**Background:** Implant-based interventions for chronic conditions (e.g., hearing loss, glaucoma, cardiovascular disease) require long-term care, yet patient preferences for such care are understudied. This study aimed to identify and quantify the relative importance of attributes of long-term implant care from the perspective of implant wearers, using discrete choice experiments (DCEs) in three clinical fields: cochlear implants (CI), glaucoma implants (GI), and cardiovascular implants (CVI). The work was part of the RESPONSE collaborative project in Germany, focusing on patient-centered development and implementation of innovative implant technologies.
**Methods:** Three DCEs were conducted via online surveys (November 2021–March 2022). Attributes and levels were derived from a systematic literature review, qualitative group discussions, and a diary study with implant wearers, then refined through cognitive interviews and expert validation. Each DCE included six attributes: for CI—decision making (shared, patient-sided), information source (manufacturer, clinic), future treatment options (preserve, not preserve), technological compatibility (compatible, not compatible), aftercare (varying, constant), and education (comprehensive, basic); for GI—decision making (shared, patient-sided), information exchange (yes, no), treatment success probability (75%, 50%), corrective intervention (yes, no), implant removal (yes, no), and additional information (yes, no); for CVI—decision making (shared, patient-sided), information source (clinic, manufacturer), data transparency (yes, no), information exchange (yes, no), means of maintaining treatment success (lifelong medication, reimplantation every 10 years), and invasiveness (minimally invasive, open surgery). An optimal orthogonal fractional factorial design was used, with 36 choice tasks (CI, GI) or 24 (CVI) split into two blocks. Participants were recruited via clinical departments, patient forums, and self-help groups. Eligibility criteria included age ≥18 years and having the respective implant or disease (for GI, glaucoma disease was also accepted). Data were analyzed using binary logit regression with robust variance estimation, accounting for clustered data (participant ID as repeated measure). Beta coefficients and odds ratios (OR) were calculated.
**Key Results:**
- **CI-DCE (n=92, mean age 57 years, 43 female):** All attributes except aftercare (p=0.137) significantly influenced choice (p<0.001). Technological compatibility had the highest relative importance (OR=4.8, p<0.001), meaning a care scenario was ~5 times more likely to be chosen if the CI was compatible with newer models and accessories. Shared decision making (OR=2.6), preservation of future treatment options (OR=2.3), comprehensive education (OR=2.1), patient-sided decision making (OR=1.9), and automatic information provision (OR=1.5) followed. Age and sex were not significant.
- **GI-DCE (n=21, mean age 57 years, 9 female):** All attributes except information exchange (p=0.814) were significant (p<0.05). The highest impact was for 75% treatment success (no medication needed after 2 years) vs. 50% (OR=5.551, p<0.001). Other significant attributes: availability of clinic statistics (OR=2.9), additional information (e.g., nutrition, dry eyes; OR=2.5), corrective intervention for implant failure (OR=2.1), and shared decision making (OR=1.9). Age and sex were not significant.
- **CVI-DCE (n=23, mean age 58 years, 9 female):** Three of six attributes were significant: means of maintaining treatment success (OR=11.9 for lifelong medication vs. reimplantation every 10 years, p<0.001), decision making (shared and patient-sided; OR=3.2 and 2.5, respectively), and data transparency (OR=2.1). Information source (p=0.716), information exchange (p=0.818), and invasiveness (p=0.113) were not significant. Age and sex were not significant.
**Clinical Implications:** The findings underscore the importance of patient-centered long-term implant care. For CI users, technological compatibility with other devices and future models is critical, suggesting that implant developers should prioritize interoperability and updatability to enhance quality of life and social participation. For glaucoma patients, reducing dependence on daily medication is a key driver, highlighting the need for implants with high long-term success rates and the option for corrective interventions. For cardiovascular patients, the strong preference for lifelong medication over reimplantation indicates a focus on avoiding repeat procedures, which may influence shared decision-making discussions about valve type (mechanical vs. bioprosthetic). Shared decision-making was consistently valued across all groups, emphasizing the need for healthcare providers to involve patients in choices and provide clear, accessible information about long-term consequences. The study also points to the importance of technological health literacy, as patients desire reliable information from medical professionals amidst rapid technological change. Limitations include small sample sizes for GI and CVI DCEs (exploratory only), potential selection bias (CI participants from a single clinic), and focus on main effects only. Despite these, the results provide novel, patient-derived insights for improving implant development, care delivery, and resource prioritization.