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Eliciting patients' preferences for the intensity of preference-sensitive health care: An integrated research strategy.

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Call No.	Ph.D. 2010
Author	Crump, Robert Trafford.
Title	Eliciting patients' preferences for the intensity of preference-sensitive health care: An integrated research strategy.
Date	2010
Abstract	Statement of Problem Characterizing the public's preferential attitudes towards relatively more-/less-intense elective options in "preference-sensitive" health care situations is particularly relevant for the prioritization policies of publicly-funded systems. However, there are a number of issues that need to be considered when designing studies aimed at measuring these preferential attitudes in terms of strength-of-preference scores within community settings, including: whom to sample (since sub-groups might vary in their motives for preferring the same option); how many health care "scenarios" to present (since fewer are needed if preferential attitudes are consistent), and what evaluative techniques to use (since engaging techniques are costly). In three sub-studies, I explored whether strength-of-preference scores for elective health care options tend to be: 1) associated with particular "reasons" or "social influences"; 2) "state-like" or "trait-like"; and 3) influenced by prior use of an "engaging" evaluative technique. Methods 202 Medicare beneficiaries considered 8 preference-sensitive scenarios involving choices between relatively more-/less-intense elective options. For each, they reported: their favored option; a strength-of-preference score for that option; and the reasons, sources of social endorsement, and sources of social pressure affecting their choice of that option. Results Sub-study participation ranged from 196-199 individuals. In the first sub-study, for each of the relevant scenarios, sub-groups who strongly-/weakly favored the most-popular option did not differ in the reasons for choosing that option, and the social influences (endorsement and pressure) on their choice tended to be similar. In the second sub-study, preferential attitudes appeared to be state-like, in that there was little across-scenario consistency (using Kendall's coefficient of concordance) in the strength-of-preference scores. In the third sub-study, the engaging evaluative technique had no significant effect (using Kendall tau-b correlation coefficient) on the strength-of-preference scores elicited with the subsequent non-engaging technique. Conclusions In community-wide surveys, researchers: 1) need not assume that, because they differ in terms of their strength-of-preference scores, individuals have different motivational patterns for favoring the same option; 2) carefully select the sets of scenarios used to elicit strength-of-preference scores, since attitudes may vary depending on what's at stake; and 3) might safely use a non-engaging technique when eliciting strength-of-preference scores.
Description	xi, 296 leaves : col. ill. ; 28 cm.
Format	application/pdf
Advisor	Hilary A Llewellyn-Thomas, Jonathan S Skinner, Denise L Anthony, James G Dolan
Subject	Patients -- Decision making. Patients -- Attitudes. Motivation (Psychology) -- Social aspects. Preferences (Philosophy) Medical care -- Evaluation. Medical care -- Research -- Methodology. Medical care -- Decision making.
College	Dartmouth Institute for Health Policy and Clinical Practice.
Issuing Body	Dartmouth Dissertations are made available through the Dartmouth Digital Library.
Degree	Thesis (Ph.D.)--Dartmouth College.
Copyright	All rights reserved. No part of this book may be reproduced in any form by any electronic or mechanical means without permission in writing from the author.
DOI	http://dx.doi.org/10.1349/ddlp.385

Title	Page 1
Format	application/pdf
Issuing Body	Dartmouth Dissertations are made available through the Dartmouth Digital Library.
Degree	Thesis (Ph.D.)--Dartmouth College.
Full Text	ELICITING PATIENTS’ PREFERENCES FOR THE INTENSITY OF PREFERENCE-SENSITIVE HEALTH CARE: AN INTEGRATED RESEARCH STRATEGY A Thesis Submitted to the Faculty in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Health Policy and Clinical Practice by Robert Trafford Crump DARTMOUTH COLLEGE Hanover, New Hampshire February 2010 Examining Committee: _______________________________ Hilary A. Llewellyn-Thomas, B.Sc., M.Sc., Ph.D. _______________________________ Jonathan S. Skinner B.A., M.A., Ph.D. _______________________________ Denise L. Anthony, B.A., M.A., Ph.D. _______________________________ James G. Dolan, B.A., M.D. _______________________________ Brian W. Pogue, Ph.D. Dean of Graduate Studies

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