Scoring the Icecap-a capability instrument. Estimation of a UK general population tariff

This paper reports the results of a best-worst scaling (BWS) study to value the Investigating Choice Experiments Capability Measure for Adults (ICECAP-A), a new capability measure among adults, in a UK setting. A main effects plan plus its foldover was used to estimate weights for each of the four levels of all five attributes. The BWS study was administered to 413 randomly sampled individuals, together with sociodemographic and other questions. Scale-adjusted latent class analyses identified two preference and two (variance) scale classes. Ability to characterize preference and scale heterogeneity was limited, but data quality was good, and the final model exhibited a high pseudo-r-squared. After adjusting for heterogeneity, a population tariff was estimated. This showed that 'attachment' and 'stability' each account for around 22% of the space, and 'autonomy', 'achievement' and 'enjoyment' account for around 18% each. Across all attributes, greater value was placed on the difference between the lowest levels of capability than between the highest. This tariff will enable ICECAP-A to be used in economic evaluation both within the field of health and across public policy generally.

Nothing About Us Without Us? A Comparison of Adolescent and Adult Health-State Values for the Child Health Utility-9D Using Profile Case Best-Worst Scaling

The main objective of this study was to compare and contrast adolescent and adult values for the Child Health Utility-9D (CHU9D), a new generic preference-based measure of health-related quality of life designed for application in the economic evaluation of treatment and preventive programmes for children and adolescents. Previous studies have indicated that there may be systematic differences in adolescent and adult values for identical health states. An online survey including a series of best-worst scaling discrete choice experiment questions for health states defined by the CHU9D was administered to two general population samples comprising adults and adolescents, respectively. The results highlight potentially important age-related differences in the values attached to CHU9D dimensions. Adults, in general, placed less weight upon impairments in mental health (worried, sad, annoyed) and more weight upon moderate to severe levels of pain relative to adolescents. The source of values (adults or adolescents) has important implications for economic evaluation and may impact significantly upon healthcare policy.

Patient-centered benefit-risk assessment in duchenne muscular dystrophy

INTRODUCTION

This study quantified caregiver and patient preferences for a therapeutic agent with demonstrated pulmonary benefits for Duchenne muscular dystrophy (DMD). Caregiver and patient differences were also explored.

METHODS

A best-worst scaling survey (BWS) was administered to caregivers and patients. Across 9 profiles, respondents selected the best and worst attributes. Utility scores were estimated using mixed logistic regression.

RESULTS

Respondents indicated greatest preference for therapies that maintain their current level of cough strength for 10 years or for 2 years. Preference scores for risks were low: 50% chance of diarrhea and 4 additional blood draws per year.

CONCLUSION

There is a strong preference for pulmonary benefit and willingness to trade off risks and burden to achieve these benefits. In exchange for maintaining cough strength for 10 years, respondents were willing to tolerate high probabilities of diarrhea and additional blood draws. Muscle Nerve 55: 626-634, 2017.

Using Best-Worst Scaling to Understand Patient Priorities: A Case Example of Papanicolaou Tests for Homeless Women

PURPOSE

Best-worst scaling (BWS) is a survey method for assessing individuals' priorities. It identifies the extremes-best and worst items, most and least important factors, biggest and smallest influences-among sets. In this article, we demonstrate an application of BWS in a primary care setting to illustrate its use in identifying patient priorities for services.

METHODS

We conducted a BWS survey in 2014 in Boston, Massachusetts, to assess the relative importance of 10 previously identified attributes of Papanicolaou (Pap) testing services among women experiencing homelessness. Women were asked to evaluate 11 sets of 5 attributes of Pap services, and identify which attribute among each set would have the biggest and smallest influence on promoting uptake. We show how frequency analysis can be used to analyze results.

RESULTS

In all, 165 women participated, a response rate of 72%. We identified the most and least salient influences on encouraging Pap screening based on their frequency of report among our sample, with possible standardized scores ranging from+1.0 (biggest influence) to -1.0 (smallest influence). Most important was the availability of support for issues beyond health (+0.39), while least important was the availability of accommodations for personal hygiene (-0.27).

CONCLUSIONS

BWS quantifies patient priorities in a manner that is transparent and accessible. It is easily comprehendible by patients and relatively easy to administer. Our application illustrates its use in a vulnerable population, showing that factors beyond those typically provided in health care settings are highly important to women in seeking Pap screening. This approach can be applied to other health care services where prioritization is helpful to guide decisions.

Dairy farmers' use and non-use values in animal welfare: Determining the empirical content and structure with anchored best-worst scaling

In this study, we sought to identify empirically the types of use and non-use values that motivate dairy farmers in their work relating to animal welfare of dairy cows. We also sought to identify how they prioritize between these use and non-use values. Use values are derived from productivity considerations; non-use values are derived from the wellbeing of the animals, independent of the present or future use the farmer may make of the animal. In particular, we examined the empirical content and structure of the economic value dairy farmers associate with animal welfare of dairy cows. Based on a best-worst scaling approach and data from 123 Swedish dairy farmers, we suggest that the economic value those farmers associate with animal welfare of dairy cows covers aspects of both use and non-use type, with non-use values appearing more important. Using principal component factor analysis, we were able to check unidimensionality of the economic value construct. These findings are useful for understanding why dairy farmers may be interested in considering dairy cow welfare. Such understanding is essential for improving agricultural policy and advice aimed at encouraging dairy farmers to improve animal welfare; communicating to consumers the values under which dairy products are produced; and providing a basis for more realistic assumptions when developing economic models about dairy farmers' behavior.

Patient Preferences for Device-Aided Treatments Indicated for Advanced Parkinson Disease

BACKGROUND

Effective treatment for advanced Parkinson disease (PD) uncontrolled with oral medication includes device-aided therapies such as deep brain stimulation (DBS) and continuous levodopa-carbidopa infusion to the duodenum via a portable pump.

OBJECTIVE

Our objective was to quantify patient preferences for attributes of these device-aided treatments.

METHODS

We administered a Web-enabled survey to 401 patients in the United States. A discrete-choice experiment (DCE) was used to evaluate patients' willingness to accept tradeoffs among efficacy, tolerability, and convenience of alternative treatments. DCE data were analyzed using random-parameters logit. Best-worst scaling (BWS) was used to elicit the relative importance of device-specific attributes. Conditional logit was used to analyze the BWS data. We tested for differences in preferences among subgroups of patients.

RESULTS

Improving ability to think clearly was twice as important as a 6-hour-per-day improvement in control of movement symptoms. After controlling for efficacy, treatment delivered via portable infusion pump was preferred over DBS, and both devices were preferred to oral therapy with poor symptom control. Patients were most concerned about device attributes relating to risk of stroke, difficulty thinking, and neurosurgery. Avoiding surgery to insert a wire in the brain was more important than avoiding surgery to insert a tube into the small intestine. Some differences in preferences among subgroups were statistically, but not qualitatively, significant.

CONCLUSIONS

This study clarifies the patient perspective in therapeutic choices for advanced PD. These findings may help improve communication between patients and providers and also provide evidence on patient preferences to inform regulatory and access decisions.

Comparison of preferences of healthcare professionals and MS patients for attributes of disease-modifying drugs: A best-worst scaling

Background

The choice between disease‐modifying drugs (DMDs) for the treatment of multiple sclerosis (MS) becomes more often a shared decision between the patient and the neurologist and MS nurse. This study aimed to assess which DMD attributes are most important for the healthcare professionals in selecting a DMD for a patient. Subsequently, within this perspective, the neurologists’ and nurses’ perspectives were compared. Lastly, the healthcare professionals’ perspective was compared with the patients’ perspective to detect any differences that may need attention in the communication about DMDs.

Design

A best‐worst scaling (BWS) was conducted among 27 neurologists and 33 MS nurses treating patients with MS to determine the importance of 27 DMD attributes. These attributes were identified through three focus groups with MS patients in a previous study (N=19). Relative importance scores (RISs) were estimated for each attribute. Multivariable linear regression analyses were used to compare the different perspectives.

Results

According to the neurologists and nurses, safety of the DMD was the most important DMD attribute in the treatment decision, closely followed by effect on disability progression, quality of life and relapse rate. Patients with MS agreed with the importance of the last three attributes, but valued safety significantly lower (b=−2.59, P<.001).

Conclusions

This study suggests that, overall, neurologists and nurses regard the same DMD attributes as important as MS patients with the notable exception of safety. This study provides valuable information for the development of interventions to support shared decision making and highlights which attributes of DMDs may need additional attention.

Exploring expert opinion on the practicality and effectiveness of biosecurity measures on dairy farms in the United Kingdom using choice modeling

Biosecurity, defined as a series of measures aiming to stop disease-causing agents entering or leaving an area where farm animals are present, is very important for the continuing economic viability of the United Kingdom dairy sector, and for animal welfare. This study gathered expert opinion from farmers, veterinarians, consultants, academics, and government and industry representatives on the practicality and effectiveness of different biosecurity measures on dairy farms. The study used best-worst scaling, a technique that allows for greater discrimination between choices and avoids the variability in interpretation associated with other methods, such as Likert scales and ranking methods. Keeping a closed herd was rated as the most effective measure overall, and maintaining regular contact with the veterinarian was the most practical measure. Measures relating to knowledge, planning, and veterinary involvement; buying-in practices; and quarantine and treatment scored highly for effectiveness overall. Measures relating to visitors, equipment, pest control, and hygiene scored much lower for effectiveness. Overall, measures relating to direct animal-to-animal contact scored much higher for effectiveness than measures relating to indirect disease transmission. Some of the most effective measures were also rated as the least practical, such as keeping a closed herd and avoiding nose-to-nose contact between contiguous animals, suggesting that real barriers exist for farmers when implementing biosecurity measures on dairy farms. We observed heterogeneity in expert opinion on biosecurity measures; for example, veterinarians rated the effectiveness of consulting the veterinarian on biosecurity significantly more highly than dairy farmers, suggesting a greater need for veterinarians to promote their services on-farm. Still, both groups rated it as a practical measure, suggesting that the farmer-veterinarian relationship holds some advantages for the promotion of biosecurity.

Evaluating Benefit-risk Decision-making in Spinal Muscular Atrophy: A First-ever Study to Assess Risk Tolerance in the SMA Patient Community

PURPOSE

Patients' perceptions of benefit-risk are essential to informing the regulatory process and the context in which potential therapies are evaluated. To bring this critical information to regulators, Cure SMA launched a first-ever Benefit-Risk Survey for spinal muscular atrophy (SMA) to characterize decision-making and benefit-risk trade-offs in SMA associated with a potential therapy. We hypothesized that risk tolerance would be correlated with SMA type/severity and disease progression. This article presents the results of a benefit-risk survey to enhance understanding of how patients with SMA and caregivers evaluate specific benefits and risks associated with potential therapies.

METHODS

Affected adults, representing all SMA types (I-IV) within the Cure SMA database, and caregivers of affected individuals of all ages/types were invited via e-mail to participate. Best-worst scaling (BWS) was used to assess participants' priorities on benefit-risk trade-offs, as it provides higher discrimination and importance scaling among tested attributes. Twelve potentially clinically meaningful treatment benefits and 11 potential risks (ranging in severity and immediacy) were tested. Multiple factors were correlated with individual responses, including: SMA type/disease severity, stage of disease, respondent type, sex, and quality of life/level of independence (current and expected). Survey respondents were also evaluated for "risk-taking attitudes."

FINDINGS

A total of 298 responses were evaluated (28% affected adults and 72% caregivers, mostly parents). Most respondents were diagnosed >5 years ago (67.3%), with 22.1% SMA type I, 45.6% SMA type II, and 27.9% SMA type III. No strong correlation was found between risk tolerance and SMA type, stage of disease progression, respondent type, sex, quality of life assessment, or rated levels of independence. Irrespective of SMA type, respondents consistently rated the following risks, associated with a potential treatment, as "least tolerable": life-threatening allergic reactions; 1 in 1000 risk of life-threatening side effects leading to possible organ failure; or worsening quality of life. Furthermore, all SMA type respondents rated these risks as "most tolerable": invasive mode of treatment administration (including need for general anesthesia); side effect of dizziness; and other common side effects such as nausea, vomiting, loss of appetite, headaches, back pain, or fatigue.

IMPLICATIONS

With the approval of the first SMA treatment, these findings offer a unique opportunity to assess and characterize baseline risk-tolerance in SMA against which to evaluate future SMA treatment options. Although differences had been expected in risk tolerance among respondents based on disease baseline and certain patient attributes, this was not observed. Survey results should inform future SMA drug development and benefit-risk assessments.

Is Best-Worst Scaling Suitable for Health State Valuation? A Comparison with Discrete Choice Experiments

Health utility indices (HUIs) are widely used in economic evaluation. The best-worst scaling (BWS) method is being used to value dimensions of HUIs. However, little is known about the properties of this method. This paper investigates the validity of the BWS method to develop HUI, comparing it to another ordinal valuation method, the discrete choice experiment (DCE). Using a parametric approach, we find a low level of concordance between the two methods, with evidence of preference reversals. BWS responses are subject to decision biases, with significant effects on individuals' preferences. Non parametric tests indicate that BWS data has lower stability, monotonicity and continuity compared to DCE data, suggesting that the BWS provides lower quality data. As a consequence, for both theoretical and technical reasons, practitioners should be cautious both about using the BWS method to measure health-related preferences, and using HUI based on BWS data. Given existing evidence, it seems that the DCE method is a better method, at least because its limitations (and measurement properties) have been extensively researched. Copyright © 2016 John Wiley & Sons, Ltd.

Measuring the Preferences of Homeless Women for Cervical Cancer Screening Interventions: Development of a Best-Worst Scaling Survey

OBJECTIVE

Despite having multiple risk factors, women experiencing homelessness are screened for cervical cancer at a lower rate than women in the general US population. We report on the design of a stated preference study to assess homeless women's preferences for cervical cancer screening interventions, to inform efforts to overcome this disparity.

METHODS

We conducted focus groups with homeless women (n = 8) on cervical cancer screening decisions and analyzed the data using thematic analysis. We applied inclusion criteria to select factors for a stated preference survey: importance to women, relevance to providers, feasibility, and consistency with clinical experience. We conducted pretests (n = 35) to assess survey procedures (functionality, recruitment, administration) and content (understanding, comprehension, wording/language, length).

RESULTS

We chose best-worst scaling (BWS)-also known as object scaling-to identify decision-relevant screening intervention factors. We chose an experimental design with 11 "objects" (i.e., factors relevant to women's screening decision) presented in 11 subsets of five objects each. Of 25 objects initially identified, we selected 11 for the BWS instrument: provider-related factors: attitude, familiarity, and gender; setting-related factors: acceptance and cost; procedure-related factors: explanation during visit and timing/convenience of visit; personal fears and barriers: concerns about hygiene, addiction, and delivery/fear of results; and a general factor of feeling overwhelmed.

CONCLUSION

Good practices for the development of stated preference surveys include considered assessment of the experimental design that is used and the preference factors that are included, and pretesting of the presentation format. We demonstrate the development of a BWS study of homeless women's cervical cancer screening intervention preferences. Subsequent research will identify screening priorities to inform intervention design.

Are component endpoints equal? A preference study into the practice of composite endpoints in clinical trials

Objectives

To examine patients’ perspectives regarding composite endpoints and the utility patients put on possible adverse outcomes of revascularization procedures.

Design

In the PRECORE study, a stated preference elicitation method Best‐Worst Scaling (BWS) was used to determine patient preference for 8 component endpoints (CEs): need for redo percutaneous coronary intervention (PCI) within 1 year, minor stroke with symptoms <24 hours, minor myocardial infarction (MI) with symptoms <3 months, recurrent angina pectoris, need for redo coronary artery bypass grafting (CABG) within 1 year, major MI causing permanent disability, major stroke causing permanent disability and death within 24 hours.

Setting

A tertiary PCI/CABG centre.

Participants

One hundred and sixty patients with coronary artery disease who underwent PCI or CABG.

Main outcome measures

Importance weights (IWs).

Results

Patients considered need for redo PCI within 1 year (IW: 0.008), minor stroke with symptoms <24 hours (IW: 0.017), minor MI with symptoms <3 months (IW: 0.027), need for redo CABG within 1 year (IW: 0.119), recurrent angina pectoris (IW: 0.300) and major MI causing permanent disability (IW: 0.726) less severe than death within 24 hours (IW: 1.000). Major stroke causing permanent disability was considered worse than death within 24 hours (IW: 1.209). Ranking of CEs and the relative values attributed to the CEs differed among subgroups based on gender, age and educational level.

Conclusion

Patients attribute different weight to individual CEs. This has significant implications for the interpretation of clinical trial data.

Eliciting Preferences for Clinical Follow-Up in Patients with Head and Neck Cancer Using Best-Worst Scaling

OBJECTIVES

There are no commonly accepted standards for monitoring patients treated for head and neck cancer. The aim of this study was to assess patients' preferences for different aspects of follow-up.

METHODS

A best-worst survey was conducted in a sample of head and neck cancer patients in clinical follow-up at the National Cancer Institute (Milan, Italy). Conditional logit regression with choice as the dependent variable was run to analyse the data. A covariate-adjusted analysis was performed in order to identify socio-demographic and clinical factors related to the selection of best-worst items. The participants were asked to report any difficulties encountered during the survey.

RESULTS

A total of 143 patients, predominantly male (74%) and with a mean age of 58 years were enrolled in the survey. The strongest positive preference was expressed for a hospital-based program of physical examinations with frequency decreasing over time. Conversely, the lowest valued item was not performing any positron emission tomography (PET) scan during follow-up. Patients with high educational levels were more likely to value attending a primary care-based program and undergoing intensive radiological investigations. Other patient-specific variables significantly associated with the choice of items were employment and living status, time already spent in follow-up and number of treatments received.

CONCLUSIONS

Overall, patients were more likely to choose an intensive follow-up scheme broadly consistent with the program currently administered by the hospital. There is little evidence of preference heterogeneity that might justify customized programs based on demographics. The best-worst scaling task appeared feasible for most participants.

Exploring Social Desirability Bias in Perceptions of Dog Adoption: All's Well that Ends Well? Or Does the Method of Adoption Matter?

Simple Summary

Dog adoption is often cited as an ethical and popular method of acquisition but interpretation of the term ‘adoption’ may vary. In a nationally representative survey of the U.S., 767 respondents were asked questions regarding their opinions of dog acquisition including adoption. Within the sample, 45% had a dog; of those, 40% had adopted a dog and 47% visited a veterinarian once a year. Respondents’ preferences for the most ethical method of dog adoption were elicited using a survey instrument. Our results indicate that respondents had the largest preference share for adoption from a municipal animal shelter’ (56%) and the smallest preference share for adoption from a pet store (3%). Dog acquisition was further evaluated by creating an index of social desirability bias comparing how important respondents believed certain dog characteristics were and how important respondents believed others would rate/rank the same dog characteristics. The highest incidences of social desirability bias occurred for the dog characteristics of appearance and breed.

Abstract

Dogs are a popular companion animal in the United States; however, dog acquisition is often a contentious subject. Adoption is often cited as an ethical and popular method of acquisition but interpretation of the term ‘adoption’ may vary. In a nationally representative survey of the U.S., 767 respondents were asked questions regarding their opinions of dog acquisition and adoption. Within the sample, 45% had a dog; of those, 40% had adopted a dog, and 47% visited a veterinarian once a year. A best-worst choice experiment, where respondents were asked to choose the most ethical and least ethical method of acquiring a dog from a statistically determined set of choices, was used to elicit respondents’ preferences for the most ethical method of dog adoption. A random parameters logit and a latent class model were used to estimate relative rankings of dog adoption methods. In the random parameters logit model, the largest preference share was for adoption from a municipal animal shelter (56%) and the smallest preference share was for adoption from a pet store (3%). Dog acquisition was further evaluated by creating an index of social desirability bias using how important respondents believed certain dog characteristics were compared to how important respondents believed others would rate/rank the same dog characteristics. The highest incidences of social desirability bias occurred for the dog characteristics of appearance and breed.

An examination of help-seeking preferences via best-worst scaling

OBJECTIVE

This study utilized best-worst scaling and latent class analysis to assess mental health treatment preferences and identify subgroups of college student help seekers.

METHOD

College students (N = 504; age: M = 20.3, 79.2% female) completed assessments of mental health treatment preferences, self-stigma, and distress.

RESULTS

Students preferred utilizing friends and family, followed by professional mental health providers, self-help, keeping concerns to themselves, physicians, and lastly religious leaders. Latent class analyses identified four classes of respondents.

CONCLUSIONS

Subgroups of student help seekers include Formal Help Seekers who prefer professional mental health providers, Informal Help Seekers who prefer friends and family, Ambivalent Help Seekers who prefer family and friends but also keeping concerns to themselves, and Help Avoiders who prefer keeping concerns to themselves. Assessing treatment preferences among different student subgroups may constitute an initial step in identifying effective ways to address university-wide mental health concerns.

For better or worse? Investigating the validity of best-worst discrete choice experiments in health

Discrete choice experiments (DCEs) are frequently used in health economics to measure preferences for nonmarket goods. Best-worst discrete choice experiment (BWDCE) has been proposed as a variant of the traditional "pick the best" approach. BWDCE, where participants choose the best and worst options, is argued to generate more precise preference estimates because of the additional information collected. However, the validity of the approach relies on two necessary conditions: (a) best and worst decisions provide similar information about preferences and (b) asking individuals to answer more than one choice question per task does not reduce data quality. Whether these conditions hold in empirical applications remains under researched. This is the first study to compare participants' choices across three experimental conditions: (a) BEST choices only, (b) WORST choices only, and (c) BEST and WORST choices (BWDCE). We find responses to worst choices are noisier. Implied preferences from the best only and worst only choices are qualitatively different, leading to different WTP values. Responses to BWDCE tasks have lower consistency, and respondents are more likely to use simplifying decision heuristics. We urge caution in using BWDCE as an alternative to the traditional "pick the best" DCE.

Japanese patient preferences regarding intermediate to advanced hepatocellular carcinoma treatments

Purpose: This study aimed to evaluate Japanese patient preferences regarding features of intermediate or advanced (Progressed) hepatocellular carcinoma (HCC) treatments: transarterial chemoembolization (TACE), hepatic arterial infusion chemotherapy (HAIC), and oral anti-cancer therapy. Methods: Patients with HCC, recruited from clinical sites and a patient panel in Japan, completed a cross-sectional web-based survey. Preferences were quantified using best-worst scaling, where patients identified the best and worst among 13 treatment features. Direct elicitation was used to identify preference for TACE, HAIC, or oral therapy, including the likelihood of trying each. Additional items asked for the willingness to try an oral medication that delays progression by six months but has an 8% or 21% risk of severe hand-foot skin reaction (HFSR). Results: The sample (N=119; 29 early stage; 90 Progressed) most preferred "oral medication", "artery branches plugged", and "prevents formation of new blood vessels", and least preferred "risk of liver damage" and "risk of catheter-related complications". Overall, 51%, 40%, and 8% preferred oral therapy, TACE, and HAIC, respectively (p<0.05), and the mean likelihood of trying each were 59%, 52%, and 35%, respectively (p<0.001). Patients with sorafenib or TACE experience most preferred what they had received; however, both groups were equally willing to try the other treatment. Patients preferring oral therapy favored "oral medication" over "artery branches plugged", "surgery is repeated as required when the cancer grows again", and "risk of liver damage", compared to those preferring TACE (p<0.05). Sixty-eight percent would probably try therapy with an 8% risk of severe HFSR, compared to 50% with a 21% risk. Conclusion: Treatment type, mode of action, and risks may drive HCC patient preferences. Such features likely should be incorporated into physician-patient interactions regarding treatment decision-making.

A best-worst scaling in Colombian patients to rank the characteristics of HIV/AIDS treatment

AIM

To elicit patients' preferences for HIV/AIDS treatment characteristics in Colombia.

MATERIALS AND METHODS

A best-worst scaling case was used to provide a ranking of 26 HIV/AIDS treatment characteristics that were similar to a previous study conducted in Germany. In each choice task, participants were asked to choose the most important and the least important treatment characteristics from a set of five from the master list. Using the Hierarchical Bayes method, relative importance scores were calculated. Sub-group analyses were conducted according to sex, education, source of infection, symptoms, and age.

RESULTS

A total of 195 patients fully completed the questionnaire. The three most important characteristics were "drug has very high efficacy" (relative importance score [RIS] = 10.1), "maximum prolongation of life expectancy" (RIS = 9.7), and "long duration of efficacy" (RIS = 7.4). Sub-group analysis showed only three significant (but minor) differences between older and younger people.

CONCLUSION

This study suggests that treatment characteristics regarding efficacy and prolongation of life are particularly important for patients in Colombia. Further investigation on how patients make trade-offs between these important characteristics and incorporating this information in clinical and policy decision-making would be needed to improve adherence with HIV/AIDS medication.

How Patients Choose a Laryngologist: A Pilot Stated Preference Study

Objective

Patients consider many factors when deciding how to receive medical care. This study used best-worst scaling (BWS), a technique novel to otolaryngology, to quantitatively examine preferences among patients choosing a laryngologist. Our objective was to quantify in a pilot cohort the relative importance patients place on a variety of attributes when seeking a laryngologist.

Study Design

BWS survey.

Setting

Academic voice clinic.

Methods

New patients were recruited to take a computerized BWS survey developed using attributes derived from patient input, expert opinion, and literature review. Attributes were grouped into 4 categories: physician reputation, physician qualifications, hospital-related factors, and other nonclinical factors. Responses were analyzed using multinomial logit regression to determine importance scores and associations with other variables.

Results

Eighty-seven of 93 patients recruited participated (93.5% response rate). Physician qualifications were the most important attributes to patients, with specialty laryngology training receiving the highest importance score (20.8; 95% CI, 20.2 to 21.5; P < .0001). Recommendations from referring physicians (15.6; 95% CI, 14.3 to 16.9) and use of cutting-edge technology (11.9; 95% CI, 10.7 to 13.1) were the second and third most important, respectively. Least important were nonclinical factors, including wait time to get an appointment (4.3; 95% CI, 2.8 to 5.8) and convenience of office location (1.5; 95% CI, 0.9 to 2.1). Just over half of patients (51.2%) reported willingness to wait 4 weeks for an appointment with a laryngologist. Older patients were less concerned with convenience-related factors.

Conclusion

Nonclinical factors were less important to patients than clinical factors, and laryngology-specific training was paramount. Stated preference methodologies can elucidate underlying preferences and help providers make care more patient centered.

Which Factors Drive Consumer Decisions during Milk Purchase? New Individuals' Profiles Considering Fresh Pasteurized and UHT Treated Milk

The cow’s milk market is going through a critical period characterised by a continuous contraction in consumption as a consequence of the lack of competitiveness on the market of the conventional product (commodity) versus numerous specialties. This paper aimed to define the profiles of milk consumers in terms of individual preferences (assessed using the best-worst scaling methodology) and socio-demographic features. A survey was conducted in several stores of large-scale retail, convenience stores, and open-air markets distributed in north-west Italy to collect data from 1216 respondents. For milk shopper purchasing habits, two consumer groups were defined and compared in terms of preferences: the fresh pasteurized milk consumer (FPc) (56% of the total sample) and the ultra-high temperature treated milk consumer (UHT_c) (35%). A series of two-ways multivariate analysis of variance (MANOVA) were conducted to assess the effect of individuals’ socio-demographic characteristics and the type of milk chosen on the consumer preferences, simultaneously. Significant differences in milk purchasing habits and preferences emerged when comparing the two consumer groups (UHT_c and FP_c). Empirical evidence of the study supported the starting hypothesis, suggesting the significance or relevance of the consumer socio-demographic characteristic, as well as their interaction effect with the type of milk on the level of importance given to the considered milk quality attributes. On the contrary, the gender results were not significant for the milk preferences definition. The assessment of consumer preferences, associated with the individuals’ socio-demographic characteristics could have important implications for outlining more effective marketing strategies based on a more targeted communication (i.e., related to the sustainability dimension of the local product, nutritional value and brand), leading the consumer back to the commodity rediscovery concerning individuals’ features and habits.

Caregivers' Priorities and Observed Outcomes of Attention-Deficit Hyperactivity Disorder Medication for Their Children

OBJECTIVE

To document variability among caregivers' priorities when considering medication to treat their Children's attention-deficit hyperactivity disorder (ADHD) and explore associations between these priorities and medication-related improvements.

METHODS

Caregivers of children, ages 4 to 14 years, diagnosed with ADHD were recruited from outpatient clinics and support groups across Maryland. A survey gathered data on caregiver-reported concerns when considering ADHD medication, demographic characteristics, and observed and desired improvements in their child's ADHD. A validated Best-Worst Scaling instrument assessed priorities among 16 concerns when considering ADHD medication. Latent class analysis identified subgroups with similar ADHD medication concerns. Differences in self-reported medication-related improvements were examined across subgroups.

RESULTS

The 184 participants (mean = 42 yrs) were primarily the biological mother, 68% white and 25% black. Their children were mostly male (73%) and using medication (81%). Overall, the most important ADHD medication concerns were the child becoming a successful adult (p < 0.0001), school behavior improvements (p < 0.0001), and better grades (p < 0.0001). Others thinking badly of the child was a significantly less important concern (p < 0.0001). Three subgroups were identified: short-term outcomes-oriented group (39%), long-term outcomes-oriented group (37%), and side effects/safety-oriented group (27%). Relative to the other 2 groups, a smaller proportion of the side effects/safety-oriented group desired these improvements (p < 0.2618).

CONCLUSION

Most caregivers prioritize short- and long-term outcomes when considering ADHD medication. However, those most concerned with long- or short-term outcomes tended to desire additional improvements in their child's ADHD.

Use of best-worst scaling to estimate the magnitude of stressful life events in older adults

AIM

The magnitude of stressful life events can be measured by using rating scales such as the Social Readjustment Rating Scale. This study aimed to estimate the magnitude of stressful life events by using a best-worst scaling approach in a sample of community-dwelling older persons in Taiwan.

METHODS

Participants aged 55 years or older were asked to rate the stressfulness of 11 life events on a scale from 0 to 10 and the best-worst scaling. We used the case one (object case) best-worst scaling design: each task on a list of events was presented to participants, and they were asked to indicate the events that they considered most and least stressful.

RESULTS

A total of 61 persons (66% women) provided valid responses for analysis; the mean age was 64.8 ± 8.6 years. For best-worst scaling, 'major illness of family member' (mean best-minus-worst score = 128) was rated the most stressful, and 'sexual difficulties' was rated the least stressful (mean best-minus-worst score = -153). For the rating scale, 'major personal illness' was rated the most stressful (mean rating = 6.95), and 'sexual difficulties' was again the least stressful (mean rating = 2.05). Rankings of events based on both methods were similar but were different from ratings based on the Social Readjustment Rating Scale.

CONCLUSION

The current study explored using BWS to estimate the magnitude of stressful life events. The magnitude of events estimated in our study was found to differ from the magnitude estimated previously by some common scales for assessing stressful life events.

The Role of Trust in Explaining Food Choice: Combining Choice Experiment and Attribute Best-Worst Scaling

This paper presents empirical findings from a combination of two elicitation techniques-discrete choice experiment (DCE) and best-worst scaling (BWS)-to provide information about the role of consumers' trust in food choice decisions in the case of credence attributes. The analysis was based on a sample of 459 Taiwanese consumers and focuses on red sweet peppers. DCE data were examined using latent class analysis to investigate the importance and the utility different consumer segments attach to the production method, country of origin, and chemical residue testing. The relevance of attitudinal and trust-based items was identified by BWS using a hierarchical Bayesian mixed logit model and was aggregated to five latent components by means of principal component analysis. Applying a multinomial logit model, participants' latent class membership (obtained from DCE data) was regressed on the identified attitudinal and trust components, as well as demographic information. Results of the DCE latent class analysis for the product attributes show that four segments may be distinguished. Linking the DCE with the attitudinal dimensions reveals that consumers' attitude and trust significantly explain class membership and therefore, consumers' preferences for different credence attributes. Based on our results, we derive recommendations for industry and policy.

Evidence-Based Medicine in Otolaryngology Part XII: Assessing Patient Preferences

OBJECTIVE

To provide a contemporary resource to update clinicians and researchers on the current state of assessment of patient preferences.

DATA SOURCES

Published studies and literature regarding patient preferences, evidence-based practice, and patient-centered management in otolaryngology.

REVIEW METHODS

Patients make choices based on both physician input and their own preferences. These preferences are informed by personal values and attitudes, and they ideally result from a deliberative evaluation of the risks, benefits, and other outcomes pertaining to medical care. To date, rigorous evaluation of patient preferences for otolaryngologic conditions has not been integrated into clinical practice or research. This installment of the "Evidence-Based Medicine in Otolaryngology" series focuses on formal assessment of patient preferences and the optimal methods to determine them.

CONCLUSIONS

Methods have been developed to optimize our understanding of patient preferences.

IMPLICATIONS FOR PRACTICE

Understanding these patient preferences may help promote an evidence-based approach to the care of individual patients.

National Beef Quality Audit-2016: Phase 1, Face-to-face interviews

The National Beef Quality Audit (NBQA) is conducted every 5 yr and was most recently again conducted in 2016. Face-to-face interviews gauged progress in quality associated with live cattle production using procedures first utilized in NBQA 2011. The 2016 NBQA was the first in which interviews concerning fed steers and heifers were combined with an audit of market cow and bull beef. Face-to-face interviews were designed to illicit definitions for beef quality, estimate willingness to pay (WTP) for quality attributes, establish relative importance rankings for important quality factors, and assess images, strengths, weaknesses, potential threats, and shifting trends in the beef industry since the 2011 audit. Individuals making purchasing decisions in 5 market sectors of the steer/heifer and cow/bull beef supply chain were interviewed, including packers (n = 36), retailers (including large and small supermarket companies and warehouse food sales companies; n = 35), food service operators (including quick-serve, full-service, and institutional establishments; n = 29), further processors (n = 64), and peripherally-related government and trade organizations (GTO; n = 30). Face-to-face interviews were conducted between January and November of 2016 using a designed dynamic routing system. Definitions (as described by interviewees) for 7 pre-determined quality factors, including: (1) How and where the cattle were raised, (2) Lean, fat, and bone, (3) Weight and size, (4) Visual characteristics, (5) Food safety, (6) Eating satisfaction, and (7) Cattle genetics were recorded verbatim and categorized into similar responses for analysis. Compared to NBQA-2011, a higher percentage of companies were willing to pay premiums for guaranteed quality attributes, but overall were willing to pay lower average premiums than the companies interviewed in 2011. Food safety had the highest share of preference among all interviewees, generating a double-digit advantage over any other quality factor. The 2 beef industries have an overall positive image among interviewees, and despite lingering weaknesses, product quality continued to be at the forefront of the strengths category for both steer and heifer beef and market cow and bull beef.