Eliciting Health Care Preferences With Discrete Choice Experiments

O’Hara, Nathan N.

doi:10.1001/jamanetworkopen.2022.8794

Cited by 14 publications

(10 citation statements)

References 9 publications

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“…Ultimately, ACBC analysis provides an efficient method to quantify the RI of factors that vary among reconstruction options. Eliciting individual-level preferences for surgical care can provide a framework for a decision aid that provides objective educational information to patients about their treatment decisions and better aligns patient expectations with the reality of their surgical outcome …”

Section: Discussionmentioning

confidence: 99%

Patient Preferences for Postmastectomy Breast Reconstruction

Shammas,

Hung,

Mullikin

et al. 2023

JAMA Surg

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ImportanceUp to 40% of women experience dissatisfaction after breast reconstruction due to unexpected outcomes that are poorly aligned with personal preferences. Identifying what attributes patients value when considering surgery could improve shared decision-making. Adaptive choice–based conjoint (ACBC) analysis can elicit individual-level treatment preferences.ObjectivesTo identify which attributes of breast reconstruction are most important to women considering surgery and to describe how these attributes differ by those who prefer flap vs implant reconstruction.Design, Setting, and ParticipantsThis web-based, cross-sectional study was conducted from March 1, 2022, to January 31, 2023, at Duke University and between June 1 and December 31, 2022, through the Love Research Army with ACBC analysis. Participants were 105 women at Duke University with a new diagnosis of or genetic predisposition to breast cancer who were considering mastectomy with reconstruction and 301 women with a history of breast cancer or a genetic predisposition as identified through the Love Research Army registry.Main Outcomes and MeasuresRelative importance scores, part-worth utility values, and maximum acceptable risks were estimated.ResultsOverall, 406 women (105 from Duke University [mean (SD) age, 46.3 (10.5) years] and 301 from the Love Research Army registry [mean (SD) age, 59.2 (11.9) years]) participated. The attribute considered most important was the risk of abdominal morbidity (mean [SD] relative importance [RI], 28% [11%]), followed by chance of major complications (RI, 25% [10%]), number of additional operations (RI, 23% [12%]), appearance of the breasts (RI, 13% [12%]), and recovery time (RI, 11% [7%]). Most participants (344 [85%]) preferred implant-based reconstruction; these participants cared most about abdominal morbidity (mean [SD] RI, 30% [11%]), followed by the risk of complications (mean [SD], RI, 26% [11%]) and additional operations (mean [SD] RI, 21% [12%]). In contrast, participants who preferred flap reconstruction cared most about additional operations (mean [SD] RI, 31% [15%]), appearance of the breasts (mean [SD] RI, 27% [16%]), and risk of complications (mean [SD] RI, 18% [6%]). Factors independently associated with choosing flap reconstruction included being married (odds ratio [OR], 2.30 [95% CI, 1.04-5.08]; P = .04) and higher educational level (college education; OR, 2.43 [95% CI, 1.01-5.86]; P = .048), while having an income level of greater than $75 000 was associated with a decreased likelihood of choosing the flap profile (OR, 0.45 [95% CI, 0.21-0.97]; P = .01). Respondents who preferred flap appearance were willing to accept a mean (SD) increase of 14.9% (2.2%) chance of abdominal morbidity (n = 113) or 6.4% (4.8%) chance of complications (n = 115).Conclusions and RelevanceThis study provides information on how women value different aspects of their care when making decisions for breast reconstruction. Future studies should assess how decision aids that elicit individual-level preferences can help tailor patient-physician discussions to focus preoperative counseling on factors that matter most to each patient and ultimately improve patient-centered care.

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Section: Discussionmentioning

confidence: 99%

Patient Preferences for Postmastectomy Breast Reconstruction

Shammas,

Hung,

Mullikin

et al. 2023

JAMA Surg

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“…Stated preference methods enable both elicitations of underlying patient preferences and the elucidation of the underlying tradeoffs inherent in complex medical decision‐making. 21 , 22 , 23 These techniques have previously been used in otolaryngology and thyroid surgery. 17 , 24 , 25 , 26 , 27 , 28 Studies have demonstrated that antithyroid drugs for Graves disease were generally preferred by patients over surgery or radioactive iodine, 29 that significant cosmetic considerations regarding thyroid surgery should be factored into decision‐making, 30 and that risk of needing a subsequent contralateral hemithyroidectomy for those undergoing unilateral procedures is a significant driver of decision‐making.…”

Section: Discussionmentioning

confidence: 99%

“…These seeming contradictions in what patients want, and the tensions between concern for disease progression and concern for treatment‐related side effects, suggest that further large‐scale, quantitative work should be undertaken. Stated preference methods enable both elicitations of underlying patient preferences and the elucidation of the underlying tradeoffs inherent in complex medical decision‐making 21‐23 . These techniques have previously been used in otolaryngology and thyroid surgery 17,24‐28 .…”

Section: Discussionmentioning

confidence: 99%

Patient Experiences With Thyroid Nodules: A Qualitative Interview Survey

et al. 2023

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Objective To qualitatively explore the broad set of preferences and attitudes patients have about thyroid nodules, which influence the decision‐making process. Study Design A descriptive survey design was administered as interviews. Setting Outpatient thyroid surgery clinic. Methods Semistructured interviews were conducted with 20 patients presenting for initial evaluation of thyroid nodules at a surgeon's office. Probative, open‐ended questions were posed regarding diagnosis, treatment, risk attitudes, and the decision‐making process. Thematic analysis was used to develop code‐transcribed interviews, and an iterative refinement resulted in underlying themes. Results During the diagnostic process, patients integrated emotional responses (fear, anxiety, and shock) with rationale concerns (likelihood of cancer, risk assessment), and ultimately relied heavily on expert opinion and recommendation. Contextualization with other personal or familial health problems served as helpful touchstones for decision‐making. Overtreatment and overdiagnosis were not commonly discussed. When thinking about potential therapies, there was a strong bias to action rather than surveillance among patients. Surgical risk and the possibility of lifelong medication, however, were strong motivators for a subset of patients to seek nonsurgical alternatives. Conclusion Patients describe a decision‐making process that incorporates emotional response and rational consideration of risks, contextualized within the personal experience and physician expertise. The bias for action and intervention is strong, and most patients strongly weighted physicians' recommendations. Themes from this qualitative analysis may serve as the backbone for future stated preference research pertaining to thyroid disease.

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“…It is an effective method for eliciting the stated preferences of participants (41–43) and have been widely used in health research, especially in health policy and health economics studies (43–46). DCEs are used to reflect the real-world decision context than other methods in situations where conducting a trial or observational study is impossible or impractical (21, 42, 43). DCEs have been used to identify and evaluate the determinants of hospital choices for patients in a number of settings (9).…”

Section: Introductionmentioning

confidence: 99%

What do Iranians value most when choosing a hospital? Evidence from a discrete choice experiment

Ranjbar,

Bazyar,

Pahlevanshamsi

et al. 2023

Preprint

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Background: Individual preferences have preceded the use of health care services, and it has been affected by different hospital attributes. This study aimed to elicit the Iranians' preferences in choosing hospitals using a discrete choice experiment. Methods: A discrete choice experiment (DCE) was conducted through face to face interviews with 301 respondents. The DCE was constructed by six attributes were included based on a literature review, qualitative interviews, Focus Group Discussion (FGD) and stakeholder consultation: waiting time, quality of care, travel time, hospital type, provider competency, and hospital facilities. individuals' preferences for hospital attributes were analyzed using a mixed logit model, and interaction terms were used to assess preference heterogeneity among individuals with different sociodemographic characteristics. Results: Participants had strong and significant preferences for care delivered in hospitals with 'full' (β=0.6052, p<0.001) or 'moderate' (β=0.5882, p<0.001) hospital equipment and with 'excellent' provider competency (β=0.2637, p<0.001). The estimated coefficients for the "waiting time of 120 minutes" (β=−0.1625, p<0.001) and the "travel time of 30 minutes" (β=−0.1157, p<0.001) were negative and significant. The results also show that the personal characteristics such as age, education level, and income significantly affected individual preferences in choosing a hospital. Conclusion: Considering people's preferences can be important given the more active role of today's patients in decision-making about their treatment processes. The results of this study should be taken into consideration by health policymakers and all stakeholders to be aware of differences in preferences of people and maximize their satisfaction. In this case, it is important to continuously involve people and consider their preferences in the design, topology, construction, and equipment of hospitals.

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Eliciting Health Care Preferences With Discrete Choice Experiments

Cited by 14 publications

References 9 publications

Patient Preferences for Postmastectomy Breast Reconstruction

Patient Preferences for Postmastectomy Breast Reconstruction

Patient Experiences With Thyroid Nodules: A Qualitative Interview Survey

What do Iranians value most when choosing a hospital? Evidence from a discrete choice experiment

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