Care Management for Youth With Comorbid Developmental and Mental Health Conditions: A Discrete Choice Experiment Pilot Study

Feasibility of a best-worst scaling exercise to set priorities for autism research

Background

The preferences of autism stakeholders regarding the top priorities for future autism research are largely unknown.

Objective

This study had two objectives: First, to examine what autism stakeholders think new research investments should be and the attributes of investment that they consider important, and second, to explore the feasibility, acceptability and outcomes of two prioritization exercises among autism stakeholders regarding their priorities for future research in autism.

Design

This was  a prospective stakeholder‐engaged iterative study consisting of best–worst scaling (BWS) and direct prioritization exercise.

Setting and Participants

A national snowball sample of 219 stakeholders was included: adults with autism, caregivers, service providers and researchers.

Main Outcome Measures

The main outcomes measures were attributes that participants value in future research investments, and priority research investments for future research.

Results

Two hundred and nineteen participants completed the exercises, of whom 11% were adults with autism, 58% were parents/family members, 37% were service providers and 21% were researchers. Among stakeholders, the BWS exercises were easier to understand than the direct prioritization, less frequently skipped and yielded more consistent results. The proportion of children with autism affected by the research was the most important attribute for all types of stakeholders. The top three priorities among future research investments were (1) evidence on which child, family and intervention characteristics lead to the best/worst outcomes; (2) evidence on how changes in one area of a child's life are related to changes in other areas; and (3) evidence on dietary interventions. Priorities were similar for all stakeholder types.

Conclusions

The values and priorities examined here provide a road map for investigators and funders to pursue autism research that matters to stakeholders.

Patient or Public Contribution

Stakeholders completed a BWS and direct prioritization exercise to inform us about their priorities for future autism research.

Stakeholder-Engaged Derivation of Patient-Informed Value Elements

Objectives

Our objective was to identify patient-informed value elements that can be used to make value assessment more patient centered.

Methods

Mixed methods were used iteratively to collect and integrate qualitative and quantitative data in a four-stage process: identification (stage 1), prioritization (stage 2), refinement (stage 3), and synthesis (stage 4). Qualitative methods involved one-on-one discussions with 14 patient stakeholders from diverse medical communities representing mental health, osteoporosis, blindness, lupus, eczema, oncology, chronic obstructive pulmonary disease, and hypercholesterolemia. Stakeholders completed guided activities to prioritize elements important to patient healthcare decision making. Responses were summarized descriptively as frequencies and proportions.

Results

Stakeholders identified 94 value elements in stage 1. Of these, 42 elements remained following the stage 2 prioritization and the stage 3 refinement. During the stage 4 synthesis, the 42 patient-informed value elements comprised the principal set of value elements that were organized by 11 categories: tolerability, disease burden, forecasting, accessibility of care/treatment, healthcare service delivery, cost incurred on the patient, cost incurred on the family, personal well-being, stigma, social well-being, and personal values. The categories fell under five domains: short- and long-term effects of treatment, treatment access, cost, life impact, and social impact.

Conclusions

In total, 75% of the value elements in the conceptual model were patient derived and distinct from the elements used in existing value frameworks. Recommendations for tailoring, quantifying, and applying the patient-informed value elements in distinct patient communities are provided. This provides a foundation from which future research may test patient-informed value elements in existing value frameworks and economic evaluations.

Electronic supplementary material

The online version of this article (10.1007/s40271-020-00433-8) contains supplementary material, which is available to authorized users.