Making Choices in Healthcare

By Associate Professor Sanjeewa Kularatna, Shayma Selim and Dr Sameera Senanayake

Making choices – an everyday occurrence

When did you last have to make a choice? Individuals are consciously or subconsciously making choices every day – from choosing whether to catch a bus or drive to work, to deciding whether to get a hot cup of coffee or a chilled glass of lemonade.

With every choice we make, there is a reason why we select one option over the other. The decisions we make are influenced by the preferences we hold for the options that are available to us. For example, when deciding between catching a bus or driving your car, you may have considered travel times, costs, and the convenience of each option.

Over the years, researchers have become more interested in understanding how choices are made and predicting future choice responses which can be harnessed to inform public policy. That is where Discrete Choice Experiments (DCEs), a quantitative method to study choice, come into play.

What are Discrete Choice Experiments and how can they be used for Health Services Research?

A DCE is a method used to elicit individual preferences for different aspects of services, programs, or products.  The application of DCEs in health services research has grown extensively over the years, with continual advances in the methods used. This provides a growing number of opportunities to use DCEs to understand patient preferences in a range of areas. Examples of areas that may benefit from knowledge of patient preferences include mobile health interventions or models of care for managing chronic heart disease.

A DCE typically presents individuals with several hypothetical scenarios, or “choice sets”, each containing several alternatives. Alternatives within a choice set are described by a set of characteristics. Individuals are then asked to make a choice from the presented choice sets. Data collected under a DCE is then analysed to understand the choices being made, including to what degree an individual may value one choice over another.

At AusHSI, we are progressing several DCE studies to understand patient preference, which will inform decision making around efficient allocation of resources in healthcare. One of these studies looks at patient, clinician and decision maker preferences to find out important characteristics of integrated care models to manage patients with atrial fibrillation. A second study is determining the preference for the characteristics of neurodevelopmental follow-up care for children following treatment for congenital heart disease.

These studies, among others, will allow integration of stakeholders’ and especially patients’ values in all aspects of care in one measure. We will have direct insight into how patients trade different aspects of health and care.