Methodology to derive preference for health screening programmes using discrete choice experiments: a scoping review

Preferences for breast cancer screening: Results of a discrete choice experiment

OBJECTIVES

This study aimed to assess the preferences of breast cancer patients in China for screening services using a discrete choice experiment (DCE) and latent class modeling (LCM). The findings are intended to inform the development of more patient-centered screening programs.

STUDY DESIGN

A cross-sectional, hospital-based survey employing discrete choice experiment methodology.

METHODS

A total of 278 breast cancer patients were recruited from the Department of Thyroid and Breast Surgery at a tertiary hospital in Guizhou Province. The study evaluated key attributes of screening services, including screening frequency, medical staff experience, referral sources, and out-of-pocket costs, through a DCE questionnaire. A mixed logit model was applied to assess overall patient preferences, while LCM was used to explore heterogeneity among patient subgroups. The development of the DCE questionnaire involved focus group discussions to ensure the relevance of attributes.

RESULTS

The analysis revealed that screening frequency, medical staff experience, and out-of-pocket costs were the most significant factors influencing patient preferences. Patients exhibited a strong preference for annual screenings (β = -1.622, p < 0.001) and for screening by experienced medical staff (β = 2.216, p < 0.001). Additionally, lower out-of-pocket costs significantly enhanced willingness to participate (β = -0.211, p < 0.05). LCM analysis identified two distinct patient subgroups: "process-driven" patients, who prioritized lower costs and multi-channel referral options, and "efficiency-driven" patients, who valued timely service and experienced staff.

CONCLUSION

This study emphasizes the diverse preferences of breast cancer patients for screening services and suggests that personalized screening programs could better meet the needs of different patient subgroups. Developing flexible, patient-centered screening programs will be essential to improving participation and satisfaction with breast cancer screening in China. Practical challenges in implementing such personalized approaches should be considered in future policy development.

Consumer Preferences for a Healthcare Appointment Reminder in Australia: A Discrete Choice Experiment

BACKGROUND

It is essential to consider the evidence of consumer preferences and their specific needs when determining which strategies to use to improve patient attendance at scheduled healthcare appointments.

OBJECTIVES

This study aimed to identify key attributes and elicit healthcare consumer preferences for a healthcare appointment reminder system.

METHODS

A discrete choice experiment was conducted in a general Australian population sample. The respondents were asked to choose between three options: their preferred reminder (A or B) or a 'neither' option. Attributes were developed through a literature review and an expert panel discussion. Reminder options were defined by four attributes: modality, timing, content and interactivity. Multinomial logit and mixed multinomial logit models were estimated to approximate individual preferences for these attributes. A scenario analysis was performed to estimate the likelihood of choosing different reminder systems.

RESULTS

Respondents (n = 361) indicated a significant preference for an appointment reminder to be delivered via a text message (β = 2.42, p < 0.001) less than 3 days before the appointment (β = 0.99, p < 0.001), with basic details including the appointment cost (β = 0.13, p < 0.10), and where there is the ability to cancel or modify the appointment (β = 1.36, p < 0.001). A scenario analysis showed that the likelihood of choosing an appointment reminder system with these characteristics would be 97%.

CONCLUSIONS

Our findings provide evidence on how healthcare consumers trade-off between different characteristics of reminder systems, which may be valuable to inform current or future systems. Future studies may focus on exploring the effectiveness of using patient-preferred reminders alongside other mitigation strategies used by providers.

A systematic review of discrete choice experiments in stroke rehabilitation

OBJECTIVES

Existing research qualitatively explores consumer preferences for stroke rehabilitation interventions. However, it remains unclear which intervention characteristics are most important to consumers, and how these preferences may influence uptake and participation. Discrete choice experiments (DCE) provide a unique way to quantitatively measure preferences for health and health care. This study aims to explore how DCEs have been used in stroke rehabilitation and to identify reported consumer preferences for rehabilitation interventions.

MATERIAL AND METHODS

A systematic review of published stroke rehabilitation DCEs was completed (PROSPERO registration: CRD42021282578). Six databases (including CINAHL, MEDLINE, EconLIT) were searched from January 2000-March 2023. Data extracted included topic area, sample size, aim, attributes, design process, and preference outcomes. Descriptive and thematic analyses were conducted, and two methodological checklists applied to review quality.

RESULTS

Of 2,446 studies screened, five were eligible. Studies focused on exercise preference (n = 3), the structure and delivery of community services (n = 1), and self-management programs (n = 1). All had small sample sizes (range 50-146) and were of moderate quality (average score of 77%). Results indicated people have strong preferences for one-to-one therapy (over group-based), light-moderate intensity of exercise, and delivery by qualified therapists (over volunteers).

CONCLUSIONS

Few DCEs have been conducted in stroke rehabilitation, suggesting consumer preferences could be more rigorously explored. Included studies were narrow in the scope of attributes included, limiting their application to practice and policy. Further research is needed to assess the impact of differing service delivery models on uptake and participation.

A discrete choice experiment to elicit preferences for a chronic disease screening programme in Queensland, Australia

OBJECTIVE

Patient-centred care, increasingly highlighted in healthcare strategies, necessitates understanding public preferences for healthcare service attributes. We aimed to understand the preferences of the Australian population regarding the attributes of chronic disease screening programmes.

STUDY DESIGN

The preferences were elicited using the discrete choice experiment (DCE) methodology.

METHODS

A DCE was administered to a sample of the Australian general population. Respondents were asked to make choices, each offering two hypothetical screening scenarios defined by screening conduct, quality and accuracy of the test results, cost to the patient, wait time and source of information. Data were analysed using a panel mixed multinomial logit model.

RESULTS

A strong preference for highly accurate screening tests and nurse-led screenings at local health clinics was evident. They expressed disutility for waiting time and out-of-pocket costs but were indifferent about the source of information. Their preference for a nurse-led programme was highlighted by the fact that they were willing to pay $81 and $88 to get a nurse-led programme when they were offered a general practitioner-led and a specialist-led programme, respectively. Furthermore, they were willing to pay $32 to reduce a week of waiting time and $205 for a 95% accurate test compared to a 75% accurate test. Preferences remained consistent irrespective of the respondent's place of residence.

CONCLUSIONS

Our findings highlight the importance of diagnostic test accuracy and nurse-led service delivery in chronic disease screening programmes. These insights could guide the development of patient-centric services by enhancing test accuracy, reducing waiting times and promoting nurse-led care models.

Analysis of Current Situation Regarding Scientific Fitness Literacy of Nurses in Sports Medicine Integration

Objective

The present study aims to analyze the current situation of scientific fitness literacy in nurses and provide a basis for all-round strategies for its improvement.

Methods

Nurses in tertiary hospitals were conveniently selected as subjects in order to investigate the current situation regarding the scientific fitness literacy of nurses. The selection process was completed via the demographics questionnaire and the adult scale of scientific fitness literacy in sports medicine integration. As the minimum sample size was 5–10 times the number of variables in the study of exploring influencing factors of related variables and using the equation \documentclass[12pt]{minimal} \usepackage{wasysym} \usepackage[substack]{amsmath} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage[mathscr]{eucal} \usepackage{mathrsfs} \DeclareFontFamily{T1}{linotext}{} \DeclareFontShape{T1}{linotext}{m}{n} {linotext }{} \DeclareSymbolFont{linotext}{T1}{linotext}{m}{n} \DeclareSymbolFontAlphabet{\mathLINOTEXT}{linotext} \begin{document} $${\rm{N = }}\left[{{\rm{number of variables \times }}\left({{\rm{5 - 10}}} \right)} \right]{\rm{ \times `1 + 10\% ]}}$$ \end{document}, given 20% of invalid questionnaires, the sample size should be >600 persons. The methods used for statistical analysis were descriptive statistical analysis and the t-test.

Results

The scientific fitness literacy score in nurses was 110.81 ± 25.04 (relative value: 69.7%); this consisted of 50.85 ± 11.19 (73.7%) for scientific fitness knowledge dimension, 25.99 ± 5.35 (78.8%) for scientific fitness attitude dimension, and 33.97 ± 13.59 (59.6%) for scientific fitness behavior and skill dimension. The results of the independent sample t-test and analysis of variance showed that the differences in gender, education level, position, exercise habits, and balanced diet in daily life among nurses (regarding scientific fitness literacy) were statistically significant (P < 0.05).

Conclusion

Nurses generally have an above-average level of scientific fitness literacy; this is mainly due to their good cognition and attitude regarding scientific fitness. However, their scientific fitness behaviors and skills are greatly inadequate. They are especially weak in completing WHO’s recommended amount of exercise, mastering the cores of sports skills, undergoing a professional assessment before exercise, and developing exercise plans.