scholarly journals Preferences and priorities to manage clinical uncertainty for older people with frailty and multimorbidity: a discrete choice experiment and stakeholder consultations

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
India Tunnard ◽  
Deokhee Yi ◽  
Clare Ellis-Smith ◽  
Marsha Dawkins ◽  
Irene J. Higginson ◽  
...  
Keyword(s):  
Older People ◽  
Discrete Choice Experiment ◽  
Discrete Choice ◽  
Continuity Of Care ◽  
Choice Experiment ◽  
Adverse Outcomes ◽  
Evidence Based ◽  
Ageing Population ◽  
Clinical Uncertainty ◽  
Care Processes

Abstract Background Clinical uncertainty is inherent for people with frailty and multimorbidity. Depleted physiological reserves increase vulnerability to a decline in health and adverse outcomes from a stressor event. Evidence-based tools can improve care processes and outcomes, but little is known about priorities to deliver care for older people with frailty and multimorbidity. This study aimed to explore the preferences and priorities for patients, family carers and healthcare practitioners to enhance care processes of comprehensive assessment, communication and continuity of care in managing clinical uncertainty using evidence-based tools. Methods A parallel mixed method observational study in four inpatient intermediate care units (community hospitals) for patients in transition between hospital and home. We used a discrete choice experiment (DCE) to examine patient and family preferences and priorities on the attributes of enhanced services; and stakeholder consultations with practitioners to discuss and generate recommendations on using tools to augment care processes. Data analysis used logit modelling in the DCE, and framework analysis for consultation data. Results Thirty-three patients participated in the DCE (mean age 84 years, SD 7.76). Patients preferred a service where family were contacted on admission and discharge (β 0.36, 95% CI 0.10 to 0.61), care received closer to home (β − 0.04, 95% CI − 0.06 to − 0.02) and the GP is fully informed about care (β 0.29, 95% CI 0.05–0.52). Four stakeholder consultations (n = 48 participants) generated 20 recommendations centred around three main themes: tailoring care processes to manage multiple care needs for an ageing population with frailty and multimorbidity; the importance of ongoing communication with patient and family; and clear and concise evidence-based tools to enhance communication between clinical teams and continuity of care on discharge. Conclusion Family engagement is vital to manage clinical uncertainty. Both patients and practitioners prioritise engaging the family to support person-centred care and continuity of care within and across care settings. Patients wished to maximise family involvement by enabling their support with a preference for care close to home. Evidence-based tools used across disciplines and services can provide a shared succinct language to facilitate communication and continuity of care at points of transition in care settings.

scholarly journals Is the Nintendo Wii Fit really acceptable to older people?: a discrete choice experiment

2011 ◽  
Vol 11 (1) ◽  
Author(s):  
Kate Laver ◽  
Julie Ratcliffe ◽  
Stacey George ◽  
Leonie Burgess ◽  
Maria Crotty
Keyword(s):  
Older People ◽  
Discrete Choice Experiment ◽  
Discrete Choice ◽  
Choice Experiment ◽  
Nintendo Wii ◽  
Wii Fit ◽  
Nintendo Wii Fit

scholarly journals Understanding the value of adhering to or adapting evidence-based interventions: a study protocol of a discrete choice experiment

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
Ulrica von Thiele Schwarz ◽  
Aaron R. Lyon ◽  
Kristoffer Pettersson ◽  
Fabrizia Giannotta ◽  
Pernilla Liedgren ◽  
...  
Keyword(s):  
Decision Making ◽  
Discrete Choice Experiment ◽  
Discrete Choice ◽  
Choice Experiment ◽  
Local Context ◽  
Optimal Decision ◽  
Evidence Based ◽  
Trade Offs ◽  
Using Data ◽  
The Way

Abstract Background Whereas the value of an evidence-based intervention (EBI) is often determined by its effect on clinical outcomes, the value of implementing and using EBIs in practice is broader, reflecting qualities such as appropriateness, equity, costs, and impact. Reconciling these value conflicts involves a complicated decision process that has received very limited scholarly attention. Inspired by studies on decision-making, the objective of this project is to explore how practitioners appraise the values of different outcomes and to test how this appraisal influences their decisions surrounding the so-called fidelity–adaptation dilemma. This dilemma is related to the balance between using an EBI as it was designed (to ensure its effectiveness) and making appropriate adaptations (to ensure alignment with constraints and possibilities in the local context). Methods This project consists of three sub-studies. The participants will be professionals leading evidence-based parental programs in Sweden and, in Sub-study 1, parents and decision-makers. Sub-study 1 will use sequential focus groups and individual interviews to explore parameters that influence fidelity and adaptation decisions—the dilemmas encountered, available options, how outcomes are valued by practitioners as well as other stakeholders, and value trade-offs. Sub-study 2 is a discrete choice experiment that will test how value appraisals influence decision-making using data from Sub-study 1 as input. Sub-study 3 uses a mixed-method design, with findings from the two preceding sub-studies as input in focus group interviews to investigate how practitioners make sense of findings from optimal decision situations (experiment) and constrained, real-world decision situations. Discussion The project will offer unique insights into decision-making processes that influence how EBIs are used in practice. Such knowledge is needed for a more granular understanding of how practitioners manage the fidelity–adaptation dilemma and thus, ultimately, how the value of EBI implementation can be optimized. This study contributes to our knowledge of what happens once EBIs are adopted—that is, the gap between the way in which EBIs are intended to be used and the way in which they are used in practice.

scholarly journals Quantifying healthcare and welfare sector workers’ preferences around COVID-19 vaccination: a cross-sectional, single-profile discrete-choice experiment in France

BMJ Open ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. e055148
Author(s):  
Carolina Díaz Luévano ◽  
Jonathan Sicsic ◽  
Gerard Pellissier ◽  
Sandra Chyderiotis ◽  
Pierre Arwidson ◽  
...  
Keyword(s):  
Older People ◽  
Discrete Choice Experiment ◽  
Discrete Choice ◽  
Vaccine Efficacy ◽  
Messenger Rna ◽  
Choice Experiment ◽  
Reference Level ◽  
Secondary Outcome ◽  
Epidemic Control ◽  
Risk Balance

ObjectivesTo analyse preferences around promotion of COVID-19 vaccination among workers in the healthcare and welfare sector in Fance at the start of the vaccination campaign.DesignSingle-profile discrete-choice experiment. Respondents in three random blocks chose between accepting or rejecting eight hypothetical COVID-19 vaccination scenarios.Setting4346 healthcare and welfare sector workers in France, recruited through nation-wide snowball sampling, December 2020 to January 2021.OutcomeThe primary outcomes were the effects of attributes’ levels on hypothetical acceptance, expressed as ORs relative to the reference level. The secondary outcome was vaccine eagerness as certainty of decision, ranging from −10 to +10.ResultsAmong all participants, 61.1% made uniform decisions, including 17.2% always refusing vaccination across all scenarios (serial non-demanders). Among 1691 respondents making variable decisions, a strong negative impact on acceptance was observed with 50% vaccine efficacy (compared with 90% efficacy: OR 0.05, 95% CI 0.04 to 0.06) and the mention of a positive benefit–risk balance (compared with absence of severe and frequent side effects: OR 0.40, 0.34 to 0.46). The highest positive impact was the prospect of safely meeting older people and contributing to epidemic control (compared with no indirect protection: OR 4.10, 3.49 to 4.82 and 2.87, 2.34 to 3.50, respectively). Predicted acceptance was 93.8% for optimised communication on messenger RNA vaccines and 16.0% for vector-based vaccines recommended to ≥55-year-old persons. Vaccine eagerness among serial non-demanders slightly but significantly increased with the prospect of safely meeting older people and epidemic control and reduced with lower vaccine efficacy.DiscussionVaccine promotion towards healthcare and welfare sector workers who hesitate or refuse vaccination should avoid the notion of benefit–risk balance, while collective benefit communication with personal utility can lever acceptance. Vaccines with limited efficacy will unlikely achieve high uptake.

scholarly journals Investigating the preferences of older people for telehealth as a new model of health care service delivery: A discrete choice experiment

2016 ◽  
Vol 23 (2) ◽  
pp. 301-313 ◽  
Author(s):  
Billingsley Kaambwa ◽  
Julie Ratcliffe ◽  
Wendy Shulver ◽  
Maggie Killington ◽  
Alan Taylor ◽  
...  
Keyword(s):  
Health Care ◽  
Service Delivery ◽  
Older People ◽  
Discrete Choice Experiment ◽  
Discrete Choice ◽  
Choice Experiment ◽  
Health Care Service ◽  
Easy Access ◽  
Face To Face ◽  
Health Assessments

Introduction Telehealth approaches to health care delivery can potentially improve quality of care and clinical outcomes, reduce mortality and hospital utilisation, and complement conventional treatments. However, substantial research into the potential for integrating telehealth within health care in Australia, particularly in the provision of services relevant to older people, including palliative care, aged care and rehabilitation, is lacking. Furthermore, to date, no discrete choice experiment (DCE) studies internationally have sought the views and preferences of older people about the basic features that should make up a telehealth approach to these services. Methods Using a DCE, we investigated the relative importance of six salient features of telehealth (what aspects of care are to be pursued during telehealth sessions, distance to the nearest hospital or clinic, clinicians’ attitude to telehealth, patients’ experience of using technology, what types of assessments should be conducted face-to-face versus via telehealth sessions and the costs associated with receiving telehealth). Data were obtained from an online panel of older people aged 65 years and above, drawn from the Australian general population. Results The mean age for 330 study participants was 69 years. In general, individuals expressed strong preferences for telehealth services that offered all aspects of care, were relatively inexpensive and targeted specifically at individuals living in remote regions without easy access to a hospital or clinic. Participants also preferred telehealth services to be offered to individuals with some prior experience of using technology, provided by clinicians who were positive about telehealth but wanted all or some pre-telehealth health assessments to take place in a hospital or clinic. Preferences only differed by gender. Additionally, respondents did not feel that telehealth led to loss of privacy and confidentiality. Discussion Our findings indicate a preference amongst respondents for face-to-face pre-telehealth health assessments and, thereafter, a comprehensive telehealth model (in terms of services offered) targeted at those with some technological know-how as a substitute for attendance at hospitals and clinics, especially where these health facilities were far away from older people’s homes. The findings may be usefully incorporated into the design of future telehealth models of service delivery for older people.

What factors influence older people in the decision to relinquish their driver's licence? A discrete choice experiment

2013 ◽  
Vol 55 ◽  
pp. 178-184 ◽  
Author(s):  
Annabel McNamara ◽  
Gang Chen ◽  
Stacey George ◽  
Ruth Walker ◽  
Julie Ratcliffe
Keyword(s):  
Older People ◽  
Discrete Choice Experiment ◽  
Discrete Choice ◽  
Choice Experiment
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