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Wallace MJ, Weissler EH, Yang JC, Brotzman L, Corriere MA, Secemsky EA, Sutphin J, Johnson FR, Marcos Gonzalez J, Tarver ME, Saha A, Chen AL, Gebben DJ, Malone M, Farb A, Babalola O, Rorer EM, Zikmund-Fisher BJ, Reed SD. Using Separate Single-Outcome Risk Presentations Instead of Integrated Multioutcome Formats Improves Comprehension in Discrete Choice Experiments. Med Decis Making 2024; 44:649-660. [PMID: 38903012 DOI: 10.1177/0272989x241258466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2024]
Abstract
INTRODUCTION Despite decades of research on risk-communication approaches, questions remain about the optimal methods for conveying risks for different outcomes across multiple time points, which can be necessary in applications such as discrete choice experiments (DCEs). We sought to compare the effects of 3 design factors: 1) separated versus integrated presentations of the risks for different outcomes, 2) use or omission of icon arrays, and 3) vertical versus horizontal orientation of the time dimension. METHODS We conducted a randomized study among a demographically diverse sample of 2,242 US adults recruited from an online panel (mean age 59.8 y, s = 10.4 y; 21.9% African American) that compared risk-communication approaches that varied in the 3 factors noted above. The primary outcome was the number of correct responses to 12 multiple-choice questions asking survey respondents to identify specific numbers, contrast options to recognize dominance (larger v. smaller risks), and compute differences. We used linear regression to test the effects of the 3 design factors, controlling for health literacy, graph literacy, and numeracy. We also measured choice consistency in a subsequent DCE choice module. RESULTS Mean comprehension varied significantly across versions (P < 0.001), with higher comprehension in the 3 versions that provided separated risk information for each risk. In the multivariable regression, separated risk presentation was associated with 0.58 more correct responses (P < 0.001; 95% confidence interval: 0.39, 0.77) compared with integrated risk information. Neither providing icon arrays nor using vertical versus horizontal time formats affected comprehension rates, although participant understanding did correlate with DCE choice consistency. CONCLUSIONS In presentations of multiple risks over multiple time points, presenting risk information separately for each health outcome appears to increase understanding. HIGHLIGHTS When conveying information about risks of different outcomes at multiple time points, separate presentations of single-outcome risks resulted in higher comprehension than presentations that combined risk information for different outcomes.We also observed benefits of presenting single-outcome risks separately among respondents with lower numeracy and graph literacy.Study participants who scored higher on risk understanding were more internally consistent in their responses to a discrete choice experiment.
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Affiliation(s)
| | | | | | - Laura Brotzman
- University of Michigan School of Public Health, Ann Arbor, MI, USA
| | | | | | | | | | | | | | - Anindita Saha
- US Food and Drug Administration, Silver Spring, MD, USA
| | - Allen L Chen
- US Food and Drug Administration, Silver Spring, MD, USA
| | | | - Misti Malone
- US Food and Drug Administration, Silver Spring, MD, USA
| | - Andrew Farb
- US Food and Drug Administration, Silver Spring, MD, USA
| | | | - Eva M Rorer
- US Food and Drug Administration, Silver Spring, MD, USA
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Donnelly PS, Sweeney A, Wilson E, Passmore AP, McCorry NK, Boeri M, Kane JPM. Developing a person-centered stated preference survey for dementia with Lewy bodies: value of a personal and public involvement process. FRONTIERS IN DEMENTIA 2024; 3:1421556. [PMID: 39081616 PMCID: PMC11285556 DOI: 10.3389/frdem.2024.1421556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 06/27/2024] [Indexed: 08/02/2024]
Abstract
Introduction The development of high-quality stated preference (SP) surveys requires a rigorous design process involving engagement with representatives from the target population. However, while transparency in the reporting of the development of SP surveys is encouraged, few studies report on this process and the outcomes. Recommended stages of instrument development includes both steps for stakeholder/end-user engagement and pretesting. Pretesting typically involves interviews, often across multiple waves, with improvements made at each wave; pretesting is therefore resource intensive. The aims of this paper are to report on the outcomes of collaboration with a Lewy body dementia research advisory group during the design phase of a SP survey. We also evaluate an alternative approach to instrument development, necessitated by a resource constrained context. Method The approach involved conducting the stages of end-user engagement and pretesting together during a public involvement event. A hybrid approach involving a focus group with breakout interviews was employed. Feedback from contributors informed the evolution of the survey instrument. Results Changes to the survey instrument were organized into four categories: attribute modifications; choice task presentation and understanding; information presentation, clarity and content; and best-best scaling presentation. The hybrid approach facilitated group brainstorming while still allowing the researcher to assess the feasibility of choice tasks in an interview setting. However, greater individual exploration and the opportunity to trial iterative improvements across waves was not feasible with this approach. Discussion Involvement of the research advisory group resulted in a more person-centered survey design. In a context constrained by time and budget, and with consideration of the capacity and vulnerability of the target population, the approach taken was a feasible and pragmatic mechanism for improving the design of a SP survey.
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Affiliation(s)
- Paula Sinead Donnelly
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, United Kingdom
| | - Aoife Sweeney
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, United Kingdom
| | - Emily Wilson
- Northern Ireland Lewy Body Dementia Research Advisory Group, Queen's University Belfast, Belfast, United Kingdom
| | - Anthony Peter Passmore
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, United Kingdom
| | - Noleen K. McCorry
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, United Kingdom
| | - Marco Boeri
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, United Kingdom
- Patient-Centered Outcomes, OPEN Health, London, United Kingdom
| | - Joseph P. M. Kane
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, United Kingdom
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Morrish N, Snowsill T, Dodman S, Medina-Lara A. Preferences for Genetic Testing to Predict the Risk of Developing Hereditary Cancer: A Systematic Review of Discrete Choice Experiments. Med Decis Making 2024; 44:252-268. [PMID: 38323553 PMCID: PMC10988993 DOI: 10.1177/0272989x241227425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 01/03/2024] [Indexed: 02/08/2024]
Abstract
BACKGROUND Understanding service user preferences is key to effective health care decision making and efficient resource allocation. It is of particular importance in the management of high-risk patients in whom predictive genetic testing can alter health outcomes. PURPOSE This review aims to identify the relative importance and willingness to pay for attributes of genetic testing in hereditary cancer syndromes. DATA SOURCES Searches were conducted in Medline, Embase, PsycINFO, HMIC, Web of Science, and EconLit using discrete choice experiment (DCE) terms combined with terms related to hereditary cancer syndromes, malignancy synonyms, and genetic testing. STUDY SELECTION Following independent screening by 3 reviewers, 7 studies fulfilled the inclusion criteria, being a DCE investigating patient or public preferences related to predictive genetic testing for hereditary cancer syndromes. DATA EXTRACTION Extracted data included study and respondent characteristics, DCE attributes and levels, methods of data analysis and interpretation, and key study findings. DATA SYNTHESIS Studies covered colorectal, breast, and ovarian cancer syndromes. Results were summarized in a narrative synthesis and the quality assessed using the Lancsar and Louviere framework. LIMITATIONS This review focuses only on DCE design and testing for hereditary cancer syndromes rather than other complex diseases. Challenges also arose from heterogeneity in attributes and levels. CONCLUSIONS Test effectiveness and detection rates were consistently important to respondents and thus should be prioritized by policy makers. Accuracy, cost, and wait time, while also important, showed variation between studies, although overall reduction in cost may improve uptake. Patients and the public would be willing to pay for improved detection and clinician over insurance provider involvement. Future studies should seek to contextualize findings by considering the impact of sociodemographic characteristics, health system coverage, and insurance policies on preferences. HIGHLIGHTS Test effectiveness and detection rates are consistently important to respondents in genetic testing for hereditary cancer syndromes.Reducing the cost of genetic testing for hereditary cancer syndromes may improve uptake.Individuals are most willing to pay for a test that improves detection rates, identifies multiple cancers, and for which results are shared with a doctor rather than with an insurance provider.
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Affiliation(s)
- N. Morrish
- Public Health Economics Group, Department of Public Health and Sport Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - T. Snowsill
- Health Economics Group, Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | | | - A. Medina-Lara
- Public Health Economics Group, Department of Public Health and Sport Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
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DiSantostefano RL, Smith IP, Falahee M, Jiménez-Moreno AC, Oliveri S, Veldwijk J, de Wit GA, Janssen EM, Berlin C, Groothuis-Oudshoorn CGM. Research Priorities to Increase Confidence in and Acceptance of Health Preference Research: What Questions Should be Prioritized Now? THE PATIENT 2024; 17:179-190. [PMID: 38103109 PMCID: PMC10894084 DOI: 10.1007/s40271-023-00650-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/01/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND AND OBJECTIVE There has been an increase in the study and use of stated-preference methods to inform medicine development decisions. The objective of this study was to identify prioritized topics and questions relating to health preferences based on the perspective of members of the preference research community. METHODS Preference research stakeholders from industry, academia, consultancy, health technology assessment/regulatory, and patient organizations were recruited using professional networks and preference-targeted e-mail listservs and surveyed about their perspectives on 19 topics and questions for future studies that would increase acceptance of preference methods and their results by decision makers. The online survey consisted of an initial importance prioritization task, a best-worst scaling case 1 instrument, and open-ended questions. Rating counts were used for analysis. The best-worst scaling used a balanced incomplete block design. RESULTS One hundred and one participants responded to the survey invitation with 66 completing the best-worst scaling. The most important research topics related to the synthesis of preferences across studies, transferability across populations or related diseases, and method topics including comparison of methods and non-discrete choice experiment methods. Prioritization differences were found between respondents whose primary affiliation was academia versus other stakeholders. Academic researchers prioritized methodological/less studied topics; other stakeholders prioritized applied research topics relating to consistency of practice. CONCLUSIONS As the field of health preference research grows, there is a need to revisit and communicate previous work on preference selection and study design to ensure that new stakeholders are aware of this work and to update these works where necessary. These findings might encourage discussion and alignment among different stakeholders who might hold different research priorities. Research on the application of previous preference research to new contexts will also help increase the acceptance of health preference information by decision makers.
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Affiliation(s)
| | - Ian P Smith
- Janssen Research & Development LLC, 1125 Trenton Harbourton Rd, Titusville, NJ, 08560, USA
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Marie Falahee
- Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | | | - Serena Oliveri
- Applied Research Division for Cognitive and Psychological Science, Istituto Europeo di Oncologia, IEO IRCCS, Milan, Italy
| | - Jorien Veldwijk
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - G Ardine de Wit
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Ellen M Janssen
- Janssen Research & Development LLC, 1125 Trenton Harbourton Rd, Titusville, NJ, 08560, USA
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Pestana J, Frutuoso J, Costa E, Fonseca F. Heterogeneity in physician's job preferences in a dual practice context - Evidence from a DCE. Soc Sci Med 2024; 343:116551. [PMID: 38242030 DOI: 10.1016/j.socscimed.2023.116551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 11/26/2023] [Accepted: 12/21/2023] [Indexed: 01/21/2024]
Abstract
Many countries are facing challenges in recruiting and retaining physicians, particularly in regions where the public and private sectors compete for doctors. Understanding the factors influencing physicians' job choices can help inform policies aimed at attracting and retaining this valuable workforce. This study aims to elicit the strength of physicians' preferences regarding various job-related aspects, including earnings, time flexibility, discussion of clinical cases, frequency of facilities and equipment updates, training opportunities and autonomy in decision making. To achieve this, a Discrete Choice Experiment (DCE) was administered to 697 physicians. Each participant completed a series of eight choice tasks, where they had to choose between two hypothetical jobs differing in these attributes with levels mirroring positions in the public and private sectors in Portugal. The resulting choices were analysed using mixed logit, generalized multinomial logit and latent classes models to account for diverse unobserved variations in physicians' preferences and to explore preference heterogeneity across different observable characteristics. Jobs that offered more autonomy and training opportunities were strongly preferred, as physicians would require additional compensation to work with reduced autonomy (equivalent to 28.62% of gross income) or less frequent training (equivalent to 22.75%). This study also shows that the ranking of the job characteristics is similar between physicians working exclusively in the public sector and those engaged in dual practice. Nevertheless, public sector physicians place more emphasis on the availability of frequent training possibilities and frequent updates of facilities and equipment compared to their counterparts in dual practice. These findings contribute to existing knowledge by highlighting the significance of non-monetary attributes and shedding light on the preferences of physicians across various employment scenarios. They offer valuable insights for policy development aimed at influencing physicians' allocation of time between sectors.
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Affiliation(s)
- Joana Pestana
- Nova School of Business and Economics, Lisbon, Portugal.
| | - João Frutuoso
- Serviço de Medicina Intensiva do Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Eduardo Costa
- Nova School of Business and Economics, Lisbon, Portugal
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Raghunandan R, Howard K. Research Note: Discrete choice experiments to elicit preferences for decision-making in physiotherapy. J Physiother 2024; 70:73-77. [PMID: 38072716 DOI: 10.1016/j.jphys.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 11/07/2023] [Indexed: 01/07/2024] Open
Affiliation(s)
- Rakhee Raghunandan
- Menzies Centre for Health Policy and Economics, School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Kirsten Howard
- Menzies Centre for Health Policy and Economics, School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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Govathson C, Long L, Moolla A, Mngadi-Ncube S, Ngcobo N, Mongwenyana C, Lince-Deroche N, Pascoe S. Understanding school-going adolescent's preferences for accessing HIV and contraceptive care: findings from a discrete choice experiment among learners in Gauteng, South Africa. BMC Health Serv Res 2023; 23:1378. [PMID: 38066547 PMCID: PMC10704722 DOI: 10.1186/s12913-023-10414-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 11/30/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Many Adolescents in Sub-Saharan Africa do not access HIV and reproductive health services optimally. To improve uptake of these services, it is important to understand the Learners' preferences for how services are delivered so that implementation strategies can reflect this. METHODS A discrete choice experiment (DCE) was used to elicit preferences. The DCE was completed between 07/2018 and 09/2019 and conducted in 10 high schools situated in neighbourhoods of varying socio-economic status (SES) in Gauteng (South Africa). Learners aged ≥ 15 years (Grades 9-12) were consented and enrolled in the DCE. Parental consent and assent were required if < 18 years old. Conditional logistic regression was used to determine preferred attributes for HIV and contraceptive service delivery. Results were stratified by gender and neighbourhood SES quintile (1 = Lowest SES; 5 = Highest SES). RESULTS 805 Learners were enrolled (67% female; 66% 15-17 years; 51% in grades 9-10). 54% of Learners in quintile 1 schools had no monthly income (family support, grants, part-time jobs etc.); 38% in quintile 5 schools had access to R100 ($7.55) per month. Preferences for accessing HIV and contraceptive services were similar for male and female Learners. Learners strongly preferred services provided by friendly, non-judgmental staff (Odds ratio 1.63; 95% Confidence Interval: 1.55-1.72) where confidentiality was ensured (1.33; 1.26-1.40). They preferred services offered after school (1.14; 1.04-1.25) with value-added services like free Wi-Fi (1.19; 1.07-1.32), food (1.23; 1.11-1.37) and youth-only waiting areas (1.18; 1.07-1.32). Learners did not have a specific location preference, but preferred not to receive services within the community (0.82; 0.74-0.91) or school (0.88; 0.80-0.96). Costs to access services were a deterrent for most Learners irrespective of school neighbourhood; female Learners were deterred by costs ≥$3.85 (0.79; 0.70-0.91); males by costs ≥ R100 ($7.55) (0.86; 0.74-1.00). CONCLUSIONS Preferences that encourage utilisation of services do not significantly differ by gender or school neighbourhood SES. Staff attitude and confidentiality are key issues affecting Learners' decisions to access HIV and contraceptive services. Addressing how healthcare providers respond to young people seeking sexual and reproductive health services is critical for improving adolescents' uptake of these services.
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Affiliation(s)
- Caroline Govathson
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, 39 Empire Road, Parktown,, Johannesburg, 2193, South Africa
| | - Lawrence Long
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Aneesa Moolla
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, 39 Empire Road, Parktown,, Johannesburg, 2193, South Africa
| | - Sithabile Mngadi-Ncube
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, 39 Empire Road, Parktown,, Johannesburg, 2193, South Africa
| | - Nkosinathi Ngcobo
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, 39 Empire Road, Parktown,, Johannesburg, 2193, South Africa
| | - Constance Mongwenyana
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, 39 Empire Road, Parktown,, Johannesburg, 2193, South Africa
| | | | - Sophie Pascoe
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, 39 Empire Road, Parktown,, Johannesburg, 2193, South Africa.
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Varhol RJ, Norman R, Randall S, Man Ying Lee C, Trevenen L, Boyd JH, Robinson S. Public preference on sharing health data to inform research, health policy and clinical practice in Australia: A stated preference experiment. PLoS One 2023; 18:e0290528. [PMID: 37972118 PMCID: PMC10653479 DOI: 10.1371/journal.pone.0290528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 08/10/2023] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVE To investigate public willingness to share sensitive health information for research, health policy and clinical practice. METHODS A total of 1,003 Australian respondents answered an online, attribute-driven, survey in which participants were asked to accept or reject hypothetical choice sets based on a willingness to share their health data for research and frontline-medical support as part of an integrated health system. The survey consisted of 5 attributes: Stakeholder access for analysis (Analysing group); Type of information collected; Purpose of data collection; Information governance; and Anticipated benefit; the results of which were analysed using logistic regression. RESULTS When asked about their preference for sharing their health data, respondents had no preference between data collection for the purposes of clinical practice, health policy or research, with a slight preference for having government organisations manage, govern and curate the integrated datasets from which the analysis was being conducted. The least preferred option was for personal health records to be integrated with insurance records or for their data collected by privately owned corporate organisations. Individuals preferred their data to be analysed by a public healthcare provider or government staff and expressed a dislike for any private company involvement. CONCLUSIONS The findings from this study suggest that Australian consumers prefer to share their health data when there is government oversight, and have concerns about sharing their anonymised health data for clinical practice, health policy or research purposes unless clarity is provided pertaining to its intended purpose, limitations of use and restrictions to access. Similar findings have been observed in the limited set of existing international studies utilising a stated preference approach. Evident from this study, and supported by national and international research, is that the establishment and preservation of a social license for data linkage in health research will require routine public engagement as a result of continuously evolving technological advancements and fluctuating risk tolerance. Without more work to understand and address stakeholder concerns, consumers risk being reluctant to participate in data-sharing and linkage programmes.
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Affiliation(s)
- Richard J. Varhol
- School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Richard Norman
- School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Sean Randall
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Melbourne, Victoria, Australia
| | - Crystal Man Ying Lee
- School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Luke Trevenen
- School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - James H. Boyd
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Suzanne Robinson
- School of Population Health, Curtin University, Perth, Western Australia, Australia
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Melbourne, Victoria, Australia
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Enoch J, Ghulakhszian A, Sekhon M, Crabb DP, Taylor DJ, Dinah C. Piloting a forced-choice task to elicit treatment preferences in geographic atrophy. BMC Res Notes 2023; 16:244. [PMID: 37777762 PMCID: PMC10543887 DOI: 10.1186/s13104-023-06531-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 09/21/2023] [Indexed: 10/02/2023] Open
Abstract
OBJECTIVE Geographic Atrophy (GA) is the advanced form of the non-neovascular ('dry') type of age-related macular degeneration (AMD) and responsible for one-quarter of legal blindness in the UK. New therapies delivered by intravitreal injection are in late-stage development, and two such therapies (pegcetacoplan (Syfovre) and avacincaptad pegol (Izervay)) have now been approved for clinical use by the US Food and Drug Administration. These therapies slow down, but do not stop or reverse, progression of GA and they may also increase the risk of developing the neovascular ('wet') type of AMD. Within a larger study exploring the acceptability of these new treatments to people living with GA, we developed a forced-choice exercise to evaluate how participants weigh up benefits and drawbacks of different treatment regimens. This research note reports quantitative and qualitative findings from this exercise. RESULTS Twenty-eight participants took part in this exercise. The exercise demonstrated that participants were generally, although not unanimously, in favour of less frequent treatment for GA that was slightly less efficacious in terms of preserving visual function but presented a lower risk of developing wet AMD. Even among a small sample, the exercise demonstrated the highly personal and idiosyncratic decision-making processes influencing participants' choices of preferred hypothetical GA treatment.
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Affiliation(s)
- Jamie Enoch
- Department of Optometry and Visual Sciences, City, University of London, London, UK
| | - Arevik Ghulakhszian
- Ophthalmology Department, London North West University Healthcare NHS Trust, Central Middlesex Hospital, London, UK
| | - Mandeep Sekhon
- Centre for Applied Health and Social Care Research, Kingston and St George's, University of London, London, UK
| | - David P Crabb
- Department of Optometry and Visual Sciences, City, University of London, London, UK
| | - Deanna J Taylor
- Department of Optometry and Visual Sciences, City, University of London, London, UK
| | - Christiana Dinah
- Ophthalmology Department, London North West University Healthcare NHS Trust, Central Middlesex Hospital, London, UK.
- Department of Brain Sciences, Imperial College, London, UK.
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Turner A, Wolvaardt J, Ryan M. Exploring doctors' trade-offs between management, research and clinical training in the medical curriculum: a protocol for a discrete choice experiment in Southern Africa. BMJ Open 2023; 13:e070836. [PMID: 37536974 PMCID: PMC10401257 DOI: 10.1136/bmjopen-2022-070836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 06/28/2023] [Indexed: 08/05/2023] Open
Abstract
INTRODUCTION Medical curricula should prepare doctors for roles that extend beyond that of a clinician. But the formal inclusion of both management and research training still appear to be neglected. It is important to understand what the profession would be willing to give up in terms of clinical training time for management and research content teaching prior to making any changes in a medical curriculum. METHODS AND ANALYSIS A discrete choice experiment will elicit the preferences and trade-offs that medical doctors in Southern Africa are prepared to make about the management, research and clinical training. Attention will also be given to the teaching method and placement of the content. DCE data will be collected using an online survey with an estimated sample size of 368 medical doctors. Data regarding participants' preference for a traditional or revised curriculum will be assessed using the Resistance to Change-Beliefs (RC-B) scale and demographic information will also be collected to assess preference heterogeneity.Analysis of the DCE data will be based on the Random Utility Maximisation framework using variants of the multinomial logit model. Data quality will be assessed. Value will be estimated in terms of clinical time, that is, how much clinical training time medical doctors are willing to give up to have research and management training within a curriculum that has a maximum of 40 hours per week. Observed preference heterogeneity will be assessed using the RC-B scale data and characteristics of respondents. Latent class models will be used to test for unobserved heterogeneity. ETHICS AND DISSEMINATION The research ethics and institutional committees of the sites have approved the study. The survey includes an informed consent section. Study findings will be reported to the medical schools and papers will be submitted to peer-reviewed, accredited journals and higher education and health economic conferences.
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Affiliation(s)
- Astrid Turner
- School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
| | - Jacqueline Wolvaardt
- School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
| | - Mandy Ryan
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
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Aina IV, Thiam DR, Dinar A. Economics of household preferences for water-saving technologies in urban South Africa. JOURNAL OF ENVIRONMENTAL MANAGEMENT 2023; 339:117953. [PMID: 37080102 DOI: 10.1016/j.jenvman.2023.117953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/22/2023] [Accepted: 04/14/2023] [Indexed: 05/03/2023]
Abstract
Drought severity is expected to increase in South Africa in the coming years, given the deteriorating effects of climate change on rainfall patterns, global temperature, and evaporation. A common mitigation strategy adopted by households is to promote water demand management initiatives to reduce water consumption volume and complement existing water supply management approaches implemented by suppliers. This study contributes to the discussion on adaptation strategies by investigating household preference heterogeneity for water-saving technologies through empirical evidence from urban Cape Town, South Africa. Using a choice modelling framework, we collected primary survey data from 512 urban households in five of the city's major suburbs and investigated heterogeneity among the households based on their preferences for characteristics embedded in four water-saving technologies. Four preference classes were identified by accounting for taste heterogeneity. Overall, respondents had the highest marginal willingness to pay (MWTP) for the greywater technology alternative at 17,025 ZAR (US$ 1142) while rainwater technology has the least willingness to pay value at 5206 ZAR (US$ 349). In addition, the results show that respondents in classes 1 and 2 have a high interest in technologies that save a large quantity of water, whereas members of classes 3 and 4 rely on inexpensive conservation and behavioral habits as climate adaptation measures. This study has important policy implications for many water-stressed and arid cities within and outside South Africa since like Cape Town, many large cities require long-lasting measures that help reduce the pressure on their strained water systems.
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Affiliation(s)
- Ifedotun Victor Aina
- School of Economics, University of Cape Town, Rondebosch, South Africa; Water and Production Economics Program, University of Cape Town, Rondebosch, South Africa.
| | - Djiby Racine Thiam
- School of Economics, University of Cape Town, Rondebosch, South Africa; Water and Production Economics Program, University of Cape Town, Rondebosch, South Africa
| | - Ariel Dinar
- School of Public Policy, University of California, Riverside, USA
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12
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Haynes A, Howard K, Johnson L, Williams G, Clanchy K, Tweedy S, Scheinberg A, Chagpar S, Wang B, Vassallo G, Ashpole R, Sherrington C, Hassett L. Physical Activity Preferences of People Living with Brain Injury: Formative Qualitative Research to Develop a Discrete Choice Experiment. THE PATIENT 2023:10.1007/s40271-023-00628-9. [PMID: 37204699 DOI: 10.1007/s40271-023-00628-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Accepted: 03/31/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND AND OBJECTIVE The World Health Organization physical activity guidelines for people living with disability do not consider the needs of people living with moderate-to-severe traumatic brain injury. This paper describes the qualitative co-development of a discrete choice experiment survey to inform the adaption of these guidelines by identifying the physical activity preferences of people living with moderate-to-severe traumatic brain injury in Australia. METHODS The research team comprised researchers, people with lived experience of traumatic brain injury and health professionals with expertise in traumatic brain injury. We followed a four-stage process: (1) identification of key constructs and initial expression of attributes, (2) critique and refinement of attributes, (3) prioritisation of attributes and refinement of levels and (4) testing and refining language, format and comprehensibility. Data collection included deliberative dialogue, focus groups and think-aloud interviews with 22 purposively sampled people living with moderate-to-severe traumatic brain injury. Strategies were used to support inclusive participation. Analysis employed qualitative description and framework methods. RESULTS This formative process resulted in discarding, merging, renaming and reconceptualising attributes and levels. Attributes were reduced from an initial list of 17 to six: (1) Type of activity, (2) Out-of-pocket cost, (3) Travel time, (4) Who with, (5) Facilitated by and (6) Accessibility of setting. Confusing terminology and cumbersome features of the survey instrument were also revised. Challenges included purposive recruitment, reducing diverse stakeholder views to a few attributes, finding the right language and navigating the complexity of discrete choice experiment scenarios. CONCLUSIONS This formative co-development process significantly improved the relevance and comprehensibility of the discrete choice experiment survey tool. This process may be applicable in other discrete choice experiment studies.
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Affiliation(s)
- Abby Haynes
- Sydney Musculoskeletal Health: The University of Sydney and Sydney Local Health District, Gadigal Land, Sydney, NSW, Australia.
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Gadigal Land, Sydney, NSW, Australia.
- Sydney Musculoskeletal Health, Level 10 KGV Building, Missenden Road, Camperdown (Gadigal land), NSW, 2050, Australia.
| | - Kirsten Howard
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Gadigal Land, Sydney, NSW, Australia
| | - Liam Johnson
- School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia
- School of Behavioural and Health Sciences, Faculty of Health Sciences, Australian Catholic University, Melbourne, VIC, Australia
| | - Gavin Williams
- School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia
- Physiotherapy Department, Epworth HealthCare, Melbourne, VIC, Australia
| | - Kelly Clanchy
- School of Health Sciences and Social Work, Griffith Health, Griffith University, Gold Coast, QLD, Australia
- Menzies Health Institute of Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Sean Tweedy
- School of Human Movement and Nutrition Sciences, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, QLD, Australia
| | - Adam Scheinberg
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Sakina Chagpar
- Sydney Musculoskeletal Health: The University of Sydney and Sydney Local Health District, Gadigal Land, Sydney, NSW, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Gadigal Land, Sydney, NSW, Australia
| | - Belinda Wang
- Sydney Musculoskeletal Health: The University of Sydney and Sydney Local Health District, Gadigal Land, Sydney, NSW, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Gadigal Land, Sydney, NSW, Australia
| | | | - Rhys Ashpole
- Insurance and Care (icare) NSW, Sydney, NSW, Australia
| | - Catherine Sherrington
- Sydney Musculoskeletal Health: The University of Sydney and Sydney Local Health District, Gadigal Land, Sydney, NSW, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Gadigal Land, Sydney, NSW, Australia
| | - Leanne Hassett
- Sydney Musculoskeletal Health: The University of Sydney and Sydney Local Health District, Gadigal Land, Sydney, NSW, Australia
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Implementation Science Academy, Sydney Health Partners, Sydney, NSW, Australia
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13
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Veldwijk J, Marceta SM, Swait JD, Lipman SA, de Bekker-Grob EW. Taking the Shortcut: Simplifying Heuristics in Discrete Choice Experiments. THE PATIENT 2023:10.1007/s40271-023-00625-y. [PMID: 37129803 DOI: 10.1007/s40271-023-00625-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/16/2023] [Indexed: 05/03/2023]
Abstract
Health-related discrete choice experiments (DCEs) information can be used to inform decision-making on the development, authorisation, reimbursement and marketing of drugs and devices as well as treatments in clinical practice. Discrete choice experiment is a stated preference method based on random utility theory (RUT), which imposes strong assumptions on respondent choice behaviour. However, respondents may use choice processes that do not adhere to the normative rationality assumptions implied by RUT, applying simplifying decision rules that are more selective in the amount and type of processed information (i.e., simplifying heuristics). An overview of commonly detected simplifying heuristics in health-related DCEs is lacking, making it unclear how to identify and deal with these heuristics; more specifically, how researchers might alter DCE design and modelling strategies to accommodate for the effects of heuristics. Therefore, the aim of this paper is three-fold: (1) provide an overview of common simplifying heuristics in health-related DCEs, (2) describe how choice task design and context as well as target population selection might impact the use of heuristics, (3) outline DCE design strategies that recognise the use of simplifying heuristics and develop modelling strategies to demonstrate the detection and impact of simplifying heuristics in DCE study outcomes.
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Affiliation(s)
- Jorien Veldwijk
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands.
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands.
- Erasmus Centre for Health Economics Rotterdam, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - Stella Maria Marceta
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus Centre for Health Economics Rotterdam, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Joffre Dan Swait
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus Centre for Health Economics Rotterdam, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Stefan Adriaan Lipman
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus Centre for Health Economics Rotterdam, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Esther Wilhelmina de Bekker-Grob
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus Centre for Health Economics Rotterdam, Erasmus University Rotterdam, Rotterdam, The Netherlands
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14
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Tervonen T, Veldwijk J, Payne K, Ng X, Levitan B, Lackey LG, Marsh K, Thokala P, Pignatti F, Donnelly A, Ho M. Quantitative Benefit-Risk Assessment in Medical Product Decision Making: A Good Practices Report of an ISPOR Task Force. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:449-460. [PMID: 37005055 DOI: 10.1016/j.jval.2022.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 12/06/2022] [Indexed: 05/06/2023]
Abstract
Benefit-risk assessment is commonly conducted by drug and medical device developers and regulators, to evaluate and communicate issues around benefit-risk balance of medical products. Quantitative benefit-risk assessment (qBRA) is a set of techniques that incorporate explicit outcome weighting within a formal analysis to evaluate the benefit-risk balance. This report describes emerging good practices for the 5 main steps of developing qBRAs based on the multicriteria decision analysis process. First, research question formulation needs to identify the needs of decision makers and requirements for preference data and specify the role of external experts. Second, the formal analysis model should be developed by selecting benefit and safety endpoints while eliminating double counting and considering attribute value dependence. Third, preference elicitation method needs to be chosen, attributes framed appropriately within the elicitation instrument, and quality of the data should be evaluated. Fourth, analysis may need to normalize the preference weights, base-case and sensitivity analyses should be conducted, and the effect of preference heterogeneity analyzed. Finally, results should be communicated efficiently to decision makers and other stakeholders. In addition to detailed recommendations, we provide a checklist for reporting qBRAs developed through a Delphi process conducted with 34 experts.
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Affiliation(s)
| | - Jorien Veldwijk
- Erasmus School of Health Policy and Management & Erasmus Choice Modelling Center, Rotterdam, The Netherlands
| | - Katherine Payne
- Manchester Centre for Health Economics, School of Health Sciences, The University of Manchester, Manchester, England, UK
| | - Xinyi Ng
- Office of Biostatistics and Pharmacovigilance, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | | | - Leila G Lackey
- Decision Support and Analysis Staff, Office of Program and Strategic Analysis, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | | | - Praveen Thokala
- School of Health and Related Research, University of Sheffield, Sheffield, England, UK
| | | | - Anne Donnelly
- Patient Council of the Michael J. Fox Foundation for Parkinson's Research, New York, NY, USA
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15
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Nicolet A, Perraudin C, Krucien N, Wagner J, Peytremann-Bridevaux I, Marti J. Preferences of older adults for healthcare models designed to improve care coordination: evidence from Western Switzerland. Health Policy 2023; 132:104819. [PMID: 37060718 DOI: 10.1016/j.healthpol.2023.104819] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 12/02/2022] [Accepted: 04/04/2023] [Indexed: 04/08/2023]
Abstract
Implementing innovations in care delivery in Switzerland is challenging due to the fragmented nature of the system and the specificities of the political process (i.e., direct democracy, decentralized decision-making). In this context, it is particularly important to account for population preferences when designing policies. We designed a discrete choice experiment to study population preferences for coordination-improving care models. Specifically, we assessed the relative importance of model characteristics (i.e., insurance premium, presence of care coordinator, access to specialists, use of EMR, cost-sharing for chronic patients, incentives for informal care), and predicted uptake under different policy scenarios. We accounted for heterogeneity in preferences for the status quo option using an error component logit model. Respondents attached the highest importance to the price attribute (i.e. insurance premium) (0.31, CI: 0.27- 0.36) and to the presence of a care coordinator (0.27, CI: 0.23 - 0.31). Policy scenarios showed for instance that gatekeeping would be preferred to free access to specialists if the model includes a GP or an interprofessional team as a care coordinator. Although attachment to the status quo is high in the studied population, there are potential ways to improve acceptance of alternative care models by implementation of positively valued innovations.
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16
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Khor S, Elsisi ZA, Carlson JJ. How Much Does the US Public Value Equity in Health? A Systematic Review. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:418-426. [PMID: 36216706 DOI: 10.1016/j.jval.2022.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 08/01/2022] [Accepted: 08/22/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES This systematic review aims to summarize and qualitatively assess published evaluations on the US public's preferences for health equity and their willingness to trade-off efficiency for equity. METHODS Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses literature search extension guidelines, we searched MEDLINE and Embase for relevant peer-reviewed publications on this topic before February 2021. We included English-language articles that solicited US preferences regarding efficiency-equity trade-offs and prioritizing healthcare resources based on socioeconomic status, race, disability, or burden of disease. Quantitative and qualitative data captured were decided a priori and iteratively adapted as themes emerged. RESULTS Fourteen studies were found over a 25-year span. Only 4 focused on resource allocation across social groups. Three distinct notions of fairness were studied: equal distribution of resources, priority to the worse-off, and equal health achieved. We found modest support for equal distribution of resources and willingness to sacrifice efficiency for equity in the United States. Prioritizing the underserved was relatively less studied and received less support and was more preferred when resources were scarce, when allocating resources between social groups, or when participants were informed about the fundamental origins of health inequities. Equal health was the least studied, but received nontrivial support. CONCLUSIONS The existing literature evaluating the US public's understanding and preferences toward equity was severely limited by the lack of rigorous quantitative studies and heterogeneous attribute selection and fairness definitions. High-quality studies that clearly define fairness, focus on social groups, and apply rigorous methods to quantify equity preferences are needed to integrate the public's value on equity into healthcare decisions.
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Affiliation(s)
- Sara Khor
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, School of Pharmacy, University of Washington, Seattle, WA, USA.
| | - Zizi A Elsisi
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, School of Pharmacy, University of Washington, Seattle, WA, USA
| | - Josh J Carlson
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, School of Pharmacy, University of Washington, Seattle, WA, USA
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17
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Thomas M, Marshall DA, Sanchez AL, Bartlett SJ, Boonen A, Fraenkel L, Proulx L, Voshaar M, Bansback N, Buchbinder R, Guillemin F, Hiligsmann M, Richards DP, Richards P, Shea B, Tugwell P, Falahee M, Hazlewood GS. Exploring perceptions of using preference elicitation methods to inform clinical trial design in rheumatology: A qualitative study and OMERACT collaboration. Semin Arthritis Rheum 2023; 58:152112. [PMID: 36372015 DOI: 10.1016/j.semarthrit.2022.152112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 09/07/2022] [Accepted: 09/14/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Clinical trial design requires value judgements and understanding patient preferences may help inform these judgements, for example when prioritizing treatment candidates, designing complex interventions, selecting appropriate outcomes, determining clinically important thresholds, or weighting composite outcomes. Preference elicitation methods are quantitative approaches that can estimate patients' preferences to quantify the absolute or relative importance of outcomes or other attributes relevant to the decision context. We aimed to explore stakeholder perceptions of using preference elicitation methods to inform judgements when designing clinical trials in rheumatology. METHODS We conducted 1-on-1 semi-structured interviews with patients with rheumatic diseases and rheumatology clinicians/researchers, recruited using purposive and snowball sampling. Participants were provided pre-interview materials, including a video and a document, to introduce the topic of preference elicitation methods and case examples of potential applications to clinical trials. Interviews were conducted via Zoom and were audio-recorded and transcribed. We used thematic analysis to analyze our data. RESULTS We interviewed 17 patients and 9 clinicians/researchers, until data and inductive thematic saturation were achieved within each group. Themes were grouped into overall perceptions, barriers, and facilitators. Patients and clinicians/researchers generally agreed that preference elicitation studies can improve clinical trial design, but that many considerations are required around preference heterogeneity and feasibility. A key barrier identified was the additional resources and expertise required to measure and incorporate preferences effectively in trial design. Key facilitators included developing guidance on how to use preference elicitation to inform trial design, as well as the role of external decision-makers in developing such guidance, and the need to leverage the movement towards patient engagement in research to encourage including patient preferences when designing trials. CONCLUSION Our findings allowed us to consider the potential applications of patient preferences in trial design according to stakeholders within rheumatology who are involved in the trial process. Future research should be conducted to develop comprehensive guidance on how to meaningfully include patient preferences when designing clinical trials in rheumatology. Doing so may have important downstream effects for shared decision-making, especially given the chronic nature of rheumatic diseases.
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Affiliation(s)
- Megan Thomas
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
| | - Deborah A Marshall
- Department of Community Health Sciences, University of Calgary, Calgary, Canada; Department of Medicine, University of Calgary, Calgary, Canada
| | - Adalberto Loyola Sanchez
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Susan J Bartlett
- Department of Medicine, McGill University, Montreal, Canada; Centre for Outcomes Research & Evaluation, Research Institute McGill University Health Centre, Montreal, Canada
| | - Annelies Boonen
- Department of Internal Medicine, Maastricht University Medical Center, Care and Public Health Research Institute, Maastricht, The Netherlands
| | - Liana Fraenkel
- Yale University School of Medicine, Section of Rheumatology, Connecticut, USA
| | - Laurie Proulx
- Patient research partner, Canadian Arthritis Patient Alliance, Ottawa, Canada
| | - Marieke Voshaar
- Patient research partner, Radboud University, Department of Pharmacy, Nijmegen, the Netherlands
| | - Nick Bansback
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Rachelle Buchbinder
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University and Monash Department of Clinical Epidemiology, Cabrini Institute, Melbourne, Australia
| | | | - Mickaël Hiligsmann
- Department of Health Services Research CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Dawn P Richards
- Patient research partner, Canadian Arthritis Patient Alliance, Ottawa, Canada; Patient research partner, Canadian Arthritis Patient Alliance and Five02 Labs Inc., Toronto, Canada
| | - Pamela Richards
- Patient research partner, University Hospitals, Bristol NHS Trust, Bristol, UK
| | - Beverley Shea
- Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Peter Tugwell
- Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Marie Falahee
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Glen S Hazlewood
- Department of Community Health Sciences, University of Calgary, Calgary, Canada; Department of Medicine, University of Calgary, Calgary, Canada.
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18
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Smith IP, Whichello CL, de Bekker-Grob EW, Mölken MPMHRV, Veldwijk J, de Wit GA. The Impact of Video-Based Educational Materials with Voiceovers on Preferences for Glucose Monitoring Technology in Patients with Diabetes: A Randomised Study. THE PATIENT 2023; 16:223-237. [PMID: 36670244 PMCID: PMC10121708 DOI: 10.1007/s40271-022-00612-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/15/2022] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Ensuring patients have enough information about healthcare choices prior to completing a preference study is necessary to support the validity of the findings. Patients are commonly informed using text-based information with supporting graphics. Video-based information may be more engaging for the general patient population. This study aimed to assess (1) the impact that educating patients using video-based educational materials with a voiceover has on patient preferences compared to traditional text, and (2) whether this impact is consistent between two countries. MATERIALS AND METHODS A video-based educational tool was developed to inform patients prior to completing a discrete choice experiment assessing preferences for glucose monitors. Patients with diabetes from the Netherlands and Poland were recruited through an online research panel. Respondents were randomised to receive information in either a text or a video with animations and a voiceover. Data were analysed using a mixed-logit model. RESULTS N = 981 completed surveys were analysed from the Netherlands (n = 459) and Poland (n = 522). Differences were found between the countries, but no interpretable pattern of differences was found between the two types of educational materials. Patients spent less time in the educational material than would be necessary to fully review all of the content. CONCLUSIONS Simply providing educational material in a video with animations and voiceovers does not necessarily lead to better engagement from respondents or different preference outcomes in a sample of diabetes patients when compared to text. Increasing engagement with educational materials should be a topic of future research for those conducting patient preference research as no amount of educational material will be helpful if respondents do not access it.
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Affiliation(s)
- Ian P Smith
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands.
| | - Chiara L Whichello
- Evidera, London, UK.,Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands.,Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Esther W de Bekker-Grob
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands.,Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | | | - Jorien Veldwijk
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands.,Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands.,Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - G Ardine de Wit
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
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Broderick L, Bjorner JB, Lauher-Charest M, White MK, Kosinski M, Mulhern B, Brazier J. Deciding Between SF-6Dv2 Health States: A Think-Aloud Study of Decision-Making Strategies Used in Discrete Choice Experiments. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:2034-2043. [PMID: 36064513 DOI: 10.1016/j.jval.2022.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 07/11/2022] [Accepted: 07/31/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE This study aimed to gain insight into decision-making strategies individuals used when evaluating pairs of SF-6Dv2 health states in discrete choice experiments (DCEs). METHODS This qualitative, cross-sectional, noninterventional study asked participants to use a think-aloud approach to compare SF-6Dv2 health states in DCEs. Thematic analysis focused on comprehension and cognitive strategies used to compare health states and make decisions. RESULTS Participants (N = 40) used 3 main strategies when completing DCEs: (1) trading, (2) reinterpretation, and (3) relying on previous experience. Trading was the most common strategy, used by everyone at least once, and involved prioritizing key attributes, such as preferring a health state with significant depression but no bodily pain. Reinterpretation was used by 17 participants and involved reconstructing health states by changing underlying assumptions (eg, rationalizing selecting a health state with significant pain because they could take pain medications). Finally, some (n = 13) relied on previous experience when making decisions on some choice tasks. Participants with experience dealing with pain, for instance, prioritized health states with the least impact in this dimension. CONCLUSIONS Qualitatively evaluating the decision-making strategies used in DCEs allows researchers to evaluate whether the tasks and attributes are interpreted accurately. The findings from this study add to the understanding of the generation of SF-6Dv2 health utility weights and the validity of these weights (e.g., reinterpreting health states could undermine the validity of DCEs and utility weights), and the overall usefulness of the SF-6Dv2. The methodology described in this study can and should be carried forth in valuing other health utility measures, not just the SF-6Dv2.
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Affiliation(s)
| | - Jakob B Bjorner
- QualityMetric, Johnston, RI, USA; University of Copenhagen, Copenhagen, Denmark
| | | | | | | | - Brendan Mulhern
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, NSW, Australia
| | - John Brazier
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, England, UK
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20
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Lim AH, Ng SW, Teh XR, Ong SM, Sivasampu S, Lim KK. Conjoint analyses of patients’ preferences for primary care: a systematic review. BMC PRIMARY CARE 2022; 23:234. [PMID: 36085032 PMCID: PMC9463739 DOI: 10.1186/s12875-022-01822-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 08/09/2022] [Indexed: 11/10/2022]
Abstract
Abstract
Background
While patients’ preferences in primary care have been examined in numerous conjoint analyses, there has been little systematic effort to synthesise the findings. This review aimed to identify, to organise and to assess the strength of evidence for the attributes and factors associated with preference heterogeneity in conjoint analyses for primary care outpatient visits.
Methods
We searched five bibliographic databases (PubMed, Embase, PsycINFO, Econlit and Scopus) from inception until 15 December 2021, complemented by hand-searching. We included conjoint analyses for primary care outpatient visits. Two reviewers independently screened papers for inclusion and assessed the quality of all included studies using the checklist by ISPOR Task Force for Conjoint Analysis. We categorized the attributes of primary care based on Primary Care Monitoring System framework and factors based on Andersen’s Behavioural Model of Health Services Use. We then assessed the strength of evidence and direction of preference for the attributes of primary care, and factors affecting preference heterogeneity based on study quality and consistency in findings.
Results
Of 35 included studies, most (82.4%) were performed in high-income countries. Each study examined 3–8 attributes, mainly identified through literature reviews (n = 25). Only six examined visits for chronic conditions, with the rest on acute or non-specific / other conditions. Process attributes were more commonly examined than structure or outcome attributes. The three most commonly examined attributes were waiting time for appointment, out-of-pocket costs and ability to choose the providers they see. We identified 24/58 attributes with strong or moderate evidence of association with primary care uptake (e.g., various waiting times, out-of-pocket costs) and 4/43 factors with strong evidence of affecting preference heterogeneity (e.g., age, gender).
Conclusions
We found 35 conjoint analyses examining 58 attributes of primary care and 43 factors that potentially affect the preference of these attributes. The attributes and factors, stratified into evidence levels based on study quality and consistency, can guide the design of research or policies to improve patients’ uptake of primary care. We recommend future conjoint analyses to specify the types of visits and to define their attributes clearly, to facilitate consistent understanding among respondents and the design of interventions targeting them.
Word Count: 346/350 words.
Trial registration
On Open Science Framework: https://osf.io/m7ts9
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21
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Patient and Public Preferences for Coordinated Care in Switzerland: Development of a Discrete Choice Experiment. THE PATIENT - PATIENT-CENTERED OUTCOMES RESEARCH 2022; 15:485-496. [PMID: 35067858 PMCID: PMC9197802 DOI: 10.1007/s40271-021-00568-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/12/2021] [Indexed: 11/10/2022]
Abstract
Objective Our objective was to develop and test a discrete choice experiment (DCE) eliciting public and patient preferences for better-coordinated care in Switzerland. Methods We applied a multistage mixed-methods procedure using qualitative and quantitative approaches. First, to identify attributes, we performed a review of the DCE literature in healthcare with a focus on chronic care. Next, attribute selection involved stakeholders (N = 7) from various healthcare sectors to select the most relevant and actionable attributes, followed by three organized focus groups involving the general public and patients (N = 21) to verify the selection and the clarity of the DCE tasks and explanations. Finally, we conducted an online pilot in the target population to test the survey and obtain priors for a final six tested attributes to refine the final design of the experiment. Results After identifying an initial 33 attributes, a final list of six attributes was selected following stakeholder involvement and the three focus groups involving the target population. At the online pilot-testing stage with 301 participants, the majority of respondents found the DCE choice tasks socially relevant for Switzerland but challenging. The quality of the answers was relatively high. Most attributes had signs matching those in the literature and focus group discussions. Conclusion This article will be useful to researchers designing DCEs from a broad health policy perspective. The multistage approach involving a range of stakeholders was essential for the development of a DCE that is relevant for policy makers and well-accepted by the general public and patients. Supplementary Information The online version contains supplementary material available at 10.1007/s40271-021-00568-2.
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Rowen D, Powell PA, Hole AR, Aragon MJ, Castelli A, Jacobs R. Valuing quality in mental healthcare: A discrete choice experiment eliciting preferences from mental healthcare service users, mental healthcare professionals and the general population. Soc Sci Med 2022; 301:114885. [PMID: 35313220 DOI: 10.1016/j.socscimed.2022.114885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 03/03/2022] [Accepted: 03/09/2022] [Indexed: 10/18/2022]
Abstract
High and sustained healthcare quality is important worldwide, though health policy may prioritise the achievement of certain aspects of quality over others. This study determines the relative importance of different aspects of mental healthcare quality to different stakeholders by eliciting preferences in a UK sample using a discrete choice experiment (DCE). DCE attributes were generated using triangulation between policy documents and mental healthcare service user and mental healthcare professional views, whilst ensuring attributes were measurable using available data. Ten attributes were selected: waiting times; ease of access; person-centred care; co-ordinated approach; continuity; communication, capacity and resources; treated with dignity and respect; recovery focus; inappropriate discharge; quality of life (QoL). The DCE was conducted online (December 2018 to February 2019) with mental healthcare service users (n = 331), mental healthcare professionals (n = 510), and members of the general population (n = 1018). Respondents' choices were analysed using conditional logistic regression. Relative preferences for each attribute were generated using the marginal rate of substitution (MRS) with QoL as numeraire. Across all stakeholders, being treated with dignity and respect was of high importance. A coordinated approach was important across all stakeholders, whereas communication had higher relative importance for healthcare professionals and service users and ease of access had higher relative importance for the general population. This implies that policy could be affected by the choice of whose preferences (service users, healthcare professionals or general population) to use, since this impacts on the relative value and implied ranking of different aspects of mental healthcare quality.
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Affiliation(s)
- Donna Rowen
- School of Health and Related Research (ScHARR), University of Sheffield, UK.
| | - Philip A Powell
- School of Health and Related Research (ScHARR), University of Sheffield, UK
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Brown A, Jones S, Yim J. Health preference research: An overview for medical radiation sciences. J Med Radiat Sci 2022; 69:394-402. [PMID: 35388630 PMCID: PMC9442284 DOI: 10.1002/jmrs.580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 03/09/2022] [Accepted: 03/12/2022] [Indexed: 11/28/2022] Open
Abstract
Understanding preferences of key stakeholders including patients, clinicians and policymakers can inform clinical practice, workforce and policy. It also allows health services to evaluate existing clinical practices, policies and procedures. This commentary aims to introduce medical radiation professionals to health preference research by describing commonly used preference methodologies, with a particular focus on discrete choice experiments. Relevant examples of health preference research will be highlighted to demonstrate the application of health preference research in medical radiation sciences.
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Affiliation(s)
- Amy Brown
- Townsville Cancer Centre, Townsville University Hospital, Townsville, Queensland, Australia
| | - Scott Jones
- Radiation Oncology Princess Alexandra Hospital Raymond Terrace, Metro South Health Service, South Brisbane, Queensland, Australia
| | - Jackie Yim
- Department of Radiation Oncology, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Centre for Health Economics Research and Evaluation, Business School, University of Technology Sydney, Sydney, New South Wales, Australia
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Sigurdson S, Harrison M, Pearce A, Richardson H, Zaza K, Brundage M. One Fraction Size Does Not Fit All: Patient Preferences for Hypofractionated Radiation Therapy From a Discrete Choice Experiment. Pract Radiat Oncol 2022; 12:e24-e33. [PMID: 34991857 DOI: 10.1016/j.prro.2021.08.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 07/29/2021] [Accepted: 08/16/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE Hypofractionated external beam radiation therapy (EBRT) is a standard of care option for localized prostate cancer. To inform clinical practice we quantified patients' preferences for convenience, efficacy, and toxicity risks, of conventional, moderate hypofractionation, and stereotactic radiation therapy regimens. METHODS AND MATERIALS We used a discrete choice experiment with a voluntary sample consisting of patients treated with EBRT for localized prostate cancer at our academic cancer center. In 2019, 58 participants, mean (SD) age of 72.9 (7.1) years, agreed to complete an in-person 1:1 discrete choice experiment. Each participant made 12 choices between 2 unique EBRT scenarios, each described by 5 attributes: (1) treatment time; (2) fiducial markers; and risk of (3) prostate specific antigen recurrence; (4) acute and (5) late GI or GU toxicity. Patient preferences were estimated using mixed multinomial logistic regression, and prespecified subgroups with conditional logistic regression. RESULTS All attributes were statistically significant, thus influenced participants' choices. Risks of prostate specific antigen recurrence (β = -2.581), late (β = -1.854), and acute (β = -1.005) toxicity were most important to participants (P < .001 for each), followed by EBRT length (β = -0.728; P = .017) and fiducial marker implantation (β = -0.563; P = .004). Older (β = -0.063; 95% confidence interval, -0.12, -0.01) and rural (β = -0.083; 95% CI -0.14, -0.02) participants significantly preferred shorter EBRT and were less willing-to-extend treatment to reduce toxicity risk. CONCLUSIONS Patients with prostate cancer place importance on EBRT attributes, and some are willing to trade-off increased risk of toxicity for improved convenience. Our findings promote shared clinical decision-making because patients are interested in learning about the trade-offs involved.
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Affiliation(s)
- Samantha Sigurdson
- Department of Radiation Oncology, Cancer Centre of Southeastern Ontario, Kingston, Ontario, Canada; Department of Public Health Sciences, Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Ontario, Canada.
| | - Mark Harrison
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Alison Pearce
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, New South Wales, Australia; Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Harriet Richardson
- Department of Public Health Sciences, Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Ontario, Canada
| | - Khaled Zaza
- Department of Radiation Oncology, Cancer Centre of Southeastern Ontario, Kingston, Ontario, Canada
| | - Michael Brundage
- Department of Radiation Oncology, Cancer Centre of Southeastern Ontario, Kingston, Ontario, Canada; Department of Public Health Sciences, Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Ontario, Canada
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Methods for Conducting Stated Preference Research with Children and Adolescents in Health: A Scoping Review of the Application of Discrete Choice Experiments. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2021; 14:741-758. [PMID: 34008164 DOI: 10.1007/s40271-021-00519-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/12/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Discrete choice experiments (DCEs) are a common method used to describe and quantitatively assess preferences in health applications. Increasingly, DCEs have been used to elicit preferences from children and adolescents and generate evidence to inform policies affecting this population. OBJECTIVES The aim of this review was to summarize and describe the application of DCEs conducted with children and adolescents and describe author-reported age-specific considerations in design, implementation, and analysis. METHODS A scoping review was conducted using a 'pearl-growing' technique whereby the reference lists of existing systematic reviews of DCEs were used to identify potential studies conducted with children or adolescents as respondents published between 1990 and 2017. This list was supplemented with an updated electronic search using the same strategy as the initial reviews to identify studies from 2017 to 2020. RESULTS Of 480 studies identified, 19 were included; topics included vaccines (32%), drugs/medical devices (26%), treatment or health promotion interventions/programs (21%), warning labels on cigarettes/nicotine products (10%), and preferences for physical activity and healthy food choices (10%). The youngest reported age for independent DCE completion was 8 years. Approaches to assessing validity and reliability of choices were consistent with best practices for the conduct of DCEs. Reported age-specific considerations included use of visual aids, age-appropriate language, reducing task complexity and cognitive burden, and exploration of interpretation of willingness-to-pay. CONCLUSION The number of DCEs conducted with children and adolescents has increased in recent years. Detailed explanation of why reported age-specific considerations were necessary, how they could be used to interpret results, or to understand the appropriateness of this methodology for different age groups was limited. Despite a recognition of the need for special consideration when conducting DCEs in this population, the unique issues in the context of age-specific considerations are largely unexplored, and further research is required. Moving forward, stated preference research conducted with children and adolescents should report in more detail methods of recruitment, results of validity assessments, and provide specific reflection on the extent to which modeled results are consistent with expectations and underlying theory.
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