Israeli lay persons' views on priority-setting criteria for Alzheimer's disease

Laypersons' Priority-Setting Preferences for Allocating a COVID-19 Patient to a Ventilator: Does a Diagnosis of Alzheimer's Disease Matter?

PURPOSE

The current study aimed 1) to assess laypersons' priority-setting preferences for allocating ventilators to COVID-19 patients with and without AD while differentiating between a young and an old person with the disease, and 2) to examine the factors associated with these preferences.

METHODS

A cross-sectional online survey was conducted among a sample of 309 Israeli Jewish persons aged 40 and above.

RESULTS

Overall, almost three quarters (71%) of the participants chose the 80-year-old patient with a diagnosis of AD to be the last to be provided with a ventilator. The preferences of the remaining quarter were divided between the 80-year-old person who was cognitively intact and the 55-year-old person with AD. Education and subjective knowledge about AD were significantly associated with participants' preferences.

CONCLUSION

Our results suggest that cognitive status might not be a strong discriminating factor for laypersons' preferences for allocating ventilators during the COVID-19 pandemic.

Health Outcome Prioritization in Alzheimer's Disease: Understanding the Ethical Landscape

BACKGROUND

Dementia has been described as the greatest global health challenge in the 21st Century on account of longevity gains increasing its incidence, escalating health and social care pressures. These pressures highlight ethical, social, and political challenges about healthcare resource allocation, what health improvements matter to patients, and how they are measured. This study highlights the complexity of the ethical landscape, relating particularly to the balances that need to be struck when allocating resources; when measuring and prioritizing outcomes; and when individual preferences are sought.

OBJECTIVE

Health outcome prioritization is the ranking in order of desirability or importance of a set of disease-related objectives and their associated cost or risk. We analyze the complex ethical landscape in which this takes place in the most common dementia, Alzheimer's disease.

METHODS

Narrative review of literature published since 2007, incorporating snowball sampling where necessary. We identified, thematized, and discussed key issues of ethical salience.

RESULTS

Eight areas of ethical salience for outcome prioritization emerged: 1) Public health and distributive justice, 2) Scarcity of resources, 3) Heterogeneity and changing circumstances, 4) Knowledge of treatment, 5) Values and circumstances, 6) Conflicting priorities, 7) Communication, autonomy and caregiver issues, and 8) Disclosure of risk.

CONCLUSION

These areas highlight the difficult balance to be struck when allocating resources, when measuring and prioritizing outcomes, and when individual preferences are sought. We conclude by reflecting on how tools in social sciences and ethics can help address challenges posed by resource allocation, measuring and prioritizing outcomes, and eliciting stakeholder preferences.

Multicriteria decision analysis (MCDA) in health care: a systematic review of the main characteristics and methodological steps

Background

The health area is one of the most affected systems on the perspective of decision-making with multiobjectives, thus becoming prone to errors in the final solution, however, multicriteria decision analysis (MDCA) appears as an aid tool for this process decision-making. Therefore,the present study aims to analyze and synthesize articles found in the literature, involing MCDA in health care, evaluating general issues and methodological aspects, structuring them in a single work.

Methods

Surveys in the bibliographic databases SCOPUS and PUBMED indicated 1852 documents on the subject, however after a careful verificatios, 66 studies were selected to be analyzed completely. The data extracted from the included articles were organized into a spreadsheet for the preparation of analysis, and the technique used was descriptive statistics.

Results

It was possible to identify a growth trend in the application of the MCDA in the health area, but no dominance was identified in relation to the authors of the publication and the periodicals where they are published, but some countries stood out in terms of the number of published researches, such as: Canada and Turkey. In defining the decision problem, and in defining criteria, the “literature” presented the greatest demand for those who wish to structure their decision problem. Finally, it was verified by the analysis of the problem, that the MCDA to solve the problems of ranking has comprehensive application and that there is a greater incidence in the use of the AHP and Logic methods Fuzzy.

Conclusion

With this, it is possible to observe, through the data of this review, that more than the multicriteria methods, the multicriteria decision model has been highlighted, also in the health area. In addition, the study can guide new applications and techniques using MCDA in the health care.

Weighting Health Outcomes by Socioeconomic Position Using Stated Preferences

BACKGROUND

The trade-off that society is willing to make to promote a more equitable distribution of health can be represented as a social welfare function (SWF). SWFs are an economic construct that can be used to illustrate concerns for total health with aversion to inequalities between socioeconomic groups.

OBJECTIVE

This study used people's preferences to estimate the shapes of health-related SWFs (HRSWFs). We tested the suitability of this method to derive equity weights.

METHODS

A questionnaire was used to elicit preferences concerning trade-offs between the total level of health and its distribution among two socioeconomic groups. The participant group was a sample of convenience that included a mix of health researchers, academics, clinicians, managers, public servants and research students. The data collected were used to develop HRSWFs with a constant elasticity of substitution. The weight was calculated using the marginal rate of substitution.

RESULTS

A marginal health gain to the lowest socioeconomic position (SEP) group was valued 14.1-81.4 times more than a marginal health gain to the high SEP group.

CONCLUSIONS

Our results provide evidence to support the idea that the public may be willing to make trade-offs between efficiency and equity, and that they value health gains differently depending on which socioeconomic group receives the health gain. Further evidence is required before such indicative weights have practical value.

Fair reckoning: a qualitative investigation of responses to an economic health resource allocation survey

OBJECTIVE

To investigate how participants in an economic resource allocation survey construct notions of fairness.

DESIGN

Qualitative interview study guided by interpretive grounded theory methods.

SETTING AND PARTICIPANTS

Qualitative interviews were conducted with volunteer university- (n=39) and community-based (n =7) economic survey participants. INTERVENTION OR MAIN VARIABLES STUDIED: We explored how participants constructed meanings to guide or explain fair survey choices, focusing on rationales, imagery and additional desired information not provided in the survey scenarios.

MAIN OUTCOME MEASURES

Data were transcribed and coded into qualitative categories. Analysis iterated with data collection iterated through three waves of interviews.

RESULTS

Participants compared the survey dilemmas to domains outside the health system. Most compared them with other micro-level, inter-personal sharing tasks. Participants raised several fairness-relevant factors beyond need or capacity to benefit. These included age, weight, poverty, access to other options and personal responsibility for illness; illness duration, curability or seriousness; life expectancy; possibilities for sharing; awareness of other's needs; and ability to explain allocations to those affected. They also articulated a fairness principle little considered by equity theories: that everybody must get something and nobody should get nothing.

DISCUSSION AND CONCLUSIONS

Lay criteria for judging fairness are myriad. Simple scenarios may be used to investigate lay commitments to abstract principles. Although principles are the focus of analysis and inference, participants may solve simplified dilemmas by imputing extraneous features to the problem or applying unanticipated principles. These possibilities should be taken into account in the design of resource allocation surveys eliciting the views of the public.

Societal values in the allocation of healthcare resources: is it all about the health gain?

Over the past decade, public distrust in unavoidable value-laden decisions on the allocation of resources to new health technologies has grown. In response, healthcare organizations have made considerable efforts to improve their acceptability by increasing transparency in decision-making processes. However, the social value judgments (distributive preferences of the public) embedded in them have yet to be defined. While the need to explicate such judgments has become widely recognized, the most appropriate approach to accomplishing this remains unclear. The aims of this review were to identify factors around which distributive preferences of the public have been sought, create a list of social values proposed or used in current resource allocation decision-making processes for new health technologies, and review approaches to eliciting such values from the general public. Social values proposed or used in making resource allocation decisions for new health technologies were identified through three approaches: (i) a comprehensive review of published, peer-reviewed, empirical studies of public preferences for the distribution of healthcare; (ii) an analysis of non-technical factors or social value statements considered by technology funding decision-making processes in Canada and abroad; and (iii) a review of appeals to funding decisions on grounds in part related to social value judgments. A total of 34 empirical studies, 10 technology funding decision-making processes, and 12 appeals to decisions were identified and reviewed. The key factors/patient characteristics addressed through policy statements and around which distributive preferences of the public have been sought included severity of illness, immediate need, age (and its relationship to lifetime health), health gain (amount and final outcome/health state), personal responsibility for illness, caregiving responsibilities, and number of patients who could benefit (rarity). Empirical studies typically examined the importance of these factors in isolation. Therefore, the extent to which preferences around one factor may be modified in the presence of others is still unclear. Research that seeks to clarify interactions among factors by asking the public to weigh several of them at once is needed to ensure the relevance of elicited preferences to real-world technology funding decisions.

Assessing the impact of deliberative processes on the views of participants: is it 'in one ear and out the other'?

BACKGROUND

Interest in citizens' juries for eliciting the views of the public to inform coverage decisions on new health technologies has grown. However, evaluative information, particularly regarding their short- and/or longer-term impact on participants' views is limited. As citizens' juries can be resource intensive, such information is required to make 'evidence-based' decisions about their use.

OBJECTIVES

To assess the impact of citizens' juries on participants' preferences for the distribution of health care across populations over time.

SETTING AND PARTICIPANTS

Two citizens' juries, involving a different representative sample of the public, were held. Participants completed identical questionnaires before (T1), directly after (T2) and 6 weeks following the jury (T3). Questionnaires comprised rating, ranking and choice-based questions related to four characteristics of competing patient populations (age, current health, life expectancy without treatment and health gain resulting from an intervention). Semi-structured telephone interviews were also conducted to explore the impact of the jury on participants' distributive preferences. Changes in responses to the self-administered survey over the three time points were assessed quantitatively, while interview questions were analysed using qualitative techniques.

RESULTS

No significant differences in responses to rating questions were observed. Pre/post-jury changes in the rankings of two factors were statistically significant in one of the juries. However, in both juries, T1-T2 changes in responses to several of the choice-based questions reached statistical significance. The number was lower between T2 and T3, suggesting that jurors retained their views. According to findings from the interviews, jurors' views changed or were clarified through participation in the jury.

CONCLUSIONS

There appears to be evidence suggesting that the views of individuals who participate in citizens' juries change as a result of the experience, and those 'informed' views are sustained.