON L8S 4K1, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4777-2617","authenticated-orcid":false,"given":"Amy","family":"Cizik","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, University of Utah, Salt Lake City, UT 84108, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2629-9752","authenticated-orcid":false,"given":"Ricardo","family":"Gehrke-Becker","sequence":"additional","affiliation":[{"name":"Hospital de Cl\u00ednicas de Porto Alegre, Porto Alegre 90035-903, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Schubert","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4778-4522","authenticated-orcid":false,"given":"Michelle","family":"Ghert","sequence":"additional","affiliation":[{"name":"Department of Surgery, McMaster University, Hamilton, ON L8S 4K1, Canada"},{"name":"Department of Orthopaedics, University of Maryland, Baltimore, MD 21201, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,5,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"7","DOI":"10.3322\/caac.21654","article-title":"Cancer Statistics, 2021","volume":"71","author":"Siegel","year":"2021","journal-title":"CA Cancer J. Clin."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e293","DOI":"10.5435\/JAAOS-D-23-00332","article-title":"Life Expectancy After Treatment of Metastatic Bone Disease: An International Trend Analysis","volume":"32","author":"Rogers","year":"2024","journal-title":"JAAOS\u2014J. Am. Acad. Orthop. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1007\/s40137-014-0049-y","article-title":"Latest Developments in Surgical and Minimally Invasive Treatment of Metastatic Bone Disease","volume":"2","author":"Kistler","year":"2014","journal-title":"Curr. Surg. Rep."},{"key":"ref_4","first-page":"87","article-title":"Estimated number of prevalent cases of metastatic bone disease in the US adult population","volume":"4","author":"Li","year":"2012","journal-title":"Clin. Epidemiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1053\/j.seminoncol.2007.03.002","article-title":"Surgical therapy of bone metastases","volume":"34","author":"Aboulafia","year":"2007","journal-title":"Semin. Oncol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1392","DOI":"10.1302\/0301-620X.100B10.BJJ-2018-0239.R1","article-title":"Trends in the surgical treatment of pathological fractures of the long bones: Based on a questionnaire among members of the Dutch Orthopaedic Society and the European Musculo-Skeletal Oncology Society (EMSOS)","volume":"100-B","author":"Willeumier","year":"2018","journal-title":"Bone Jt. J."},{"key":"ref_7","first-page":"1158","article-title":"Surgical treatment of metastatic fractures of the femur: A retrospective analysis of 142 patients","volume":"66","author":"Sarahrudi","year":"2009","journal-title":"J. Trauma"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"920","DOI":"10.1007\/s11999-011-2047-z","article-title":"Endoprosthetic treatment is more durable for pathologic proximal femur fractures","volume":"470","author":"Steensma","year":"2012","journal-title":"Clin. Orthop."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1016\/j.jor.2021.11.003","article-title":"Internal fixation versus endoprosthetic replacement of the proximal femur for metastatic bone disease: Single institutional outcomes","volume":"28","author":"Gusho","year":"2021","journal-title":"J. Orthop."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Guzik, G. (2018). Oncological and functional results after surgical treatment of bone metastases at the proximal femur. BMC Surg., 18.","DOI":"10.1186\/s12893-018-0336-0"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1007\/s40271-015-0118-z","article-title":"Sample Size Requirements for Discrete-Choice Experiments in Healthcare: A Practical Guide","volume":"8","author":"Donkers","year":"2015","journal-title":"Patien."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1302\/2046-3758.35.2000280","article-title":"Design and execution of clinical trials in orthopaedic surgery","volume":"3","author":"Mundi","year":"2014","journal-title":"Bone Jt. Res."},{"key":"ref_13","first-page":"ZE10","article-title":"Protocol Writing in Clinical Research","volume":"10","author":"Sakka","year":"2016","journal-title":"J. Clin. Diagn. Res."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e304","DOI":"10.1097\/PCC.0b013e31828a863a","article-title":"Rationale, timeline, study design, and protocol overview of the therapeutic hypothermia after pediatric cardiac arrest trials","volume":"14","author":"Moler","year":"2013","journal-title":"Pediatr. Crit. Care Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/PCC.0000000000000272","article-title":"Efficacy outcome selection in the therapeutic hypothermia after pediatric cardiac arrest trials","volume":"16","author":"Holubkov","year":"2015","journal-title":"Pediatr. Crit. Care Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e18118","DOI":"10.2196\/18118","article-title":"Protocol Development for HMU! (HIV Prevention for Methamphetamine Users), a Study of Peer Navigation and Text Messaging to Promote Pre-Exposure Prophylaxis Adherence and Persistence Among People Who Use Methamphetamine: Qualitative Focus Group and Interview Study","volume":"4","author":"McMahan","year":"2020","journal-title":"JMIR Form. Res."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e2230858","DOI":"10.1001\/jamanetworkopen.2022.30858","article-title":"Patient and Family Representation in Randomized Clinical Trials Published in 3 Medical and Surgical Journals: A Systematic Review","volume":"5","author":"Benizri","year":"2022","journal-title":"JAMA Netw. 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