Best-Worst Scaling and the Prioritization of Objects in Health: A Systematic Review

Experiences, Attitudes and Preferences of Postpartum Cisgender Women for HIV Prevention and Pre-Exposure Prophylaxis Education during Routine Postpartum Care

The postpartum period presents an opportunity to deliver comprehensive sexual health education. Understanding preferences of postpartum cisgender women (CGW) towards integration of HIV prevention education into postpartum care is necessary to support acceptability, appropriateness, and feasibility. Postpartum CGW were recruited during their postpartum hospital stay in Bronx, NY. Participants completed a survey including two best-worst scaling exercises that elicited preferences for receiving HIV prevention information and PrEP messaging. Utility scores were estimated using a hierarchical Bayes multinomial logit model and mathematically transformed into a probability scale presented as preference scores (PS), with higher numbers representing greater preference. Among 259 participants, 53% had never heard of PrEP before. Receiving information from a doctor was most preferred (13.4, 95%CI 12.7-14.0) followed by receiving information about HIV prevention combined with taking care of their health after having a baby (11.6, 95% CI 10.9-12.3). Latent class analysis revealed three classes: participants with greater preference for high touch services (e.g., in-person visits, doctor providing information), integrated information (e.g., HIV prevention information given in combination with sexual or maternal health information) and high technology services (e.g., a mobile phone application, telehealth visit). Participants preferred PrEP messaging related to themes of effectiveness, motherhood, safety and autonomy. Latent class analysis of PrEP messaging revealed two classes: one with participants preferring messages related to motherhood and safety and another preferring messages related to control and autonomy. The heterogeneity in preferences for receiving information at the patient level suggests a need for patient-centered, differentiated service delivery to support maximum receptivity.

Factors influencing the decision to discontinue treatment due to chemotherapy-induced peripheral neuropathy among patients with metastatic breast cancer: a best-worst scaling

PURPOSE

To measure the importance of factors that influence the decision to discontinue treatment due to chemotherapy-induced peripheral neuropathy (CIPN) among patients with metastatic breast cancer (mBC).

METHODS

An online survey incorporating a best-worst scaling (BWS) was conducted among women in the USA with mBC and experiencing CIPN. In the BWS, women chose the most and least important factors influencing their decision to discontinue treatment due to CIPN. Seven factors were included: relieving current neuropathy symptoms, reducing risk of long-term neuropathy, having another cancer treatment option, understanding the risk of treatment discontinuation, and receiving support for treatment discontinuation from the oncologist, loved ones, or patients with similar experiences. To measure the importance of each factor, a conditional logit model estimated coefficients, which were subsequently rescaled to importance scores that summed to 100. The dependent variable was the choice of a factor as most or least important across seven choice tasks.

RESULTS

The sample included 189 women with a mean age of 52.5 (SD = 12.65) years, 52.9% were White, 33.9% were Black, and 64.6% held a bachelor's degree or higher. When faced with the decision to discontinue treatment due to CIPN, the most important factors were having another cancer treatment option (score 23.5), followed by understanding the risk of treatment discontinuation (score 19.2), and reducing risk of long-term neuropathy (score 19.1). The least important factors in the decision to discontinue treatment due to CIPN were: support from loved ones (score 5.2) and support from other patients (score 3.3).

CONCLUSION

When faced with the decision to discontinue treatment due to CIPN, women with mBC attributed more importance to survival and reducing the risk of long-term CIPN. Knowledge of what matters most to patients may assist with shared decision-making to optimize therapeutic outcomes in patients receiving neurotoxic chemotherapy.

Identifying and Managing Fraudulent Respondents in Online Stated Preferences Surveys: A Case Example from Best-Worst Scaling in Health Preferences Research

BACKGROUND

There is limited evidence and guidance in health preferences research to prevent, identify, and manage fraudulent respondents and data fraud, especially for best-worst scaling (BWS) and discrete choice experiments with nonordered attributes. Using an example from a BWS survey in which we experienced data fraud, we aimed to: (1) develop an approach to identify, verify, and categorize fraudulent respondents; (2) assess the impact of fraudulent respondents on data and results; and (3) identify variables associated with fraudulent respondents.

METHODS

An online BWS survey on healthcare services for inflammatory bowel disease (IBD) was administered to Canadian IBD patients. We used a three-step approach to identify, verify, and categorize respondents as likely fraudulent (LF), likely real (LR), and unsure. First, responses to 12 "red flag" variables (variables identified as indicators of fraud) were coded 0 (pass) or 1 (fail) then summed to generate a "fraudulent response score" (FRS; range: 0-12 (most likely fraudulent)) used to categorize respondents. Second, respondents categorized LR or unsure underwent age verification. Third, categorization was updated on the basis of age verification results. BWS data were analyzed using conditional logit and latent class analysis. Subgroup analysis was done by final categorization, FRS, and red flag variables.

RESULTS

Overall, n = 4334 respondents underwent initial categorization resulting in 24% (n = 1019) LF and 76% (n = 3315) needing further review. After review, 75% (n = 3258) were categorized as LF and n = 484 underwent age verification. Respondent categorization was updated on the basis of age verification, with final categorization of 76% (n = 3297) LF, 14% (n = 592) unsure, 10% (n = 442) LR, and < 1% (n = 3) duplicates of LR. BWS item rankings differed most by respondent category. Latent class analysis demonstrated final categorization was significantly associated with class membership; class 1 had characteristics consistent with LR respondents and item ranking order for class 1 closely aligned with LR respondent conditional logit results. Suspicious email was the most frequently failed red flag variable and was associated with fraudulent respondents.

CONCLUSIONS

Additional steps to review data and verify age resulted in better categorization than only FRS or single red flag variables. Email authentication, single use/unique survey links, and built-in identification verification may be most effective for fraud prevention. Guidance is needed on good research practices for most effective and efficient approaches for preventing, identifying, and managing fraudulent data in health preferences research, specifically in studies with nonordered attributes.

Discrete Choice Experiment Versus Best-Worst Scaling: An Empirical Comparison in Eliciting Young People's Preferences for Web-Based Mental Health Interventions

BACKGROUND

Discrete choice experiments (DCEs) and best-worst scaling (BWS) profile cases (BWS case 2, or BWS-2) have been increasingly used in eliciting preferences towards health care interventions. However, it remains unclear which method is more suitable for preference elicitation, particularly in the mental health context. This study aims to compare: (1) the preference results elicited from a DCE and BWS-2; and (2) the acceptability of the two methods in the context of web-based mental health interventions (W-MHIs) for managing anxiety and depression in young people.

METHODS

Participants were aged 18-25 years, lived in Australia, and self-reported experiencing anxiety and/or depression in the past 12 months. They also had either an intention to use W-MHIs or previous experience with W-MHIs for managing anxiety and/or depression. Recruitment was conducted online via social media and Deakin University notice boards. Eligible participants completed an online survey containing eight DCE and eight BWS-2 choice tasks. Both types of choice tasks comprised six attributes. A multinominal logit model was used to estimate the preference weights and relative importance of attributes. Acceptability was assessed on the basis of dropout rate, completion time, task difficulty, understanding, and participants' preferred type of choice task.

RESULTS

A total of 198 participants (mean age: 21.42 ± 2.3 years, 64.65% female) completed the survey. Both DCE and BWS-2 predicted that cost was the most important attribute in young people's decision to engage with W-MHIs. However, the two methods differed in the relative importance of attributes and the preference ranking of levels within attributes. The DCE was perceived as easier to understand and answer, with nearly 64% of the participants preferring it over the BWS-2.

CONCLUSIONS

While both methods found cost was the most important attribute associated with engagement with W-MHIs, differences in the ranking of other attributes suggest that DCE and BWS-2 are not necessarily interchangeable. Increased acceptability by study participants of the DCE format suggests that this technique may have more merit than BWS-2-at least in the current study's context. Further research is required to identify the optimal method for determining the relative importance of attributes.

Using Best-Worst Scaling Survey to Investigate the Relative Importance of Attributes Associated with Public Hospital Outpatient Appointments

INTRODUCTION

Obtaining patient input before healthcare redesign improves patient experience. The Townsville Hospital and Health Service, a regional Australian public health service, seeks to reduce the long wait list for medical specialist appointments by introducing allied health substitution models of care for low-acuity patients. This paper describes a best worst scaling survey conducted to refine attributes associated with outpatient appointments which will be used in a future discrete choice experiment (DCE).

METHODS

A literature review was conducted to identify attributes associated with medical specialist outpatient appointments and allied health substitution models. An object (or case 1) best worst scaling (BWS) survey was designed using blocks of a balanced incomplete block design and analysed using multinomial logit and mixed logit models. Patients waiting at local specialist outpatient clinics were invited to complete the survey via an iPad. The interviewer collected field notes, which were analysed using content analysis.

RESULTS

A total of 12 attributes were identified in the literature review and one from local discussion. The 167 completed responses demonstrated the ranking of attributes were diagnostic accuracy, symptom relief, continuity of care, satisfaction with care, healthcare professional, manner and communication, time on waitlist and onward referral. The least important attributes were reassurance offered, appointment wait time, cost and appointment duration.

CONCLUSIONS

This BWS survey allows us to reduce the attributes for inclusion in the DCE from 13 to 8. Diagnostic accuracy and symptom relief were of most importance, and appointment wait time and duration were of least importance. This suggests that patients would be willing to be attend different models of care such as allied health primary contact model if clinical outcomes were equivalent to the current medical-led models.

Enhancing implementation of information and communication technologies for post-discharge care among hospitalized older adult patients: development of a multifaceted implementation intervention package using the behavior change wheel and implementation research logic model

BACKGROUND

The integration of information and communication technologies in clinical practice can supplement traditional care pathways on discharge education and has exhibited evident benefits in improving patient health outcomes. However, healthcare providers have reported difficulties in adopting such technologies. The existing evidence on implementation interventions supporting the implementation of information and communication technologies is insufficient, characterized by infrequent utilization or reporting of implementation theories in implementation intervention designs. This study aims to outline the creation of a theory-informed implementation intervention package to enhance the clinical implementation of information and communication technologies for post-discharge self-care among hospitalized older adults.

METHODS

This study systematically applies the Behavior Change Wheel (BCW) approach, involving behavior diagnosis, identification of intervention options, and intervention content selection, informed by conceptual frameworks, empirical data, and relevant literature. Additionally, the Implementation Research Logic Model is utilized to synthesize, organize, and visually present the collected data.

RESULTS

This structured process identified and selected five intervention functions, 11 behavior change techniques, and four policy categories. A multifaceted implementation intervention package was developed, containing four components: (i) flexible and sustainable training, (ii) mass media and opinion leader campaign, (iii) technology and workflow redesign, and (iv) regular corporate-level audit and feedback.

CONCLUSIONS

The study addresses the incomplete evidence base for implementation interventions supporting clinical information and communication technology implementation, presenting a practical, evaluable, and scalable theory-informed implementation intervention package. By providing an example of the application of the BCW approach and logic model, this study contributes to the knowledge on implementation intervention design, offering valuable insights for researchers and practitioners aiming to improve healthcare providers' behavior change and post-discharge care management with technology-based interventions.

Unique and shared partner priorities for supporting engagement in knowledge mobilization in pediatric pain: a best-worst scaling experiment

BACKGROUND

Engaging in partnerships is key to the success of knowledge mobilization (KM) activities; however, how best to engage partners in KM activities in the context of paediatric pain and children's health more broadly is not well understood. There is limited guidance on what supports the development of effective partnerships in KM activities with a variety of partner types. The purpose of this study was to examine the preferences and priorities of three partner groups (i.e. health professionals, researchers and patient/caregiver partners) when it comes to supporting their engagement in KM activities within paediatric pain and children's health.

METHODS

We used a case 1 (object case) best-worst scaling (BWS) experiment, a stated preferences method to assess priorities and relative importance of factors related to supporting engagement in KM activities and compare their importance across the three partner groups. Participants completed 12 tasks requiring them to select items that were most and least important to supporting their engagement in KM activities. A total of 11 items, generated through a previous elicitation task, were included in the balanced incomplete block experimental design for the BWS. Difference scores and ratio values were calculated for each group and relative comparisons were observed across groups.

RESULTS

A total of 127 participants completed the BWS experiment. All partner groups agreed that items related to relationships within teams were among the most important, while pragmatic items related to executing KM were amongst the least important. While there was relative similarity in the items ranked as important, varying priorities also emerged for each group; fit of KM activities in the clinical context was particularly important among researchers, while flexible communication was relatively more important within the patient/caregiver group. Health professionals differed the least from the other groups.

CONCLUSIONS

Different partner groups prioritized strong relationships when it comes to supporting engagement in KM activities, reinforcing the importance of connections in KM processes. There was nuance, however, around how partner groups valued various aspects of relationships. Individuals leading KM initiatives in paediatric pain and children's health should discuss relationships and pragmatics with partners to ensure successful collaboration and impactful activities.

Incorporating Best-Worst Scaling (BWS) Questions into Focus Groups to Improve Understanding of Patient Preferences and Refine BWS Attributes

BACKGROUND AND OBJECTIVE

Best-worst scaling (BWS) is a stated preference elicitation method used for prioritizing attributes of healthcare interventions. Best-worst scaling attribute development is commonly based on literature review, qualitative work, and methodological/clinical expert input. There is limited research incorporating BWS in focus groups as part of the attribute development process. We sought to explore how incorporating BWS questions using the list of potential attributes in focus groups could be used to improve understanding of patient preferences and refine the list of potential BWS attributes as part of the attribute development process.

METHODS

We administered BWS questions on healthcare priorities for inflammatory bowel disease in five focus groups with Canadian patients with inflammatory bowel disease to (1) understand the "what," "how," and "why" of participant choices and (2) note how participants understand the attributes and the language they use to refine the list of potential BWS attributes. A list of 20 potential attributes was used to generate the BWS questions. We coded most/least important choices ("what") and used a thematic analysis to derive subthemes indicating "how" and "why" participants made their choices. We coded how participants understood the attributes/BWS questions and language used when discussing the attributes.

RESULTS

Across the 36 participants, the most frequently chosen most/least important attributes were summarized. Three subthemes explaining the "how" and "why" of participant choices were identified: perceived gain; influence of individual experiences; current health state and personal circumstances. Participants identified challenges understanding specific attributes and BWS questions, and provided suggestions for modifications to attribute language/descriptions. Administering BWS questions in focus groups provided: (1) insight into the assumptions participants made when completing the BWS questions; (2) clarity in language and attribute descriptions, and challenges participants had when completing the BWS questions that can be used to refine the list of potential attributes as part of the attribute development process; and (3) understanding of which attributes were most/least important and why to identify potential attributes to remove during the next steps of the attribute development process.

CONCLUSIONS

Best-worst scaling questions conducted within focus groups can stimulate discussions around relative importance and prioritization of attributes. Through open dialogue, this method can unveil unforeseen responses or identify areas that are unclear and enable a transparent approach to refine the list of potential attributes as part of the attribute development process.

What Next for the Science of Patient Preference? Interoperability, Standardization, and Transferability

Using patient preference information (PPI) to incorporate patient voices into the drug development lifecycle can help align therapies with the needs and values of patients. However, several barriers have limited the use of PPI, including a lack of clarity on its use by decision-makers, a need for greater decision-maker trust in PPI, and a lack of time, budgets, and access to specialist expertise. The value proposition for PPI could be enhanced by making it FAIR: Findable, Accessible, Interoperable, and Reusable. To support the development of a research agenda to deliver FAIR PPI, we reviewed related endeavors in the development of repositories of existing studies, disease models, benefit transfer, and common data standards. We concluded that developing FAIR PPI would require advances in the science of PPI, including the establishment of a consortium, mirroring the Clinical Data Interchange Standards Consortium (CDISC) or Observational Medical Outcomes Partnership (OPOM), to develop PPI data standards, and research into the sources of variation in patient preferences. This will require the science of PPI to graduate from being a body of empirical observations to developing theories that explain variations in patient preferences, simultaneously driving both efficiency in the generation of PPI and trust in PPI.

Identification and Prioritization of Canadian Society of Nephrology Clinical Practice Guideline Topics

Introduction

Nephrology clinical practice guideline topics are routinely determined by clinicians and researchers, without extensive engagement of people with lived experience (PWLE) of kidney disease and their caregivers. The Canadian Society of Nephrology (CSN) Clinical Practice Guidelines Committee (CPGC) completed this modified Delphi study to incorporate diverse stakeholder perspectives in identifying and prioritizing future guideline topics.

Methods

We recruited nephrology clinicians, researchers, PWLE of kidney disease or their caregivers for this study. We collated literature-derived guideline topics from international and national guideline organizations that had relevance to nephrology, in addition to suggestions from participants. Consenting participants were taken through a 3 round Delphi survey process, where items were ranked on a 9-point Likert scale in terms of their importance. Based on predetermined consensus criteria, items were accepted as a priority or excluded from further consideration. We ranked the prioritized topics and compared the median ranking between clinicians or researchers and PWLE in the round where consensus was reached.

Results

Of the 85 consenting participants, 76 to 78 completed each Delphi round. From the initial list of 100 topics for consideration, 12 were priorities. All stakeholder groups felt it was important for PWLE to be included in topic prioritization and guideline development. The 3 most highly prioritized topics were de novo guidelines on novel therapeutics to prevent or slow progression of chronic kidney disease (CKD), recommendations for primary care, and patient-oriented guidelines on diet and exercise in kidney disease. There were no statistical differences in the median ranking between stakeholder groups (P > 0.05).

Conclusion

This study will inform the future nephrology guidelines and commentaries developed by the CSN.

Unmet Needs in the Management of Chronic Kidney Disease-Associated Pruritus and the Characteristics of the Ideal Treatment: A Spanish Cross-Sectional Survey from a Multidisciplinary Perspective

Objectives: Chronic kidney disease-associated pruritus (CKD-aP) is underdiagnosed and not fully understood by healthcare professionals, which leads to poor patient management and impacts patients' quality of life (QoL). The aim of this study was to analyse unmet needs in CKD-aP management and explore the attributes/characteristics that the ideal CKD-aP treatment should have from the perspective of a group of nephrologists, hospital pharmacists, nurses, patient representatives, and regional health authorities in Spain. Methods: A descriptive, cross-sectional study was conducted using an e-survey including ad hoc questions (6-point Likert scale) related to unmet needs in CKD-aP and best-worst scaling (BWS) to prioritise the attributes/characteristics of the ideal CKD-aP treatment. The survey was developed from a literature review, a patient focus group, and a multidisciplinary expert committee. Results: A total of 21 people participated, and it was considered, among other aspects, that CKD-aP had a significant impact on patient QoL (4.29/5), but the diagnosis rate and knowledge level of agents involved, as well as current treatment efficacy and safety, were low (1.71/5, 2.19/5, 1.91/5, and 2.67/5, respectively). The attributes "improves overall QoL (physical and mental)", "reduces itch with statistical significance", and "treatment is supported by clinical development/high evidence and has AEMPS (Spanish Agency for Medicines and Medical Devices)-approved indication for pruritus" were selected as the most valued attributes. There was a positive balance between best-worst scores (86-5, 71-2, and 78-13 points, respectively). Conclusions: The results show the need to undertake actions to drive relevant changes in current clinical practice to improve CKD-aP diagnosis and management.

Preferences and attitudes regarding early intervention in multiple sclerosis: A systematic literature review

BACKGROUND

Multiple sclerosis (MS) is a chronic inflammatory disorder affecting the brain and spinal cord, characterized by immune-mediated myelin damage. Early intervention and detection programs have emerged as promising strategies to improve patient outcomes by identifying and treating MS in its earliest stages.

OBJECTIVE

This systematic literature review aims to provide an overview of the preferences, attitudes, and opinions of both patients and healthcare professionals regarding early intervention or early detection programs for MS.

METHODS

A comprehensive search strategy was employed in March 2023 across multiple databases (MEDLINE, Scopus, PsyInfo, PubMed), from 1990 to 2023. A total of 38 articles were selected for analysis based on predefined inclusion and exclusion criteria.

RESULTS

The majority of articles were published in recent years and represented different methods from case reports to randomized controlled trials, with fewer systematic literature reviews. Data collection approaches included patients, healthcare workers, or mixed samples with varying age ranges and gender ratios, frequently preferring women. These samples represented different preference study methods. The included studies were primarily conducted in the USA and the UK. Thematic analysis revealed several key themes : 1) differences emerged between healthcare professionals' and patients' perspectives 2) interventions for MS outside Disease-Modifying Therapies (DMTs) 3) severe side effects 4) communication, information, and knowledge 5) psychological and emotional aspects.

CONCLUSIONS

Understanding these diverse factors and subgroups within the MS population can inform more effective, personalized approaches to MS prevention and treatment.

Preferences of people living with HIV for features of tuberculosis preventive treatment regimens in Uganda: a discrete choice experiment

INTRODUCTION

Tuberculosis (TB) preventive treatment (TPT) is recommended for people living with HIV (PLHIV) in high TB burden settings. While 6 months of daily isoniazid remains widely used, shorter regimens are now available. However, little is known about preferences of PLHIV for key features of TPT regimens.

METHODS

From July to November 2022, we conducted a discrete choice experiment among adult PLHIV engaged in care at an urban HIV clinic in Kampala, Uganda. Participants chose between two hypothetical TPT regimens with five different features (pills per dose, frequency, duration, need for adjusted antiretroviral therapy [ART] dosage and side effects), organized across nine random choice tasks. We analysed preferences using hierarchical Bayesian estimation, latent class analysis and willingness-to-trade simulations.

RESULTS

Of 400 PLHIV, 392 (median age 44, 72% female, 91% TPT-experienced) had high-quality choice task responses. Pills per dose was the most important attribute (relative importance 32.4%, 95% confidence interval [CI] 31.6-33.2), followed by frequency (20.5% [95% CI 19.7-21.3]), duration (19.5% [95% CI 18.6-20.5]) and need for ART dosage adjustment (18.2% [95% CI 17.2-19.2]). Latent class analysis identified three preference groups: one prioritized less frequent, weekly dosing (N = 222; 57%); another was averse to ART dosage adjustment (N = 107; 27%); and the last prioritized short regimens with fewer side effects (N = 63; 16%). All groups highly valued fewer pills per dose. Overall, participants were willing to accept a regimen of 2.8 months' additional duration [95% CI: 2.4-3.2] to reduce pills per dose from five to one, 3.6 [95% CI 2.4-4.8] months for weekly rather than daily dosing and 2.2 [95% CI 1.3-3.0] months to avoid ART dosage adjustment.

CONCLUSIONS

To align with preferences of PLHIV in Uganda, decision-makers should prioritize the development and implementation of TPT regimens with fewer pills, less frequent dosing and no need for ART dosage adjustment, rather than focus primarily on duration of treatment.

Perspectives on Drug Product Design Among Patients with Lung Cancer in the United Kingdom

INTRODUCTION

The use of oral anticancer medications has become more prevalent in cancer therapy. This is particularly the case in the management of advanced non-small cell lung cancer (NSCLC). However, when the treatment delivery interaction between the patient and the healthcare provider is removed, the risk of non-adherence increases. Insights into patient preferences can allow drug product formulation scientists to design more patient-centric medications that may promote an increase in adherence which, in turn, may lead to more beneficial health outcomes.

METHODS

We conducted an advisory board with patients with NSCLC in the United Kingdom to elicit and understand preferences for drug product attributes related to appearance, instructions, and modality. The advisory board was preceded by a quantitative preference survey that included three object-case best-worst scaling exercises and was followed by administering the same survey to a broader group of patients to confirm the results.

RESULTS

Patients strongly prefer once-daily dosing over more frequent dosing, regardless of the number of pills because taking tablets or capsules multiple times each day can disrupt daily activities. In addition, patients place high importance on surface smoothness because a rough surface implies decreased swallowability. Finally, food restrictions involving directions regarding taking medication with or without food represent difficulties for patients with cancer. Results of the follow-up survey confirmed these results.

CONCLUSIONS

Drug developers should attempt to limit the dosing of these medications to once-daily regimens, avoid surface roughness, and develop formulations that can be taken without regard to the timing of meals to the greatest extent possible.

Physician and Patient Preferences for Oral Anticoagulation Therapy Decision Making in Atrial Fibrillation: Results From a National Best-Worst Scaling Survey in Türkiye

Atrial fibrillation (AF) is the most common cardiac dysrhythmia and a common cause of ischemic stroke. Stroke prevention with oral anticoagulation (OAC) is the cornerstone of AF management. Patients and their treating physicians may have different views on different attributes of OACs. The objective of this study was to quantify the relative importance that patients and physicians in Turkey place on different OAC attributes when making treatment decisions in AF. A cross-sectional survey was administered to AF patients (≥ 50 years) receiving OAC and practising cardiologists, including residents with ≥ 2 years of experience in Turkey. For both patients (N = 230; 50% male) and physicians (N = 194; 74% male), the most important attributes for OAC treatment decision making in AF were "success in preventing stroke" (57% and 73.9% or overall importance, respectively) and "risk of major bleeding" (20% and 23.4%, respectively). For patients, other attributes were much less important, but not altogether unimportant: reversal agent availability (7%), monitoring (5%), food or drug interactions (3%), minor bleeding (3%), and ease of swallowing (2%). For physicians, among the other attributes, only the need for monitoring (1.3%) had a relative importance of > 1%. For all Turkish participants, efficacy and safety were found to be the most important attributes influencing OAC choice in AF with these two attributes accounting for 77% and 97.3% of overall importance for patients and physicians, respectively. Certain considerations, especially reversal agent availability and monitoring appear to be more important to patients than to physicians This is the first study to use BWS to quantify patient and physician preferences for OAC treatments in AF in Turkey.

A Reporting Checklist for Discrete Choice Experiments in Health: The DIRECT Checklist

BACKGROUND

Reporting standards of discrete choice experiments (DCEs) in health have not kept pace with the growth of this method, with multiple reviews calling for better reporting to improve transparency, assessment of validity and translation. A key missing piece has been the absence of a reporting checklist that details minimum standards of what should be reported, as exists for many other methods used in health economics.

METHODS

This paper reports the development of a reporting checklist for DCEs in health, which involved a scoping review to identify potential items and a Delphi consensus study among 45 DCE experts internationally to select items and guide the wording and structure of the checklist. The Delphi study included a best-worst scaling study for prioritisation.

CONCLUSIONS

The final checklist is presented along with guidance on how to apply it. This checklist can be used by authors to ensure that sufficient detail of a DCE's methods are reported, providing reviewers and readers with the information they need to assess the quality of the study for themselves. Embedding this reporting checklist into standard practice for health DCEs offers an opportunity to improve consistency of reporting standards, thereby enabling transparency of review and facilitating comparison of studies and their translation into policy and practice.

Using best-worst scaling to inform policy decisions in Africa: a literature review

BACKGROUND

Stakeholder engagement in policy decision-making is critical to inform required trade-offs, especially in low-and-middle income settings, such as many African countries. Discrete-choice experiments are now commonly used to engage stakeholders in policy decisions, but other methods such as best-worst scaling (BWS), a theory-driven prioritization technique, could be equally important. We sought to document and explore applications of BWS to assess stakeholder priorities in the African context to bring attention to BWS as a method and to assess how and why it is being used to inform policy.

METHODS

We conducted a literature review of published applications of BWS for prioritization in Africa.

RESULTS

Our study identified 35 studies, with the majority published in the past four years. BWS has most commonly been used in agriculture (43%) and health (34%), although its broad applicability is demonstrated through use in fields influencing social and economic determinants of health, including business, environment, and transportation. Published studies from eastern, western, southern, and northern Africa include a broad range of sample sizes, design choices, and analytical approaches. Most studies are of high quality and high policy relevance. Several studies cited benefits of using BWS, with many of those citing potential limitations rather than observed limitations in their study.

CONCLUSIONS

Growing use of the method across the African continent demonstrates its feasibility and utility, recommending it for consideration among researchers, program implementers, policy makers, and funders when conducting preference research to influence policy and improve health systems.

REGISTRATION

The review was registered on PROSPERO (CRD42020209745).

Comparing the Self-Reported Acceptability of Discrete Choice Experiment and Best-Worst Scaling: An Empirical Study in Patients with Type 2 Diabetes Mellitus

Purpose

Discrete choice experiment (DCE) and profile case (case 2) best-worst scaling (BWS) present uncertainties regarding the acceptability of quantifying individual healthcare preferences, which may adversely affect the validity of responses and impede the reflection of true healthcare preferences. This study aimed to assess the acceptability of these two methods from the perspective of patients with type 2 diabetes mellitus (T2DM) and examine their association with specific characteristics of the target population.

Patients and Methods

This cross-sectional study was based on a nationally representative survey; data were collected using a multistage stratified cluster-sampling procedure between September 2021 and January 2022. Eligible adults with confirmed T2DM voluntarily participated in this study. Participants completed both the DCE and case 2 BWS (BWS-2) choice tasks in random order and provided self-reported assessments of acceptability, including task completion difficulty, comprehension of task complexity, and response preference. Logistic regression and random forest models were used to identify variables associated with acceptability.

Results

In total, 3286 patients with T2DM were included in the study. Respondents indicated there was no statistically significant difference in completion difficulty between the DCE and BWS-2, although the DCE scores were slightly higher (3.07 ± 0.68 vs 3.03 ± 0.67, P = 0.06). However, 1979 (60.2%) respondents found the DCE easier to comprehend. No significant preferences were observed between the two methods (1638 (49.8%) vs 1648 (50.2%)). Sociodemographic factors, such as residence, monthly out-of-pocket costs, and illness duration were significantly associated with comprehension complexity and response preference.

Conclusion

This study yielded contrasting results to most of previous studies, suggesting that DCE may be less cognitively demanding and more suitable for patients with T2DM from the perspective of self-reported acceptability of DCE and BWS. This study promotes a focus on patient acceptability in quantifying individual healthcare preferences to inform tailored optimal stated-preference method for a target population.

Preferences for COVID-19 Vaccines: Systematic Literature Review of Discrete Choice Experiments

BACKGROUND

Vaccination can be viewed as comprising the most important defensive barriers to protect susceptible groups from infection. However, vaccine hesitancy for COVID-19 is widespread worldwide.

OBJECTIVE

We aimed to systematically review studies eliciting the COVID-19 vaccine preference using discrete choice experiments.

METHODS

A literature search was conducted in PubMed, Embase, Web of Science, Scopus, and CINAHL Plus platforms in April 2023. Search terms included discrete choice experiments, COVID-19, and vaccines and related synonyms. Descriptive statistics were used to summarize the study characteristics. Subgroup analyses were performed by factors such as high-income countries and low- and middle-income countries and study period (before, during, and after the pandemic wave). Quality appraisal was performed using the 5-item Purpose, Respondents, Explanation, Findings, and Significance checklist.

RESULTS

The search yield a total of 623 records, and 47 studies with 53 data points were finally included. Attributes were grouped into 4 categories: outcome, process, cost, and others. The vaccine effectiveness (21/53, 40%) and safety (7/53, 13%) were the most frequently reported and important attributes. Subgroup analyses showed that vaccine effectiveness was the most important attribute, although the preference varied by subgroups. Compared to high-income countries (3/29, 10%), a higher proportion of low- and middle-income countries (4/24, 17%) prioritized safety. As the pandemic progressed, the duration of protection (2/24, 8%) during the pandemic wave and COVID-19 mortality risk (5/25, 20%) after the pandemic wave emerged as 2 of the most important attributes.

CONCLUSIONS

Our review revealed the critical role of vaccine effectiveness and safety in COVID-19 vaccine preference. However, it should be noticed that preference heterogeneity was observed across subpopulations and may change over time.

TRIAL REGISTRATION

PROSPERO CRD42023422720; https://tinyurl.com/2etf7ny7.

Developing a person-centered stated preference survey for dementia with Lewy bodies: value of a personal and public involvement process

Introduction

The development of high-quality stated preference (SP) surveys requires a rigorous design process involving engagement with representatives from the target population. However, while transparency in the reporting of the development of SP surveys is encouraged, few studies report on this process and the outcomes. Recommended stages of instrument development includes both steps for stakeholder/end-user engagement and pretesting. Pretesting typically involves interviews, often across multiple waves, with improvements made at each wave; pretesting is therefore resource intensive. The aims of this paper are to report on the outcomes of collaboration with a Lewy body dementia research advisory group during the design phase of a SP survey. We also evaluate an alternative approach to instrument development, necessitated by a resource constrained context.

Method

The approach involved conducting the stages of end-user engagement and pretesting together during a public involvement event. A hybrid approach involving a focus group with breakout interviews was employed. Feedback from contributors informed the evolution of the survey instrument.

Results

Changes to the survey instrument were organized into four categories: attribute modifications; choice task presentation and understanding; information presentation, clarity and content; and best-best scaling presentation. The hybrid approach facilitated group brainstorming while still allowing the researcher to assess the feasibility of choice tasks in an interview setting. However, greater individual exploration and the opportunity to trial iterative improvements across waves was not feasible with this approach.

Discussion

Involvement of the research advisory group resulted in a more person-centered survey design. In a context constrained by time and budget, and with consideration of the capacity and vulnerability of the target population, the approach taken was a feasible and pragmatic mechanism for improving the design of a SP survey.

Understanding the experience, treatment preferences and goals of people living with chronic lymphocytic leukemia (CLL) in Australia

BACKGROUND

Listening to patient voices is critical, in terms of how people experience their condition as well as their treatment preferences. This research explored the patient journey, therapy attributes and goals among treatment experienced adults with chronic lymphocytic leukemia (CLL). We sought to understand patient experiences, needs and expectations to identify areas for improvement of treatment and care delivery.

METHODS

Two online surveys were developed for completion by CLL patients. In Stage 1, participants completed a best-worst scaling (BWS) task to evaluate eleven previously validated healthcare journey moments that matter (MTM). Responses were used to generate the patient experience index (PEI) score. In Stage 2, participants completed a survey that included both a discrete choice experiment (DCE) to assess drivers of treatment preferences by evaluating the relative attribute importance (RAI) of seven features and a BWS exercise which explored long-term treatment goals.

RESULTS

Twenty-five patients completed Stage 1 and thirty patients Stage 2. Treatment experience was balanced between oral and intravenous medication. The most important/least satisfied MTM were treatment effectiveness, access to support and other treatments as well as monitoring progress. The median PEI score was 66.2 (out of 100). DCE results demonstrated that patients most value treatments for CLL that are associated with prolonged progression free survival (PFS; RAI: 24.6%), followed by treatments that have a lower risk of severe side effects and lower out-of-pocket costs (RAI: 19.5%, 17.4%, respectively). The remainder of the weight in decision making (38.5%) was split between the remaining attributes, namely 'mild to moderate side effects' (13.4%), 'long-term risks' (12.2%), type of treatment (i.e., oral, IV or a combination of oral and IV; 8.7%) and treatment duration (i.e., ongoing versus fixed; 4.2%). Patients preferred oral to intravenous therapy. The most valued long-term treatment goal was to be physically healthy, followed by living a long life, spending time with family/friends, and avoiding hospitalization.

CONCLUSION

Treatment experienced patients with CLL are focused on receiving effective, safe therapies and value long PFS. Consideration and discussion of other attributes, such as once daily dosing, oral only medication, out-of-pocket costs and access to support services may affect patient treatment choices and ultimately enhance their healthcare experience and outcomes.

Assessing patient information needs for new antidiabetic medications to inform shared decision-making: A best-worst scaling experiment in China

BACKGROUND

Shared decision-making (SDM) is a patient-centred approach to improve the quality of care. An essential requirement for the SDM process is to be fully aware of patient information needs.

OBJECTIVES

Our study aimed to assess patient information needs for new antidiabetic medications using the best-worst scaling (BWS) experiment.

METHODS

BWS tasks were developed according to a literature review and the focus group discussion. We used a balanced incomplete block design and blocking techniques to generate choice sets. The final BWS contains 11 attributes, with 6-choice scenarios in each block. The one-to-one, face-to-face BWS survey was conducted among type 2 diabetic patients in Jiangsu Province. Results were analyzed using count-based analysis and modelling approaches. We also conducted a subgroup analysis to observe preference heterogeneity.

RESULTS

Data from 539 patients were available for analysis. The most desired information domain was the comparative effectiveness of new antidiabetic medications. It consists of the incidence of macrovascular complications, the length of extended life years, changes in health-related quality of life, the incidence of microvascular complications, and the control of glycated haemoglobin. Of all the attributes, the incidence of macrovascular complications was the primary concern. Patients' glycemic control and whether they had diabetes complications exerted a significant influence on their information needs.

CONCLUSIONS

Information on health benefits is of critical significance for diabetic patients. Patients have different information needs as their disease progresses. Personalized patient decision aids that integrate patient information needs and provide evidence of new antidiabetic medications are worthy of being established.

PATIENT OR PUBLIC CONTRIBUTION

Before data collection, a pilot survey was carried out among diabetic patients to provide feedback on the acceptability and intelligibility of the attributes.

Prioritization of ethical concerns regarding HIV molecular epidemiology by public health practitioners and researchers

BACKGROUND

HIV molecular epidemiology (HIV ME) can support the early detection of emerging clusters of new HIV infections by combining HIV sequence data routinely obtained during the clinical treatment of people living with HIV with behavioral, geographic, and sociodemographic information. While information about emerging clusters promises to facilitate HIV prevention and treatment efforts, the use of this data also raises several ethical concerns. We sought to assess how those working on the frontlines of HIV ME, specifically public health practitioners (PHPs) and researchers, prioritized these issues.

METHODS

Ethical issues were identified through literature review, qualitative in-depth interviews, and stakeholder engagement. PHPs and researchers using HIV ME prioritized the issues using best-worst scaling (BWS). A balanced incomplete block design was used to generate 11 choice tasks each consisting of a sub-set of 5 ethical concerns. In each task, respondents were asked to assess the most and least concerning issue. Data were analyzed using conditional logit, with a Swait-Louviere test of poolability. Latent class analysis was then used to explore preference heterogeneity.

RESULTS

In total, 57 respondents completed the BWS experiment May-June 2023 with the Swait-Louviere test indicating that researchers and PHPs could be pooled (p = 0.512). Latent class analysis identified two classes, those highlighting "Harms" (n = 29) (prioritizing concerns about potential risk of legal prosecution, individual harm, and group stigma) and those highlighting "Utility" (n = 28) (prioritizing concerns about limited evidence, resource allocation, non-disclosure of data use for HIV ME, and the potential to infer the directionality of HIV transmission). There were no differences in the characteristics of members across classes.

CONCLUSIONS

The ethical issues of HIV ME vary in importance among stakeholders, reflecting different perspectives on the potential impact and usefulness of the data. Knowing these differences exist can directly inform the focus of future deliberations about the policies and practices of HIV ME in the United States.

A Best-Worst Scaling Study of the General Population's Preferences for Activities in Living Arrangements for Persons With Dementia

BACKGROUND

Activity involvement is a central element of dementia care. However, few studies have examined preferences for types of activities for persons who may be in need of care in the future. In this study, a best-worst scaling (BWS) was conducted to gather insights on preferred activities in small-scale living arrangements for dementia in the general population aged 50-65 years from rural and urban regions.

METHODS

BWS tasks were developed based on literature searches and focus groups. The final BWS contains ten activities, namely 'interaction with animals', 'gardening', 'painting, handicrafts, manual activities', 'household activities (e.g., folding laundry, cooking)', 'watching television', 'practicing religion', 'listening to music and singing familiar songs', 'conversations about the past', 'walks and excursions', 'sport activities (e.g., gymnastics)'. Each participant had to fill out subsets of four objects each and identify them as best and worst. A postal survey was sent to a total of 4390 persons from rural and urban regions aged between 50 and 65 years. Results were analyzed by count analysis and logit models. It was examined if preferences differ with respect to gender, religiousness, and informal caregiving experience.

RESULTS

A total of 840 questionnaires were returned, and 627 surveys were included in the analysis. In the rural sample, the highest relative importance (RI) was assigned to 'walks and excursions' (RI: 100%), 'sport activities (e.g., gymnastics)' (RI: 56%), 'gardening' (RI: 28%), and 'interaction with animals' (26%). In the urban sample, 'walks and excursions' (RI: 100%), 'sport activities (e.g., gymnastics)' (RI: 37%), 'interaction with animals' (25%) and 'gardening' (RI: 22%) were perceived as most important. In both groups, household activities and practicing religion were of lowest importance. Importance ranks differed between subgroups. Results of the logit models with random effects showed the same order as results from the count analyses.

DISCUSSION

Our findings show that respondents generally favored activities with an outdoor component, while the household activities that are part of many concepts were of low importance to respondents. Thus, our study can inform the design of a preference-based specific range of activities in small-scale living arrangements for dementia.

Prioritization of Adverse Consequences After Total Knee Arthroplasty Contributing to a Poor Response: A Best-Worst Scaling Exercise Among Total Knee Arthroplasty Patients and Knee Specialists

BACKGROUND

Total knee arthroplasty (TKA) can have a number of adverse consequences for patients that might contribute to a poor outcome. This study aimed to prioritize these consequences, from the perspective of patients and knee specialists.

METHODS

There were 95 TKA patients and 63 knee specialists who prioritized a set of 29 adverse consequences, based on a previous qualitative study, using a Maximum Difference Scaling method. A hierarchical Bayesian analysis was used to calculate relative importance scores. Differences and agreements between patients versus knee specialists and satisfied versus dissatisfied patients were analyzed using Mann-Whitney-U tests and Kendall's coefficients of concordance.

RESULTS

There were 4 out of 5 items in the top-5 of both patients and knee specialists that were similar, however, the ranking was different. The highest-ranked consequence for patients was: "Inability to do normal activities such as walking, cycling, swimming and heavy household chores", while knee specialists ranked: "No improvement in pain during the day" as the highest. "No improvement in walking" was in the patients' top-5, but was not ranked in the top-5 of knee specialists. For satisfied and dissatisfied patients, the top-5 of consequences was similar.

CONCLUSION

Comparable perspectives were found for patients versus knee specialists and satisfied versus dissatisfied patients on the importance of adverse consequences after TKA. However, when looking in more detail, differences in ranking of specific subitems suggest that patients place slightly more importance on the inability to perform valued activities, while knee specialists prioritize lack of pain relief to a higher degree.

Participatory Value Evaluation (PVE): A New Preference-Elicitation Method for Decision Making in Healthcare

Participatory value evaluation (PVE) has recently been introduced in the field of health as a new method to elicit stated preferences for public policies. PVE is a method in which respondents in a choice experiment are presented with various policy options and their attributes, and are asked to compose their portfolio of preference given a public-resource constraint. This paper aims to illustrate PVE's potential for informing healthcare decision making and to position it relative to established preference-elicitation methods. We first describe PVE and its theoretical background. Next, by means of a narrative review of the eight existing PVE applications within and outside the health domain, we illustrate the different implementations of the main features of the method. We then compare PVE to several established preference-elicitation methods in terms of the structure and nature of the choice tasks presented to respondents. The portfolio-based choice task in a PVE requires respondents to consider a set of policy alternatives in relation to each other and to make trade-offs subject to one or more constraints, which more closely resembles decision making by policymakers. When using a flexible budget constraint, respondents can trade-off their private income with public expenditures. Relative to other methods, a PVE may be cognitively more demanding and is less efficient; however, it seems a promising complementary method for the preference-based assessment of health policies. Further research into the feasibility and validity of the method is required before researchers and policymakers can fully appreciate the advantages and disadvantages of the PVE as a preference-elicitation method.

Patient Preferences in Diagnostic Imaging: A Scoping Review

BACKGROUND

As new diagnostic imaging technologies are adopted, decisions surrounding diagnostic imaging become increasingly complex. As such, understanding patient preferences in imaging decision making is imperative.

OBJECTIVES

We aimed to review quantitative patient preference studies in imaging-related decision making, including characteristics of the literature and the quality of the evidence.

METHODS

The Pubmed, Embase, EconLit, and CINAHL databases were searched to identify studies involving diagnostic imaging and quantitative patient preference measures from January 2000 to June 2022. Study characteristics that were extracted included the preference elicitation method, disease focus, and sample size. We employed the PREFS (Purpose, Respondents, Explanation, Findings, Significance) checklist as our quality assessment tool.

RESULTS

A total of 54 articles were included. The following methods were used to elicit preferences: conjoint analysis/discrete choice experiment methods (n = 27), contingent valuation (n = 16), time trade-off (n = 4), best-worst scaling (n = 3), multicriteria decision analysis (n = 3), and a standard gamble approach (n = 1). Half of the studies were published after 2016 (52%, 28/54). The most common scenario (n = 39) for eliciting patient preferences was cancer screening. Computed tomography, the most frequently studied imaging modality, was included in 20 studies, and sample sizes ranged from 30 to 3469 participants (mean 552). The mean PREFS score was 3.5 (standard deviation 0.8) for the included studies.

CONCLUSIONS

This review highlights that a variety of quantitative preference methods are being used, as diagnostic imaging technologies continue to evolve. While the number of preference studies in diagnostic imaging has increased with time, most examine preventative care/screening, leaving a gap in knowledge regarding imaging for disease characterization and management.

Prioritizing Treatment Goals of People Diagnosed with Bipolar I Disorder in the US: Best-Worst Scaling Results

Purpose

Bipolar I disorder (BP-I) is associated with significant disease burden, but evidence on treatment goals in people diagnosed with BP-I is scarce. This study sought to quantify treatment goals related to the pharmacological management of BP-I in adults in the US and to identify if subgroups of people with similar treatment goals exist.

Patients and Methods

A best-worst scaling (BWS) of treatment goals was developed based on available literature and input from experts and patients and was distributed as part of a survey between August and September 2021. Survey participants were adults with a self-reported diagnosis of BP-I who were recruited via an online panel in the US. Participants were asked to prioritize the importance of 16 treatment goals using BWS. BWS scores were computed using multinomial logistic regression, with the scores across all goals summing to 100 for each participant. Subgroups of people with similar preferences were identified using latent class analysis.

Results

The most important treatment goals for people diagnosed with BP-I (N=255) were "being less impulsive, angry, or irritable" (score: 9.73), or being "able to feel pleasure or happiness" (score: 9.54). Goals related to reducing the incidence of various potential adverse events of medication (scores: ≤4.51) or "reducing dependence on others" (score: 3.04) were less important. Two subgroups were identified. One subgroup (n=111) prioritized symptom-focused goals, considering "reducing frequency of mania, depression, and mixed episodes" and "being less impulsive, angry or irritable" the most important (scores: 12.46 and 11.85, respectively). The other subgroup (n=144) placed significantly more importance on social functioning-focused goals, including beginning or maintaining a relationship with a partner/significant other, and with family and/or friends (scores: 8.45 and 7.70, respectively).

Conclusion

People diagnosed with BP-I prioritized emotional improvements. Subgroups of people with BP-I prioritized either symptom-focused or social functioning-focused treatment goals.

Preferences of people living with HIV for features of tuberculosis preventive treatment regimens - a discrete choice experiment

Background

Tuberculosis (TB) preventive treatment (TPT) is recommended for people living with HIV (PLHIV) in high TB burden settings. While 6 months of daily isoniazid remains widely used, shorter regimens are now available. However, little is known about preferences of PLHIV for key features of TPT regimens.

Methods

We conducted a discrete choice experiment among adult PLHIV engaged in care at an urban HIV clinic in Kampala, Uganda. In nine random choice tasks, participants chose between two hypothetical TPT regimens with different features (pills per dose, frequency, duration, need for adjusted antiretroviral therapy [ART] dosage and side effects). We analyzed preferences using hierarchical Bayesian estimation, latent class analysis, and willingness-to-trade simulations.

Results

Of 400 PLHIV, 392 (median age 44, 72% female, 91% TPT-experienced) had high quality choice task responses. Pills per dose was the most important attribute (relative importance 32.4%, 95% confidence interval [CI] 31.6 - 33.2), followed by frequency (20.5% [95% CI 19.7 - 21.3]), duration (19.5% [95% CI 18.6 - 20.5]), and need for ART dosage adjustment (18.2% [95% CI 17.2 - 19.2]). Latent class analysis identified three preference groups: one prioritized less frequent, weekly dosing (N=222; 57%); another was averse to ART dosage adjustment (N=107; 27%); and the last prioritized short and tolerable regimens (N=63; 16%). All groups highly valued fewer pills per dose. Participants were willing to accept a regimen of 2.8 months' additional duration [95% CI: 2.4 - 3.2] to reduce pills per dose from five to one, 3.6 [95% CI 2.4 - 4.8] months for weekly rather than daily dosing, and 2.2 [95% CI 1.3 - 3.0] months to avoid ART dosage adjustment.

Conclusions

To align with preferences of PLHIV, decision-makers should prioritize the development and implementation of TPT regimens with fewer pills, less frequent dosing, and no need for ART dosage adjustment, rather than focus primarily on duration of treatment.

Increasing Access to Buprenorphine for Opioid Use Disorder in Primary Care: an Assessment of Provider Incentives

BACKGROUND

Primary care providers (PCPs) are essential to increasing access to office-based buprenorphine medication treatment for opioid use disorder (B-MOUD). Barriers to B-MOUD prescribing are well-documented, but there is little information regarding incentives to overcome these barriers.

OBJECTIVE

To identify optimal incentives for PCPs to promote B-MOUD prescribing and compare incentive preferences across provider and practice characteristics.

DESIGN

We surveyed PCPs using best-worst scaling (BWS) to prioritize seven potential incentives for B-MOUD prescribing (monetary compensation, paid vacation, protected time, professional development, reduced workload, service recognition, clinical resources). We then used a direct elicitation approach to determine preferred incentive levels (e.g., monetary thresholds) and types (e.g., specific clinical resources).

PARTICIPANTS

Primary care physicians and advanced practice providers (APPs) at a large Department of Veterans Affairs healthcare system.

MAIN MEASURES

B-MOUD prescribing incentive preferences and relative preference levels using descriptive statistics and conditional logistic regression with relative importance scale transformation (coefficients sum to 100, higher coefficient=greater importance).

KEY RESULTS

Fifty-three PCPs responded (73% response), including 47% APPs and 36% from community-based clinics. Reduced workload (relative importance score=26.8), protected time (18.7), and clinical resources (16.8) were significantly more preferred (Ps < 0.001) than professional development (10.5), paid vacation (10.3), or service recognition (1.5). Relative importance of monetary compensation varied between physicians (12.6) and APPs (17.5) and between PCPs located at a medical center (11.4) versus community clinic (22.3). APPs were more responsive than physicians to compensation increases of $5000 and $12,000 but less responsive to $25,000; trends were similar for medical center versus community clinic PCPs. The most frequently requested clinical resource was on-demand consult access to an addiction specialist.

CONCLUSIONS

Interventions promoting workload reductions, protected time, and clinical resources could increase access to B-MOUD in primary care. Monetary incentives may be additionally needed to improve B-MOUD prescribing among APPs and within community clinics.

Impact of Potential Symptoms and Risks Associated with Acid Sphingomyelinase Deficiency on Patients and Caregivers: A Best-Worst Scaling Study

Purpose

Acid sphingomyelinase deficiency (ASMD) is a rare, progressive, and potentially fatal disease affecting major organs; its symptoms present heterogeneously. Data on the most bothersome symptoms for patients with ASMD types B or A/B and their caregivers or parents are limited. We conducted a survey to quantify the relative impact of potential ASMD symptoms and risks for patients and parents/caregivers.

Patients and Methods

Twenty respondents, recruited via National Niemann-Pick Disease Foundation (United States) and Niemann-Pick United Kingdom, took a preference survey: 11 patients who had a self-reported diagnosis of ASMD types B or A/B and 9 parents who had a child with ASMD types B or A/B. Using object-case best-worst scaling, we explored the most and least bothersome among a set of 15 ASMD symptoms/risks selected based on clinical input and qualitative research with patients and caregivers. In 15 experimentally designed questions containing five items each, respondents ranked the symptoms/risks, irrespective of their experiences with them. Data were analyzed using a conditional multinomial logit model.

Results

Patients reported constant abdominal pain, severe pain in bones and joints, and severe fatigue to be the most bothersome potential symptoms or risks, followed by a chance of bleeding in the spleen. The next most bothersome potential symptom was constant shortness of breath. Easy bruising and noticeable abdominal enlargement were among the least bothersome symptoms. The most bothersome symptom for parents was bleeding in the spleen.

Conclusion

Patients and parents had similar perceptions of the most bothersome potential symptoms/risks. Despite the small sample size typical of rare disease studies, understanding patient preferences is important for such diseases and can inform shared decision-making.

Measuring the preferences of injectable opioid agonist treatment (iOAT) clients: Development of a person-centered scale (best-worst scaling)

BACKGROUND

Injectable opioid agonist treatment (iOAT) is effective for opioid use disorder (OUD), yet little is known about client preferences for accessing iOAT (e.g., with diacetylmorphine, hydromorphone, buprenorphine, fentanyl, etc.). Best-worst scaling (BWS) is a preference elicitation method from health economics that has never been applied to addiction care broadly, or iOAT specifically. We describe the stages of developing a BWS scale that assesses iOAT clients' treatment delivery preferences to inform program planning and maximize healthcare efficiency.

METHODS

We underwent several steps to reveal the relevant attributes/levels and design the scale structure. An initial list of potential attributes and levels was established from a literature review and prior qualitative data. Then, we conducted semi-structured interviews and focus groups with clients (n=21) on their iOAT preferences to confirm the attributes and prioritize/include new ones. Next, we conducted semi-structured interviews and focus groups with iOAT experts and stakeholders to receive their input on the draft list of attributes and levels. A BWS profile case design was piloted with iOAT clients (n=18) from different sites during a think aloud interview. After several rounds of revisions, the final version was tested by iOAT clients (n=2) before the scale was launched.

RESULTS

We developed a person-centered scale that assesses current and former iOAT clients' most and least wanted aspects of iOAT delivery. The final version yielded 7 unique attributes: choice of medication, choice of dose, convenience, location & space, scheduling & routines, staff & training, and types of services offered.

CONCLUSION

This scale can help expand iOAT programs in a way that is person-centered, rapid, and affordable. The methodology is a guide for other regions with similar populations who aim to develop strong quantitative methodologies that prioritize client collaboration.

A Roadmap for Increasing the Usefulness and Impact of Patient-Preference Studies in Decision Making in Health: A Good Practices Report of an ISPOR Task Force

Many qualitative and quantitative methods are readily available to study patient preferences in health. These methods are now being used to inform a wide variety of decisions, and there is a growing body of evidence showing studies of patient preferences can be used for decision making in a wide variety of contexts. This ISPOR Task Force report synthesizes current good practices for increasing the usefulness and impact of patient-preference studies in decision making. We provide the ISPOR Roadmap for Patient Preferences in Decision Making that invites patient-preference researchers to work with decision makers, patients and patient groups, and other stakeholders to ensure that studies are useful and impactful. The ISPOR Roadmap consists of 5 key elements: (1) context, (2) purpose, (3) population, (4) method, and (5) impact. In this report, we define these 5 elements and provide good practices on how patient-preference researchers and others can actively contribute to increasing the usefulness and impact of patient-preference studies in decision making. We also present a set of key questions that can support researchers and other stakeholders (eg, funders, reviewers, readers) to assess efforts that promote the ongoing impact (both intended and unintended) of a particular preference study and additional studies in the future.