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

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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.

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Acknowledgments

The authors thank John Holman for assistance with research coordination, Charlotte Dean for assistance with manuscript preparation, and all of the veterans who participated in this project. This work was previously presented in part at the Society of Medical Decision Making Annual Meeting, Pittburgh, PA, on October 24, 2017.

Author information

Authors and Affiliations

  1. Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, Iowa City VA Health Care System (152), Iowa City, IA, 52246-2208, USA

    David A. Katz, Kenda R. Stewart, Monica Paez, Mark W. Vander Weg & Christine Hamlin

  2. Department of Medicine, University of Iowa, Iowa City, IA, USA

    David A. Katz & Mark W. Vander Weg

  3. Department of Epidemiology, University of Iowa, Iowa City, IA, USA

    David A. Katz

  4. Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, USA

    Mark W. Vander Weg

  5. VA Nebraska–Western Iowa Health Care System, Omaha, NE, USA

    Kathleen M. Grant

  6. Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA

    Kathleen M. Grant

  7. Tippie School of Business, University of Iowa, Iowa City, IA, USA

    Gary Gaeth

Authors
  1. David A. Katz
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  7. Gary Gaeth
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Contributions

DAK and GG were responsible for study concept and design. KRS and MP were responsible for acquisition of the data. CH provided research coordination. KRS, MP, GG, and DAK were responsible for analysis and interpretation of the data. DAK obtained funding, supervised the study, and drafted the article. DAK, KRS, MWVW, KMG, CH, and GG were responsible for critical review of the article.

Corresponding author

Correspondence to David A. Katz.

Ethics declarations

Funding

Funding for this study was received from the US Department of Veterans Affairs, Health Services Research and Development (PPO 15-429).

Ethical Approval and Informed Consent

This study was approved by the University of Iowa Institutional Review Board. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

Conflict of interest

David Katz, Kenda Stewart, Monica Paez, Mark Vander Weg, Kathleen Grant, Christine Hamline, and Gary Gaeth have no conflicts of interest to declare.

Disclaimer

The views expressed in this article are those of the author(s) and do not necessarily represent the views of the Department of Veterans Affairs.

Data Availability Statement

Final datasets underlying all publications resulting from research will not be shared outside the Veterans Administration (VA) except as required under the Freedom of Information Act (FOIA), as original VA-funded datasets are required to be retained on VA servers behind VA firewalls. These data will be provided to interested parties following proper filing and verification of a FOIA request and approval by the VA Privacy Officer. These data will be maintained as required by VA data retention policies.

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Katz, D.A., Stewart, K.R., Paez, M. et al. Development of a Discrete Choice Experiment (DCE) Questionnaire to Understand Veterans’ Preferences for Tobacco Treatment in Primary Care. Patient 11, 649–663 (2018). https://doi.org/10.1007/s40271-018-0316-6

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