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Apolinarski B, de Jong L, Herbst FA, Huperz C, Röwer HAA, Schneider N, Damm K, Stiel S. Patients' and Relatives' Preferences for Outpatient and Day Care Services Within End-of-Life Care in Germany - A Discrete Choice Experiment. Patient Prefer Adherence 2024; 18:519-529. [PMID: 38440285 PMCID: PMC10910970 DOI: 10.2147/ppa.s442047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 02/08/2024] [Indexed: 03/06/2024] Open
Abstract
Purpose In Germany, patients with incurable chronic diseases living at home increasingly have the option of using outpatient and day care hospice and specialized palliative care services. The present study examined and compared patients' and their relatives' preferences for end-of-life outpatient and day care services. Patients and Methods The study used a questionnaire integrating a discrete choice experiment. For six scenarios, participants chose between two hypothetical end-of-life care offers, described by seven attributes. The model compared place of care, frequency and duration of care and support, specialized medical palliative care, accompanied activities, and relieving patient counselling. The model also included optional overnight care and willingness to pay. Patients and the relatives of patients suffering from incurable, chronic diseases who were not yet receiving palliative care were recruited via hospitals and self-help groups (06/2021-07/2022). Results The results were based on data from 436 questionnaires (patients: n=263, relatives: n=173). All attributes had a statistically significant impact on choice decisions, with place of care showing the greatest importance. All respondents highly preferred care in the patient's home over out-of-home care. Patients stressed the importance of special medical (palliative) care and valued accompanied activities, often facilitated by hospice volunteers. Relatives, but not patients, considered the frequency and duration of care highly relevant. Conclusion The results suggest a higher demand for care in the patient's home than for out-of-home care. Patients' and relatives' high preference for special medical care and the relief of family caregiver burden should be considered in the design of day care services.
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Affiliation(s)
- Beate Apolinarski
- Institute for General Practice and Palliative Care, Hannover Medical School, Hannover, Germany
| | - Lea de Jong
- Center for Health Economics Research Hannover (CHERH), Leibniz University Hannover, Hannover, Germany
| | - Franziska A Herbst
- Institute for General Practice and Palliative Care, Hannover Medical School, Hannover, Germany
| | - Carolin Huperz
- Institute for General Practice and Palliative Care, Hannover Medical School, Hannover, Germany
- Faculty of Engineering and Mathematics, Bielefeld University of Applied Sciences, Bielefeld, Germany
| | - Hanna A A Röwer
- Institute for General Practice and Palliative Care, Hannover Medical School, Hannover, Germany
| | - Nils Schneider
- Institute for General Practice and Palliative Care, Hannover Medical School, Hannover, Germany
| | - Kathrin Damm
- Center for Health Economics Research Hannover (CHERH), Leibniz University Hannover, Hannover, Germany
| | - Stephanie Stiel
- Institute for General Practice and Palliative Care, Hannover Medical School, Hannover, Germany
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Skedgel C, Mott DJ, Elayan S, Cramb A. A Longer Life or a Quality Death? A Discrete Choice Experiment to Estimate the Relative Importance of Different Aspects of End-of-Life Care in the United Kingdom. MDM Policy Pract 2024; 9:23814683241252425. [PMID: 38766465 PMCID: PMC11100281 DOI: 10.1177/23814683241252425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 04/02/2024] [Indexed: 05/22/2024] Open
Abstract
Background. Advocates argue that end-of-life (EOL) care is systematically disadvantaged by the quality-adjusted life-year (QALY) framework. By definition, EOL care is short duration and not primarily intended to extend survival; therefore, it may be inappropriate to value a time element. The QALY also neglects nonhealth dimensions such as dignity, control, and family relations, which may be more important at EOL. Together, these suggest the QALY may be a flawed measure of the value of EOL care. To test these arguments, we administered a stated preference survey in a UK-representative public sample. Methods. We designed a discrete choice experiment (DCE) to understand public preferences over different EOL scenarios, focusing on the relative importance of survival, conventional health dimensions (especially physical symptoms and anxiety), and nonhealth dimensions such as family relations, dignity, and sense of control. We used latent class analysis to understand preference heterogeneity. Results. A 4-class latent class multinomial logit model had the best fit and illustrated important heterogeneity. A small class of respondents strongly prioritized survival, whereas most respondents gave relatively little weight to survival and, generally speaking, prioritized nonhealth aspects. Conclusions. This DCE illustrates important heterogeneity in preferences within UK respondents. Despite some preferences for core elements of the QALY, we suggest that most respondents favored what has been called "a good death" over maximizing survival and find that respondents tended to prioritize nonhealth over conventional health aspects of quality. Together, this appears to support arguments that the QALY is a poor measure of the value of EOL care. We recommend moving away from health-related quality of life and toward a more holistic perspective on well-being in assessing EOL and other interventions. Highlights Advocates argue that some interventions, including but not limited to end-of-life (EOL) care, are valued by patients and the public but are systematically disadvantaged by the quality-adjusted life-year (QALY) framework, leading to an unfair and inefficient allocation of health care resources.Using a discrete choice experiment, we find some support for this argument. Only a small proportion of public respondents prioritized survival in EOL scenarios, and most prioritized nonhealth aspects such as dignity and family relations.Together, these results suggest that the QALY may be a poor measure of the value of EOL care, as it neglects nonhealth aspects of quality and well-being that appear to be important to people in hypothetical EOL scenarios.
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Affiliation(s)
- Chris Skedgel
- Office of Health Economics, London, UK
- Health Economics Group, University of East Anglia, Norwich, UK
| | | | - Saif Elayan
- Health Economics Group, University of East Anglia, Norwich, UK
- Department of Economics, Econometrics and Finance, Faculty of Economics and Business, University of Groningen, The Netherlands
| | - Angela Cramb
- Health Economics Group, University of East Anglia, Norwich, UK
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Fischer C, Bednarz D, Simon J. Methodological challenges and potential solutions for economic evaluations of palliative and end-of-life care: A systematic review. Palliat Med 2024; 38:85-99. [PMID: 38142280 PMCID: PMC10798028 DOI: 10.1177/02692163231214124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2023]
Abstract
BACKGROUND Given the increasing demand for palliative and end-of-life care, along with the introduction of costly new treatments, there is a pressing need for robust evidence on value. However, comprehensive guidance is missing on methods for conducting economic evaluations in this field. AIM To identify and summarise existing information on methodological challenges and potential solutions/recommendations for economic evaluations of palliative and end-of-life care. DESIGN We conducted a systematic review of publications on methodological considerations for economic evaluations of adult palliative and end-of-life care as per our PROSPERO protocol CRD42020148160. Following initial searches, we conducted a two-stage screening process and quality appraisal. Information was thematically synthesised, coded, categorised into common themes and aligned with the items specified in the Consolidated Health Economic Evaluation Reporting Standards statement. DATA SOURCES The databases Medline, Embase, HTADatabase, NHSEED and grey literature were searched between 1 January 1999 and 5 June 2023. RESULTS Out of the initial 6502 studies, 81 were deemed eligible. Identified challenges could be grouped into nine themes: ambiguous and inaccurate patient identification, restricted generalisability due to poor geographic transferability of evidence, narrow costing perspective applied, difficulties defining comparators, consequences of applied time horizon, ambiguity in the selection of outcomes, challenged outcome measurement, non-standardised measurement and valuation of costs as well as challenges regarding a reliable preference-based outcome valuation. CONCLUSION Our review offers a comprehensive context-specific overview of methodological considerations for economic evaluations of palliative and end-of-life care. It also identifies the main knowledge gaps to help prioritise future methodological research specifically for this field.
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Affiliation(s)
- Claudia Fischer
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Damian Bednarz
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Judit Simon
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute Applied Diagnostics, Vienna, Austria
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Xia Q, Kularatna M, Virdun C, Button E, Close E, Carter HE. Preferences for Palliative and End-of-Life Care: A Systematic Review of Discrete Choice Experiments. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:1795-1809. [PMID: 37543206 DOI: 10.1016/j.jval.2023.07.005] [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: 02/09/2023] [Revised: 06/20/2023] [Accepted: 07/22/2023] [Indexed: 08/07/2023]
Abstract
OBJECTIVES Understanding what matters most to patients and their caregivers is fundamental to delivering high-quality care. This systematic review aimed to characterize and appraise the evidence from discrete choice experiments eliciting preferences for palliative care. METHODS A systematic literature search was undertaken for publications up until August 2022. Data were synthesized narratively. Thematic analysis was applied to categorize attributes into groups. Attribute development, frequency, and relative importance were analyzed. Subgroup analyses were conducted to compare outcomes between patient and proxy respondents. RESULTS Seventeen studies spanning 11 countries were included; 59% of studies solely considered preferences for patients with cancer. A range of respondent groups were represented including patients (76%) and proxies (caregivers [35%], health providers [12%], and the public [18%]). A total of 117 individual attributes were extracted and thematically grouped into 8 broad categories and 21 subcategories. Clinical outcomes including quality of life, length of life, and pain control were the most frequently reported attributes, whereas attributes relating to psychosocial components were largely absent. Both patients and proxy respondents prioritized pain control over additional survival time. Nevertheless, there were differences between respondent cohorts in the emphasis on other attributes such as access to care, timely information, and low risk of adverse effects (prioritized by patients), as opposed to cost, quality, and delivery of care (prioritized by proxies). CONCLUSIONS Our review underscores the vital role of pain control in palliative care; in addition, it shed light on the complexity and relative strength of preferences for various aspects of care from multiple perspectives, which is useful in developing personalized, patient-centered models of care for individuals nearing the end of life.
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Affiliation(s)
- Qing Xia
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health & Social Work, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia.
| | - Mineth Kularatna
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health & Social Work, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Claudia Virdun
- Cancer and Palliative Care Outcomes Centre, Centre for Healthcare Transformation, School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Elise Button
- Cancer and Palliative Care Outcomes Centre, Centre for Healthcare Transformation, School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Eliana Close
- Australian Centre for Health Law Research, School of Law, Faculty of Business and Law (Close), Queensland University of Technology, Brisbane, QLD, Australia
| | - Hannah E Carter
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health & Social Work, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
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Müller A, Paul A, Best J, Kunkel S, Voltz R, Strupp J. "My everyday life has returned to normal"- Experiences of patients and relatives with a palliative day care clinic: a qualitative evaluation study. BMC Palliat Care 2023; 22:26. [PMID: 36927777 PMCID: PMC10020068 DOI: 10.1186/s12904-023-01140-5] [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: 07/04/2022] [Accepted: 02/22/2023] [Indexed: 03/18/2023] Open
Abstract
PURPOSE Palliative day care clinics (PDCCs) complement inpatient and home palliative care and provide access to a range of multi-professional services. However, they are not part of standard care in Germany. Yet, international studies show that PDCCs have a positive impact on e.g. quality of life. To evaluate one of the first PDCCs in Germany (Aschaffenburg-Alzenau (PDCC-AA)) by describing the experiences, satisfaction, challenges, wishes of patients and relatives and possible alternatives to treatment in the PDCC. METHODS Qualitative study using semi-structured telephone interviews. Data was analyzed using qualitative structuring content analysis according to Kuckartz with deductive a priori categories and inductive subcategories. RESULTS A total of 31 patients and 38 relatives completed telephone interviews. The majority of patients were diagnosed with a cancer or tumor disease. The following four main themes emerged: (1) alternatives to treatment at the PDCC, (2) symptom relief, (3) sense of security, (4) "everyday life framing" (normality of everyday life). Participants valued the medical treatment (especially for pain), psychosocial support given and having direct access to a range of services (e.g., wound care and pleural drainage), while relatives valued being provided respite services. A sense of security, availability of therapies, and devoted time that healthcare providers spent to explain e.g., treatment options were mentioned most positively, as well as confidence in dealing with the illness. As to whether there was an alternative to treatment in the PDCC, some saw further inpatient stays, the emergency room or care by general practitioners as options (although not preferred). Patients expressed concern that they were not treated and informed according to their needs in other care settings. CONCLUSIONS PDCCs may close a gap between inpatient and home palliative care. Participants mentioned that hospital stays can be delayed or even prevented.
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Affiliation(s)
- Anne Müller
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany.
| | - Alfred Paul
- Clinical Center Aschaffenburg-Alzenau, Alzenau, Germany
| | - Johannes Best
- Clinical Center Aschaffenburg-Alzenau, Alzenau, Germany
| | | | - Raymond Voltz
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany.,Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany.,Center for Health Services Research, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Julia Strupp
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
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Zenlea IS, Sebastianski M, Kucera M, Mushquash AR, Boles K, Brogly J, Delacruz B, McGeown L, Ball GDC, Johnston BC. Incorporation of patient and family values and preferences for health-related outcomes in paediatric obesity management: A systematic review. Pediatr Obes 2023; 18:e13006. [PMID: 36810978 DOI: 10.1111/ijpo.13006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 12/20/2022] [Accepted: 01/04/2023] [Indexed: 02/24/2023]
Abstract
OBJECTIVE A systematic review of value and preference studies conducted in children and their caregivers related to the estimated benefits and harms of interventions for managing paediatric obesity. METHODS We searched Ovid Medline (1946-2022), Ovid Embase (1974-2022), EBSCO CINAHL (inception to 2022), Elsevier Scopus (inception to 2022), and ProQuest Dissertations & Theses (inception to 2022). Reports were eligible if they included: behavioural and psychological, pharmacological, or surgical interventions; participants between (or had a mean age within) 0-18 years old with overweight or obesity; systematic reviews, primary quantitative, qualitative, or mixed/multiple methods studies; and values and preferences as main study outcomes. At least two team members independently screened studies, abstracted data, and appraised study quality. RESULTS Our search yielded 11 010 reports; eight met the inclusion criteria. One study directly assessed values and preferences based on hypothetical pharmacological treatment for hyperphagia in individuals with Prader-Willi Syndrome. Although not having reported on values and preferences using our a priori definitions, the remaining seven qualitative studies (n = 6 surgical; n = 1 pharmacological) explored general beliefs, attitudes, and perceptions about surgical and pharmacological interventions. No studies pertained to behavioural and psychological interventions. CONCLUSION Future research is needed to elicit the values and preferences of children and caregivers using the best available estimates of the benefits and harms for pharmacological, surgical, and behavioural and psychological interventions.
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Affiliation(s)
- Ian S Zenlea
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Meghan Sebastianski
- Department of Pediatrics, Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Marsha Kucera
- Sunridge Family Medicine Teaching Centre; Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Aislin R Mushquash
- Department of Psychology, Lakehead University, Thunder Bay, Ontario, Canada
| | - Kara Boles
- Department of Psychology, Lakehead University, Thunder Bay, Ontario, Canada
| | - Jennifer Brogly
- University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Brownwyn Delacruz
- University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Laura McGeown
- Department of Psychology, Lakehead University, Thunder Bay, Ontario, Canada
| | - Geoff D C Ball
- Department of Pediatrics, Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Bradley C Johnston
- Department of Nutrition, Texas A&M University, College of Agriculture and Life Sciences, College Station, Texas, USA.,Department of Epidemiology and Biostatistics, School of Public Health, College Station, Texas, USA
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Johnston BM, Daveson B, Normand C, Ryan K, Smith M, McQuillan R, Higginson I, Selman L, Tobin K. Preferences of Older People With a Life-Limiting Illness: A Discrete Choice Experiment. J Pain Symptom Manage 2022; 64:137-145. [PMID: 35490993 DOI: 10.1016/j.jpainsymman.2022.04.180] [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: 12/14/2021] [Revised: 04/08/2022] [Accepted: 04/18/2022] [Indexed: 11/25/2022]
Abstract
CONTEXT There is limited evidence about which elements and characteristics of palliative care service provision improve the experiences of older people living with life-limiting illness. OBJECTIVES To evaluate older patients' (≥65 years) preferences for elements of services and supports and to explore relationships between patient characteristics and the patterns of preferences. METHODS A cross-sectional survey undertaken in Ireland and England using a Discrete Choice Experiment with people accessing specialist palliative care services. A random-effects probit model was used to estimate patient preferences. RESULTS Of the 77 patients were interviewed, 51 participated in the Discrete Choice Experiment component of the interview (response rate = 66%). Participants prioritized support that minimized unpaid caregiver burden (P < 0.001). They also preferred ease of access to services including out-of-hours access (P < 0.001) and free care at home (P < 0.001). Quality of life was prioritized over quantity of life (<0.001). CONCLUSION People living with a life-limiting illness value care that focuses on quality of life, ensures barrier-free access to services and provides sufficient support for relatives. In the context of limited resources and growing demand for care, this study provides evidence about the service elements palliative care delivery models should prioritize and evaluate.
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Affiliation(s)
- Bridget M Johnston
- Centre of Health Policy and Management (B.M.J., C.N., M.S.), School of Medicine, Trinity College Dublin, Ireland.
| | - Barbara Daveson
- Cicely Saunders Institute (B.D., C.N., I.H., L.S.), Faculty Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London UK
| | - Charles Normand
- Centre of Health Policy and Management (B.M.J., C.N., M.S.), School of Medicine, Trinity College Dublin, Ireland; Cicely Saunders Institute (B.D., C.N., I.H., L.S.), Faculty Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London UK
| | - Karen Ryan
- Mater Misericordiae University Hospital (K.R.), Dublin, Ireland
| | - Melinda Smith
- Centre of Health Policy and Management (B.M.J., C.N., M.S.), School of Medicine, Trinity College Dublin, Ireland
| | | | - Irene Higginson
- Cicely Saunders Institute (B.D., C.N., I.H., L.S.), Faculty Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London UK; King's College Hospital NHS Foundation Trust (I.H.), London, UK
| | - Lucy Selman
- Cicely Saunders Institute (B.D., C.N., I.H., L.S.), Faculty Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London UK; Population Health Sciences, Bristol Medical School (L.S.), University of Bristol, Bristol UK
| | - Katy Tobin
- Global Brain Health Institute (K.T.), School of Medicine, Trinity College Dublin, Dublin, Ireland
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Terjung T, Stiel S, Schneider N, Herbst FA. Status, demand and practice models of palliative day-care clinics and day hospices: a scoping review. BMJ Support Palliat Care 2021:bmjspcare-2021-003171. [PMID: 34312186 DOI: 10.1136/bmjspcare-2021-003171] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 07/15/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Little is known about the structure, accessibility, service provision and needs of palliative and hospice day-care in Germany and abroad. Researchers, healthcare providers and policy makers would benefit from a systematic overview. AIM The aim was to identify, describe and summarise available evidence on status, demand and practice models of palliative day-care clinics and day hospices. A secondary aim was to disclose research gaps and present recommendations for clinical practice and future research. DESIGN The scoping review followed the methodological framework of Arksey and O'Malley. The analysed publications included studies of varying kinds to describe the current state of the art. DATA SOURCES Using a highly sensitive search strategy, the authors searched PubMed, Web of Science Core Collection, CINAHL and Google Scholar within the publication window of inception to 12 June 2020. An additional hand search of the reference lists of the identified review articles was conducted. RESULTS The authors screened the titles and abstracts of 2643 studies, retrieved 197 full texts and included 32 articles in the review. The review identified nine major themes: (1) the referral process, (2) models of care, (3) patient characteristics, (4) demand, (5) the discharge process, (6) perceptions of services, (7) funding and costs, (8) outcome measurement and (9) education. CONCLUSIONS There is a need for further research to identify groups of patients who would receive the most benefit from palliative and hospice day-care and to determine any necessary revisions in admission criteria.
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Affiliation(s)
- Teresa Terjung
- Institute for General Practice and Palliative Care, Hannover Medical School, Hannover, Germany
| | - Stephanie Stiel
- Institute for General Practice and Palliative Care, Hannover Medical School, Hannover, Germany
| | - Nils Schneider
- Institute for General Practice and Palliative Care, Hannover Medical School, Hannover, Germany
| | - Franziska A Herbst
- Institute for General Practice and Palliative Care, Hannover Medical School, Hannover, Germany
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Tobin K, Maguire S, Corr B, Normand C, Hardiman O, Galvin M. Discrete choice experiment for eliciting preference for health services for patients with ALS and their informal caregivers. BMC Health Serv Res 2021; 21:213. [PMID: 33750360 PMCID: PMC7941893 DOI: 10.1186/s12913-021-06191-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 02/18/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Amyotrophic Lateral Sclerosis (ALS) is a progressive neurodegenerative condition with a mean life expectancy of 3 years from first symptom. Understanding the factors that are important to both patients and their caregivers has the potential to enhance service delivery and engagement, and improve efficiency. The Discrete Choice Experiment (DCE) is a stated preferences method which asks service users to make trade-offs for various attributes of health services. This method is used to quantify preferences and shows the relative importance of the attributes in the experiment, to the service user. METHODS A DCE with nine choice sets was developed to measure the preferences for health services of ALS patients and their caregivers and the relative importance of various aspects of care, such as timing of care, availability of services, and decision making. The DCE was presented to patients with ALS, and their caregivers, recruited from a national multidisciplinary clinic. A random effects probit model was applied to estimate the impact of each attribute on a participant's choice. RESULTS Patients demonstrated the strongest preferences about timing of receiving information about ALS. A strong preference was also placed on seeing the hospice care team later rather than early on in the illness. Patients also indicated their willingness to consider the use of communication devices. Grouping by stage of disease, patients who were in earlier stages of disease showed a strong preference for receipt of extensive information about ALS at the time of diagnosis. Caregivers showed a strong preference for engagement with healthcare professionals, an attribute that was not prioritised by patients. CONCLUSIONS The DCE method can be useful in uncovering priorities of patients and caregivers with ALS. Patients and caregivers have different priorities relating to health services and the provision of care in ALS, and patient preferences differ based on the stage and duration of their illness. Multidisciplinary teams must calibrate the delivery of care in the context of the differing expectations, needs and priorities of the patient/caregiver dyad.
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Affiliation(s)
- Katy Tobin
- Global Brain Health Institute, School of Medicine, Trinity College Dublin, Dublin, Ireland.
| | - Sinead Maguire
- Department of Neurology, National Neuroscience Centre, Beaumont Hospital, Dublin, Ireland
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Bernie Corr
- Department of Neurology, National Neuroscience Centre, Beaumont Hospital, Dublin, Ireland
| | - Charles Normand
- Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Orla Hardiman
- Department of Neurology, National Neuroscience Centre, Beaumont Hospital, Dublin, Ireland
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
- FutureNeuro SFI Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Miriam Galvin
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
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Novel application of discrete choice experiment methodology to understand how clinicians around the world triage palliative care needs: A research protocol. Palliat Support Care 2019; 17:66-73. [DOI: 10.1017/s1478951518000913] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractObjectiveAs referrals to specialist palliative care (PC) grow in volume and diversity, an evidence-based triage method is needed to enable services to manage waiting lists in a transparent, efficient, and equitable manner. Discrete choice experiments (DCEs) have not to date been used among PC clinicians, but may serve as a rigorous and efficient method to explore and inform the complex decision-making involved in PC triage. This article presents the protocol for a novel application of an international DCE as part of a mixed-method research program, ultimately aiming to develop a clinical decision-making tool for PC triage.MethodFive stages of protocol development were undertaken: (1) identification of attributes of interest; (2) creation and (3) execution of a pilot DCE; and (4) refinement and (5) planned execution of the final DCE.ResultSix attributes of interest to PC triage were identified and included in a DCE that was piloted with 10 palliative care practitioners. The pilot was found to be feasible, with an acceptable cognitive burden, but refinements were made, including the creation of an additional attribute to allow independent analysis of concepts involved. Strategies for recruitment, data collection, analysis, and modeling were confirmed for the final planned DCE.Significance of resultsThis DCE protocol serves as an example of how the sophisticated DCE methodology can be applied to health services research in PC. Discussion of key elements that improved the utility, integrity, and feasibility of the DCE provide valuable insights.
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Guy MP, Higginson IJ, Amesbury BD. The effect of Palliative Daycare on Hope: A comparison of Daycare Patients with Two Control Groups. J Palliat Care 2018. [DOI: 10.1177/082585971102700306] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Despite expansion in palliative daycare services, research has not demonstrated an improvement in patient outcomes. This study aimed to determine the effect of palliative daycare on hope. Methods: This was a prospective cohort study that compared three groups of patients: a daycare group and two control groups, one recruited before daycare opened and a matched comparison group. Patients were interviewed at baseline and at two follow-ups using the Herth Hope Index. Results: In all, 22 daycare patients completed a baseline interview (T1); 12 a second (T2); and 9 a third (T3). Corresponding numbers were: before group (56, 34, 24) and matched group (49, 29, 19). An independent samples t-test confirmed a significant difference between the groups from T1 to T2 (mean difference=3.20, p=0.007), with the daycare group experiencing an increase in hope not seen in the other groups. However, this was not maintained. Conclusion: Daycare may effect an initial improvement in hope. The study suffered from attrition and the sample was small. Further robust evaluation of daycare is needed.
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Affiliation(s)
- Margaret P. Guy
- MP Guy (corresponding author) Phyllis Tuckwell Hospice, Waverley Lane, Farnham, Surrey, UK GU9 8BL
| | - Irene J. Higginson
- King's College London, Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, UK; BDW Amesbury: St. Wilfrid's Hospice, Chichester, Sussex, UK
| | - Brendan D.W. Amesbury
- King's College London, Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, UK; BDW Amesbury: St. Wilfrid's Hospice, Chichester, Sussex, UK
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12
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Wakefield D, Bayly J, Selman LE, Firth AM, Higginson IJ, Murtagh FE. Patient empowerment, what does it mean for adults in the advanced stages of a life-limiting illness: A systematic review using critical interpretive synthesis. Palliat Med 2018; 32:1288-1304. [PMID: 29956568 PMCID: PMC6088522 DOI: 10.1177/0269216318783919] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Patient empowerment, defined as 'a process through which people gain greater control over decisions and actions affecting their health' (World Health Organization) is a key theme within global health and social care strategies. The benefits of incorporating empowerment strategies in care are well documented, but little is known about their application or impact for patients with advanced, life-limiting illness(s). AIM To identify and synthesise the international evidence on patient empowerment for adults with advanced, life-limiting illness(s). DESIGN Systematic review (PROSPERO no. 46113) with critical interpretive synthesis methodology. DATA SOURCES Five databases (MEDLINE, Embase, CINHAL, PsycINFO and Cochrane) were searched from inception to March 2018. Grey literature and reference list/citation searches of included papers were undertaken. INCLUSION CRITERIA empirical research involving patients with advanced life-limiting illness including descriptions of, or references to, patient empowerment within the study results. RESULTS In all, 13 papers met inclusion criteria. Two qualitative studies explored patient empowerment as a study objective. Six papers evaluated interventions, referencing patient empowerment as an incidental outcome. The following themes were identified from the interpretive synthesis: self-identity, personalised knowledge in theory and practice, negotiating personal and healthcare relationships, acknowledgement of terminal illness, and navigating continued losses. CONCLUSION There are features of empowerment, for patients with advanced life-limiting illness distinct to those of other patient groups. Greater efforts should be made to progress the empowerment of patients nearing the end of their lives. We propose that the identified themes may provide a useful starting point to guide the assessment of existing or planned services and inform future research.
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Affiliation(s)
- Dominique Wakefield
- 1 Department of Palliative Care, Policy & Rehabilitation, Cicely Saunders Institute, King's College London, London, UK
| | - Jo Bayly
- 1 Department of Palliative Care, Policy & Rehabilitation, Cicely Saunders Institute, King's College London, London, UK
| | - Lucy Ellen Selman
- 2 Bristol Randomised Trials Collaboration (BRTC), School of Social and Community Medicine, Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - Alice M Firth
- 1 Department of Palliative Care, Policy & Rehabilitation, Cicely Saunders Institute, King's College London, London, UK
| | - Irene J Higginson
- 1 Department of Palliative Care, Policy & Rehabilitation, Cicely Saunders Institute, King's College London, London, UK
| | - Fliss Em Murtagh
- 3 Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
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McCaffrey N, Eckermann S. Raise the Bar, Not the Threshold Value: Meeting Patient Preferences for Palliative and End-of-Life Care. PHARMACOECONOMICS - OPEN 2018; 2:93-95. [PMID: 29623615 PMCID: PMC5972111 DOI: 10.1007/s41669-017-0039-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Nikki McCaffrey
- Deakin Health Economics, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia.
| | - Simon Eckermann
- Centre for Health Service Development, Australian Health Services Research Institute, University of Wollongong, Wollongong, NSW, 2522, Australia
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Values for the ICECAP-Supportive Care Measure (ICECAP-SCM) for use in economic evaluation at end of life. Soc Sci Med 2017; 189:114-128. [DOI: 10.1016/j.socscimed.2017.07.012] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 05/15/2017] [Accepted: 07/19/2017] [Indexed: 11/24/2022]
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15
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Foley G. What are the Care Needs for People with Motor Neurone Disease and How Can Occupational Therapists Respond to Meet These Needs? Br J Occup Ther 2016. [DOI: 10.1177/030802260707000108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Motor neurone disease is a fatal neurodegenerative disorder and from disease onset health care intervention is palliative in nature. Numerous studies on wellbeing in motor neurone disease are consistent with the palliative care literature, where the values assigned to non-physical life domains increase with disease progression. Occupational therapists should consider all components of wellbeing for people with motor neurone disease and not physical disability alone. A better understanding of motor neurone disease and an awareness of the service needs important to this client group are necessary to improve the quality of care and to assist occupational therapists in meeting care needs.
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Finkelstein EA, Bilger M, Flynn TN, Malhotra C. Preferences for end-of-life care among community-dwelling older adults and patients with advanced cancer: A discrete choice experiment. Health Policy 2015; 119:1482-9. [DOI: 10.1016/j.healthpol.2015.09.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 05/19/2015] [Accepted: 09/04/2015] [Indexed: 11/30/2022]
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17
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Malhotra C, Farooqui MA, Kanesvaran R, Bilger M, Finkelstein E. Comparison of preferences for end-of-life care among patients with advanced cancer and their caregivers: A discrete choice experiment. Palliat Med 2015; 29:842-50. [PMID: 25805740 DOI: 10.1177/0269216315578803] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patients with advanced cancer often have to make difficult decisions, such as how much to spend on moderately life-extending treatments. This and other end-of-life decisions are also influenced by their informal caregivers. Understanding the relative value that patients and their caregivers place on various aspects of end-of-life care can help clinicians tailor treatments to best meet the preferences of their patients. AIM To quantify willingness to pay of patients with advanced cancer and their caregivers to extend the patients' life by 1 year and to compare this result to their willingness to pay for other end-of-life improvements. DESIGN Cross-sectional survey using a discrete choice experiment. PARTICIPANTS A total of 211 patients with stage IV cancer and their informal caregivers. RESULTS The willingness to pay of patients to extend their life by 1 year (S$18,570; 95% confidence interval: S$6687-S$30,542) was not statistically different from their willingness to pay to avoid severe pain (S$22,199; S$11,648-S$32,450), to die at home (S$31,256; S$21,249-S$41,391), not be a burden on family and friends (S$4051; -S$3543 to S$11,568), or to receive a high-quality health-care experience (S$16,191; S$9266-S$23,037). Consistent with our hypothesis, caregivers had a greater willingness to pay than patients to extend life (S$61,368; S$37,030-S$86,210) and for most other end-of-life improvements. CONCLUSION Results highlight the importance of pain management, supporting home deaths, and addressing other end-of-life concerns, in addition to efforts to extend life. Differences in willingness to pay of patients and caregivers suggest the need for eliciting patient preferences during treatment decision making as opposed to relying on caregiver input.
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Affiliation(s)
- Chetna Malhotra
- Lien Centre for Palliative Care, Duke-NUS Graduate Medical School Singapore, Singapore
| | - Muhammad Assad Farooqui
- Program in Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore
| | | | - Marcel Bilger
- Program in Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore
| | - Eric Finkelstein
- Lien Centre for Palliative Care, Duke-NUS Graduate Medical School Singapore, Singapore Program in Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore Duke Global Health Institute, Duke University, Durham, NC, USA
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Round J, Leurent B, Jones L. A cost-utility analysis of a rehabilitation service for people living with and beyond cancer. BMC Health Serv Res 2014; 14:558. [PMID: 25407558 PMCID: PMC4245741 DOI: 10.1186/s12913-014-0558-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 10/24/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We conducted a wait-list control randomised trial of an outpatient rehabilitation service for people living with and beyond cancer, delivered in a hospice day care unit. We report the results of an economic evaluation undertaken using the trial data. METHODS Forty-one participants were recruited into the study. A within-trial stochastic cost-utility analysis was undertaken using Monte-Carlo simulation. The outcome measure for the economic evaluation was quality adjusted life years (QALYs). Costs were measured from the perspective of the NHS and personal social services. Uncertainty in the observed data was captured through probabilistic sensitivity analysis. Scenario analysis was conducted to explore the effects of changing the way QALYs were estimated and adjusting for baseline difference in the population. We also explore assumptions about the length of treatment benefit being maintained. RESULTS The incremental cost-effectiveness ratio (ICER) for the base-case analysis was £14,231 per QALY. When QALYs were assumed to change linearly over time, this increased to £20,514 per QALY at three months. Adjusting the estimate of QALYs to account for differences in the population at baseline increased the ICER to £94,748 per QALY at three months. Increasing the assumed length of treatment benefit led to reduced ICERs in all scenarios. CONCLUSIONS Although the intervention is likely to be cost-effective in some circumstances, there is considerable uncertainty surrounding the decision to implement the service. Further research, informed by a formal value of information analysis, would reduce this uncertainty.
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Affiliation(s)
- Jeff Round
- Marie Curie Palliative Care Research Unit, University College London, London, UK. .,University College London Comprehensive Clinical Trials Unit, University College London, Gower Street, London, WC1E 6BT, UK.
| | - Baptiste Leurent
- Marie Curie Palliative Care Research Unit, University College London, London, UK.
| | - Louise Jones
- Marie Curie Palliative Care Research Unit, University College London, London, UK.
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19
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THEME 5 MULTIDISCIPLINARY CARE AND QUALITY OF LIFE. Amyotroph Lateral Scler Frontotemporal Degener 2014; 15 Suppl 1:107-27. [DOI: 10.3109/21678421.2014.960178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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20
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Sutton EJ, Coast J. Development of a supportive care measure for economic evaluation of end-of-life care using qualitative methods. Palliat Med 2014; 28:151-7. [PMID: 23698452 DOI: 10.1177/0269216313489368] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND An imperative to assess the economic impact of care at the end of life is emerging in response to national policy developments in a number of settings. Current focus on health benefits in economic evaluation may not appropriately capture benefits of interventions at the end of life. No instruments are available for measuring such benefits for economic evaluation of end-of-life care. AIM To develop a descriptive system for a measure for use in economic evaluation of end-of-life care. DESIGN An initial phase of in-depth interviews was conducted to develop conceptual attributes for inclusion in a measure; a second phase of semi-structured repeat interviews with a subsample of informants was carried out to clarify and confirm the final set of attributes and to develop meaningful wording for a measure. SETTING/PARTICIPANTS In total, 23 older people from three groups across the dying trajectory: older people (1) within the general population, (2) living in residential care and (3) receiving palliative care. RESULTS Interviews suggested that the important domains to include within this framework from the perspective of those approaching the end-of-life are choice/having a say in decision-making, love and affection/being with people who care, freedom from physical suffering, freedom from emotional suffering, dignity and self-respect, support, and preparation. A full descriptive system comprising seven questions, each representing one attribute, was developed. CONCLUSION Economic evaluation should reflect the broader benefits of end-of-life care. Although the supportive care measure developed here requires validation and valuation, it provides a substantial step forward in appropriate economic evaluation of end-of-life care.
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Affiliation(s)
- Eileen J Sutton
- 1School of Oral and Dental Sciences, University of Bristol, Bristol, UK
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21
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Farquhar M, Preston N, Evans CJ, Grande G, Short V, Benalia H, Higginson IJ, Todd, on behalf of MORECare C. Mixed methods research in the development and evaluation of complex interventions in palliative and end-of-life care: report on the MORECare consensus exercise. J Palliat Med 2013; 16:1550-60. [PMID: 24195755 PMCID: PMC3868265 DOI: 10.1089/jpm.2012.0572] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2013] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Complex interventions are common in palliative and end-of-life care. Mixed methods approaches sit well within the multiphase model of complex intervention development and evaluation. Generic mixed methods guidance is useful but additional challenges in the research design and operationalization within palliative and end-of-life care may have an impact on the use of mixed methods. OBJECTIVE The objective of the study was to develop guidance on the best methods for combining quantitative and qualitative methods for health and social care intervention development and evaluation in palliative and end-of-life care. METHODS A one-day workshop was held where experts participated in facilitated groups using Transparent Expert Consultation to generate items for potential recommendations. Agreement and consensus were then sought on nine draft recommendations (DRs) in a follow-up exercise. RESULTS There was at least moderate agreement with most of the DRs, although consensus was low. Strongest agreement was with DR1 (usefulness of mixed methods to palliative and end-of-life care) and DR5 (importance of attention to respondent burden), and least agreement was with DR2 (use of theoretical perspectives) and DR6 (therapeutic effects of research interviews). Narrative comments enabled recommendation refinement. Two fully endorsed, five partially endorsed, and two refined DRs emerged. The relationship of these nine to six key challenges of palliative and end-of-life care research was analyzed. CONCLUSIONS There is a need for further discussion of these recommendations and their contribution to methodology. The recommendations should be considered when designing and operationalizing mixed methods studies of complex interventions in palliative care, and because they may have wider relevance, should be considered for other applications.
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Affiliation(s)
- Morag Farquhar
- Primary Care Unit, Institute of Public Health, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Nancy Preston
- School of Nursing, Midwifery, and Social Work, University of Manchester, Manchester, United Kingdom
| | - Catherine J. Evans
- Department of Palliative Care, Policy, and Rehabilitation, King's College London, London, United Kingdom
| | - Gunn Grande
- School of Nursing, Midwifery, and Social Work, University of Manchester, Manchester, United Kingdom
| | - Vicky Short
- School of Nursing, Midwifery, and Social Work, University of Manchester, Manchester, United Kingdom
| | - Hamid Benalia
- Department of Palliative Care, Policy, and Rehabilitation, King's College London, London, United Kingdom
| | - Irene J. Higginson
- Department of Palliative Care, Policy, and Rehabilitation, King's College London, London, United Kingdom
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22
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Hall J, Kenny P, Hossain I, Street DJ, Knox SA. Providing Informal Care in Terminal Illness: An Analysis of Preferences for Support Using a Discrete Choice Experiment. Med Decis Making 2013; 34:731-45. [PMID: 23942657 DOI: 10.1177/0272989x13500719] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Accepted: 07/09/2013] [Indexed: 11/17/2022]
Abstract
BACKGROUND The trend for terminally ill patients to receive much of their end-of-life care at home necessitates the design of services to facilitate this. Care at home also requires that informal care be provided by family members and friends. This study investigated informal carers' preferences for support services to aid the development of end-of-life health care services. METHODS This cross-sectional study used 2 discrete choice experiments to ascertain the preferences of carers supporting patients with different levels of care need, determined by the assistance needed with personal care and labeled High Care (HC) and Low Care (LC). The sample included 168 informal carers of people receiving palliative care at home from 2 palliative care services in Sydney, Australia. Data were collected in face-to-face interviews; carers chose between 2 hypothetical plans of support services and their current services. Data were analyzed with generalized multinomial logit models that were used to calculate the impact of each attribute on the probability of a carer choosing a service plan. RESULTS Preferred support included nursing services; the probability of choosing a plan increased significantly if it included nurse home visits and phone advice (P < 0.001). HC carers also wanted doctor home visits, home respite, and help with personal care (P < 0.05), and LC carers wanted help with household tasks, transport, and a case coordinator (P < 0.001). On average, both groups of carers preferred their current services, but this varied with characteristics of the carer and the caregiving situation. CONCLUSIONS The most valued services are those that support carers in their caregiving role; however, supportive care preferences vary with the different circumstances of patients and carers.
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Affiliation(s)
- Jane Hall
- Centre for Health Economics Research & Evaluation, University of Technology Sydney, Sydney, Australia (JH, PK, SAK)
| | - Patricia Kenny
- Centre for Health Economics Research & Evaluation, University of Technology Sydney, Sydney, Australia (JH, PK, SAK)
| | - Ishrat Hossain
- Finance and Economics Department, College of Business and Economics, Qatar University, Doha, Qatar (IH)
| | - Deborah J Street
- School of Mathematical Sciences, University of Technology Sydney, Sydney, Australia (DJS)
| | - Stephanie A Knox
- Centre for Health Economics Research & Evaluation, University of Technology Sydney, Sydney, Australia (JH, PK, SAK)
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23
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Lawton J, Rankin D, Elliott J. Is consulting patients about their health service preferences a useful exercise? QUALITATIVE HEALTH RESEARCH 2013; 23:876-886. [PMID: 23618684 DOI: 10.1177/1049732313485161] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
As part of the shift toward patient-centered care, patients are increasingly being consulted about their preferences for health services and interventions, including those explored during randomized controlled trials (RCTs), to ensure that service recommendations are aligned to their own circumstances and needs. Hence, we interviewed patients (N = 40) who participated in a randomized control trial comparing diabetes education courses delivered using two different formats to establish whether, and why, they preferred one format to the other, to inform recommendations for future course delivery. Not only did patients report changing their preferences, and the reasons underlying these preferences, over time, but all patients also claimed to prefer the particular course they had attended. We use our findings and experiences to problematize the notion of a patient preference and to raise questions about what we can really learn from consulting patients about the care they receive within the context of an RCT.
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Affiliation(s)
- Julia Lawton
- University of Edinburgh, Edinburgh, United Kingdom.
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24
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Setting priorities in and for end-of-life care: challenges in the application of economic evaluation. HEALTH ECONOMICS POLICY AND LAW 2012; 7:431-9. [DOI: 10.1017/s1744133112000229] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractHealth technology assessment processes aim to provide evidence on the effectiveness and cost-effectiveness of different elements of health care to assist setting priorities. There is a risk that services that are difficult to evaluate, and for which there is limited evidence on cost-effectiveness, may lose out in the competition for resources to those with better evidence. It is argued here that end-of-life care provides particular challenges for evaluation. Outcomes are difficult to measure, can take place over short time scales, and services can be difficult to characterise as they are tailored to the specific needs of individuals. Tools commonly used to measure health care outcomes do not appear to discriminate well in the end-of-life care context. It is argued that the assumption that units of time of different quality of life can simply be added to assess the overall experience at the end of life may not apply, and that alternative perspectives, such as the Peak and End Rule, might offer useful perspectives.
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25
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Vries KD, Wells J, Plaskota M. Evaluation of an admission and discharge programme at a UK specialist palliative day hospice. Int J Palliat Nurs 2012; 18:275-81. [PMID: 22885900 DOI: 10.12968/ijpn.2012.18.6.275] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This paper reports on a system of managing admissions and discharges from a specialist palliative day hospice (SPDH) in the south of England. SPDH is a well established component of palliative care provision in the UK, but studies have rarely addressed issues around admission and discharge. Case study methodology was used to evaluate the programme. Interviews were conducted with five patients who had attended the day hospice, taken a break or been discharged and returned; their carer(s); the key worker from the day hospice; and any other health professional who was involved in the patient's care during the admission. Communication issues were found within the team regarding referral and discharge processes, documentation of care, decision making, and information giving. Family members did not feel involved in decision making in relation to the programme. The most significant finding was the emotional and psychological impact on the patients of taking the break. Discharge from SPDH is known to be a difficult and sensitive issue, especially when patients are living with life-limiting illnesses that can change quickly. The patients in this study all had some form of dependency on the service and four of the five would have chosen to continue attending if they could. They experienced deterioration in psychological and physical wellbeing during the period in which they did not attend.
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Affiliation(s)
- Kay de Vries
- School of Nursing, Midwifery and Health, Victoria University of Wellington, Wellington Hospital, Newtown, New Zealand
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26
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Hyde V, Skirton H, Richardson J. Palliative day care: A qualitative study of service users' experiences in the United Kingdom. Nurs Health Sci 2011; 13:178-83. [DOI: 10.1111/j.1442-2018.2011.00598.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Bradley SE, Frizelle D, Johnson M. Patients' psychosocial experiences of attending Specialist Palliative Day Care: a systematic review. Palliat Med 2011; 25:210-28. [PMID: 21228097 DOI: 10.1177/0269216310389222] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Recent reviews conclude that the benefits of attending Specialist Palliative Day Care (SPDC) are likely to be in social, psychological and spiritual domains. However, these areas are not easily identified, leaving researchers and practitioners unclear as to what aspects of these domains patients most need and desire. The objective of this review was to systematically evaluate literature on patient-perceived psychosocial experiences of attendance at SPDC. Twelve studies were included. Evidence showed that patients value a person-centred approach that reduces isolation, increases social support, encourages communication and provides activities. Future research could focus on investigating why patients value the psychosocial experiences reported and how these experiences can be defined in a way that would be meaningful to clinical service commissioners. Once this has been done, clinicians can start to measure more effectively clinical effectiveness and devise justifiable interventions to help this patient group.
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Affiliation(s)
- Sarah E Bradley
- Department of Clinical Psychology, University of Hull, Hull, UK.
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28
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Schey S, Higginson I. Cost-effectiveness of lenalidomide in multiple myeloma. Expert Rev Pharmacoecon Outcomes Res 2010; 10:229-38. [PMID: 20545587 DOI: 10.1586/erp.10.19] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Lenalidomide represents the first drug in a novel class of agents known as IMiDs. It has both direct antimyeloma activity and an indirect effect acting through the microenvironment. In the relapsed/refractory setting, lenalidomide has been demonstrated to be highly active, producing partial and complete responses that translate into improved survival. Generally, the drug is well tolerated and more recently this agent has been used in combination with steroids, chemotherapy agents and other novel agents that have further enhanced its efficacy in clinical trials. However, the cost of this and other novel agents is significantly greater than previously used chemotherapy protocols, which in turn means that they have fallen under the scrutiny of regulatory bodies such as NICE. It is important that researchers understand the instruments used by these bodies to come to decisions regarding cost-effectiveness if patients are not to be disadvantaged by not being given access to these active new agents. This article outlines the models used by health economists and assesses their potential shortcomings. It also suggests alternative methods and identifies areas of research where improvements might be achieved.
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Affiliation(s)
- Steve Schey
- Kings College London School of Medicine, London, SE5 9RS, UK.
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29
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Does a social model of hospice day care affect advanced cancer patients’ use of other health and social services? A prospective quasi-experimental trial. Support Care Cancer 2009; 18:627-37. [DOI: 10.1007/s00520-009-0706-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2009] [Accepted: 07/14/2009] [Indexed: 10/20/2022]
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Sidani S, Epstein DR, Bootzin RR, Moritz P, Miranda J. Assessment of preferences for treatment: validation of a measure. Res Nurs Health 2009; 32:419-31. [PMID: 19434647 PMCID: PMC4446727 DOI: 10.1002/nur.20329] [Citation(s) in RCA: 113] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Systematic measurement of treatment preferences is needed to obtain well-informed preferences. Guided by a conceptualization of treatment preferences, a measure was developed to assess treatment acceptability and preference. The purpose of this study was to evaluate the psychometric properties of the treatment acceptability and preferences (TAP) measure. The TAP measure contains a description of each treatment under evaluation, items to rate its acceptability, and questions about participants' preferred treatment option. The items measuring treatment acceptability were internally consistent (alpha > .80) and demonstrated validity, evidenced by a one-factor structure and differences in the scores between participants with preferences for particular interventions. The TAP measure has the potential for the assessment of acceptability and preferences for various behavioral interventions.
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Affiliation(s)
- Souraya Sidani
- School of Nursing, Ryerson University, 350 Victoria Street, Toronto, Ontario, Canada M5B 2K3
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31
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Gomes B, Harding R, Foley KM, Higginson IJ. Optimal approaches to the health economics of palliative care: report of an international think tank. J Pain Symptom Manage 2009; 38:4-10. [PMID: 19615621 DOI: 10.1016/j.jpainsymman.2009.04.008] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2008] [Accepted: 04/23/2009] [Indexed: 11/20/2022]
Abstract
More people will need palliative care in aging societies with stretched health budgets and less ability to provide informal care. The future will bring new and tougher challenges to sustain, optimize, and expand the 8000 dedicated palliative care services that currently exist in the world. The full breakdown of the costs of palliative care is yet to be unveiled, and this has left huge unresolved questions for funding, costing, evaluating, and modeling palliative care. At an international meeting in London in November 2007, a group of 40 researchers, health economists, policy makers, and advocates exchanged their experiences, concerns, and recommendations in five main areas: shared definitions, strengths and weaknesses of different payment systems, international and country-specific research challenges, appropriate economic evaluation methods, and the varied perspectives to the costs of palliative care. This article reports the discussions that took place and the views of this international group of experts on the best research approaches to capture, analyze, and interpret data on both costs and outcomes for families and patients toward the end of life.
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Affiliation(s)
- Barbara Gomes
- King's College London/Cicely Saunders International, London, United Kingdom.
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Svidén GA, Fürst CJ, von Koch L, Borell L. Palliative day care--a study of well-being and health-related quality of life. Palliat Med 2009; 23:441-7. [PMID: 19351795 DOI: 10.1177/0269216309104891] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIM The aim of the study was to study the outcomes of palliative day care, in terms of health-related quality of life and the emotional well-being of cancer patients participating in a palliative day care programme for a period of five weeks, compared with a group of palliative cancer patients not participating in day-care. METHODS The day care sample comprised of patients in a palliative day care programme delivered in two different day care facilities. Participants in the comparison group were recruited from a palliative home care service facility. All patients had a cancer diagnosis. The participants were invited to respond to two questionnaires once a week for a period of five weeks; the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-30) and the Mood Adjective List (MACL). RESULTS The participants in the day care group and the comparison group reported similar levels of perceived functioning and symptoms, as measured by the EORTC QLQ-30, with no significant differences between the groups. However, the day care group reported higher levels of emotional well-being as measured by the MACL than the comparison group reported, although these differences were not statistically significant.
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Affiliation(s)
- G Andersson Svidén
- Department of Neurobiology, Health Care Sciences and Society, Division of Occupational Therapy, Karolinska Institutet, Huddinge, Sweden.
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Normand C. Measuring outcomes in palliative care: limitations of QALYs and the road to PalYs. J Pain Symptom Manage 2009; 38:27-31. [PMID: 19615624 DOI: 10.1016/j.jpainsymman.2009.04.005] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2008] [Accepted: 04/23/2009] [Indexed: 11/28/2022]
Abstract
Tools for measuring outcomes in health and social care have become key parts of the processes of evaluation and setting priorities. Measures of output that can be used in all settings and specialties have the advantage that they facilitate comparisons and choices between and within patient groups. However, the most commonly used composite measure of outcomes, the quality-adjusted life year (QALY) appears not to work well in complex interventions, such as palliative care, leading to the paradox that there is evidence that people would give priority to interventions and services that would be shown not to be cost-effective, using QALYs as an outcome measure. This article explores the possible reasons for this paradox, and looks at alternative approaches that may provide better tools for setting priorities within palliative care and for comparison of palliative and other care services.
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Affiliation(s)
- Charles Normand
- Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, Dublin, Republic of Ireland.
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Fisher C, O’Connor M, Abel K. The role of palliative day care in supporting patients: a therapeutic community space. Int J Palliat Nurs 2008; 14:117-25. [DOI: 10.12968/ijpn.2008.14.3.28891] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Colleen Fisher
- School of Exercise, Biomedical and Health Sciences, Edith Cowan University, Australia
| | - Moira O’Connor
- Western Australian Centre for Cancer and Palliative Care, Curtin University of Technology, Health Research Campus, Perth WA
| | - Kaye Abel
- School of Psychology, Edith Cowan University, Australia
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Foley G, O'Mahony P, Hardiman O. Perceptions of quality of life in people with ALS: effects of coping and health care. ACTA ACUST UNITED AC 2007; 8:164-9. [PMID: 17538778 DOI: 10.1080/17482960601164532] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Few qualitative studies have explored the 'meaning' of life experiences for persons with ALS. We aimed to identify the meaning of QoL in five selected individuals, and to consider how their experience of health care affected perceived well-being, using a phenomenological approach. Four of the five participants were revisited. Themes that emerged included: importance of faith, search for control, importance of dignity, desire to maintain identity, importance of family, a sense of loss, importance of altruism and support, fighting amyotrophic lateral sclerosis, and appreciation of life. All participants felt that professional services contributed to their well-being. QoL remained individual and multi-dimensional and was defined by cognitive and behavioural strategies used to cope with ALS. Our findings highlight the need to consider how persons with ALS may adapt to progressive illness.
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Affiliation(s)
- Geraldine Foley
- Occupational Therapy Department, Beaumont Hospital, Beaumont, Dublin, Ireland.
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