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Risk as an Attribute in Discrete Choice Experiments: A Systematic Review of the Literature

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Abstract

Background

Discrete choice experiments (DCEs) are used to elicit preferences of current and future patients and healthcare professionals about how they value different aspects of healthcare. Risk is an integral part of most healthcare decisions. Despite the use of risk attributes in DCEs consistently being highlighted as an area for further research, current methods of incorporating risk attributes in DCEs have not been reviewed explicitly.

Objectives

This study aimed to systematically identify published healthcare DCEs that incorporated a risk attribute, summarise and appraise methods used to present and analyse risk attributes, and recommend best practice regarding including, analysing and transparently reporting the methodology supporting risk attributes in future DCEs.

Data Sources

The Web of Science, MEDLINE, EMBASE, PsycINFO and Econlit databases were searched on 18 April 2013 for DCEs that included a risk attribute published since 1995, and on 23 April 2013 to identify studies assessing risk communication in the general (non-DCE) health literature.

Study Eligibility Criteria

Healthcare-related DCEs with a risk attribute mentioned or suggested in the title/abstract were obtained and retained in the final review if a risk attribute meeting our definition was included.

Study Appraisal and Synthesis Methods

Extracted data were tabulated and critically appraised to summarise the quality of reporting, and the format, presentation and interpretation of the risk attribute were summarised.

Results

This review identified 117 healthcare DCEs that incorporated at least one risk attribute. Whilst there was some evidence of good practice incorporated into the presentation of risk attributes, little evidence was found that developing methods and recommendations from other disciplines about effective methods and validation of risk communication were systematically applied to DCEs. In general, the reviewed DCE studies did not thoroughly report the methodology supporting the explanation of risk in training materials, the impact of framing risk, or exploring the validity of risk communication.

Limitations

The primary limitation of this review was that the methods underlying presentation, format and analysis of risk attributes could only be appraised to the extent that they were reported.

Conclusions

Improvements in reporting and transparency of risk presentation from conception to the analysis of DCEs are needed. To define best practice, further research is needed to test how the process of communicating risk affects the way in which people value risk attributes in DCEs.

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Acknowledgments

Professor Katherine Payne was part funded by a Research Councils UK (RCUK) Academic Fellowship between September 2007 and September 2012. No other sources of funding were used to conduct this study or prepare this manuscript. Caroline Vass is funded by a National Institute for Health Research (NIHR) School for Primary Care Research Studentship. Mark Harrison, Dan Rigby, Caroline Vass, Terry Flynn, Jordan Louviere, and Katherine Payne have no conflicts of interest that are directly relevant to the content of this article. The authors are grateful to Mary Ingram, Lawrence Library, Centre for Musculoskeletal Research, University of Manchester, for assistance in developing the electronic search strategies for both reviews, and to Stuart Wright, Manchester Centre for Health Economics, for double screening the abstract lists for inclusion in this review.

Contributions to authorship

Mark Harrison, Katherine Payne, Terry Flynn, Jordan Louviere and Dan Rigby conceived the idea for this study and produced the protocol which informed the systematic search strategy. Mark Harrison and Katherine Payne applied the inclusion criteria and screening of abstracts, and extracted data from the included studies. Caroline Vass conducted the rapid review. All authors contributed to the writing of the manuscript. Katherine Payne acts as the overall guarantor.

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Authors and Affiliations

  1. Centre for Health Economics, Institute of Population Health, 4th floor, Jean McFarlane Building, University Place, The University of Manchester, Oxford Road, Manchester, M13 9PL, UK

    Mark Harrison, Caroline Vass & Katherine Payne

  2. Economics, School of Social Sciences, Arthur Lewis Building, The University of Manchester, Manchester, UK

    Dan Rigby

  3. Institute for Choice, UniSA Business School, Level 13, 140 Arthur Street, North Sydney, NSW, 2061, Australia

    Terry Flynn & Jordan Louviere

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  1. Mark Harrison
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Correspondence to Katherine Payne.

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Harrison, M., Rigby, D., Vass, C. et al. Risk as an Attribute in Discrete Choice Experiments: A Systematic Review of the Literature. Patient 7, 151–170 (2014). https://doi.org/10.1007/s40271-014-0048-1

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