The importance of measuring strength-of-preference scores for health care options in preference-sensitive care

Abstract

Objective The objective was to determine whether a paired-comparison/leaning scale method: a) could feasibly be used to elicit strength-of-preference scores for elective health care options in large community-based survey settings; and b) could reveal preferential sub-groups that would have been overlooked if only a categorical-response format had been used. Study Design Medicare beneficiaries in four different regions of the United States were interviewed in person. Participants considered 8 clinical scenarios, each with 2 to 3 different health care options. For each scenario, participants categorically selected their favored option, then indicated how strongly they favored that option relative to the alternative on a paired-comparison bi-directional Leaning Scale. Results Two hundred and two participants were interviewed. For 7 of the 8 scenarios, a clear majority (> 50%) indicated that, overall, they categorically favored one option over the alternative(s). However, the bi-directional strength-of-preference Leaning Scale scores revealed that, in 4 scenarios, for half of those participants, their preference for the favored option was actually “weak” or “neutral”. Conclusion Investigators aiming to assess population-wide preferential attitudes towards different elective health care scenarios should consider gathering ordinal-level strength-of-preference scores and could feasibly use the paired-comparison/bi-directional Leaning Scale to do so.

Awareness of General Practitioners concerning cancer patients’ preferences for place of death: Evidence from four European countries

“…However, the questionnaire only captured a categorical preference from proxies, and knowing the 'strength' of that preference could help delineate the weight of place of death in comparisons with other goals of care. 1 One should remember that some patients do not have a preference on place of death or regard it as unimportant.…”

“…Cancer is a leading cause of death in Europe with standardised statistics demonstrating more than 169 deaths per 100,000 inhabitants annually died from malignancies. 1 Therefore, offering quality cancer care is crucial and palliative care is one element. Achieving patients' preference is a marker in assessing quality of care 1 and place of death deserves attention because it gives patients and their families a sense of control and thus improving the quality of death.…”

“…1 Therefore, offering quality cancer care is crucial and palliative care is one element. Achieving patients' preference is a marker in assessing quality of care 1 and place of death deserves attention because it gives patients and their families a sense of control and thus improving the quality of death. 2 Meeting patients' preferences of place of death enhances the quality of cancer care in addition to other goals such as symptom control and spending time with family at the end-of-life.…”