Development of a Discrete Choice Experiment (DCE) Questionnaire to Understand Veterans’ Preferences for Tobacco Treatment in Primary Care

David A. Katz (), Kenda R. Stewart, Monica Paez, Mark W. Weg, Kathleen M. Grant, Christine Hamlin and Gary Gaeth
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David A. Katz: Iowa City VA Health Care System (152)
Kenda R. Stewart: Iowa City VA Health Care System (152)
Monica Paez: Iowa City VA Health Care System (152)
Mark W. Weg: Iowa City VA Health Care System (152)
Kathleen M. Grant: VA Nebraska–Western Iowa Health Care System
Christine Hamlin: Iowa City VA Health Care System (152)
Gary Gaeth: University of Iowa

The Patient: Patient-Centered Outcomes Research, 2018, vol. 11, issue 6, No 9, 649-663

Abstract: Abstract Background Providers often prescribe counseling and/or medications for tobacco cessation without considering patients’ treatment preferences. Objective The primary aims of this study are to describe (1) the development of a discrete choice experiment (DCE) questionnaire designed to identify the attributes and levels of tobacco treatment that are most important to veterans; and (2) the decision-making process in choosing between hypothetical tobacco treatments. Methods We recruited current smokers who were already scheduled for a primary care appointment within a single Veterans Affairs (VA) healthcare system. Subjects were asked to rate the importance of selected treatment attributes and were interviewed during two rounds of pilot testing of initial DCE instruments. Key attributes and levels of the initial instruments were identified by targeted literature review; the instruments were iteratively revised after each round of pilot testing. Using a ‘think aloud’ approach, subjects were interviewed while completing DCE choice tasks. Constant comparison techniques were used to characterize the issues raised by subjects. Findings from the cognitive interviews were used to revise the initial DCE instruments. Results Most subjects completed the DCE questionnaire without difficulty and considered two or more attributes in choosing between treatments. Two common patterns of decision-making emerged during the cognitive interviews: (1) counting ‘pros’ and ‘cons’ of each treatment alternative; and (2) using a ‘rule-out’ strategy to eliminate a given treatment choice if it included an undesirable attribute. Subjects routinely discounted the importance of certain attributes and, in a few cases, focused primarily on a single ‘must-have’ attribute. Conclusion Cognitive interviews provide valuable insights into the comprehension and interpretation of DCE attributes, the decision processes used by veterans during completion of choice tasks, and underlying reasons for non’-compensatory decision-making.

Date: 2018
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DOI: 10.1007/s40271-018-0316-6

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