Preferences of continuous care service options for patients with venous leg ulcer development of attributes for discrete choice experiments.

Abstract

Patients suffering from lower extremity venous ulcers typically undergo prolonged dressing changes, entailing extended treatment cycles and significant costs, creating an urgent need for effective continuous care. There is scarce literature reporting on the preferences and requirements for wound care within continuous care services for such conditions. Discrete choice experiments serve as an innovative method to elicit patient preferences, where the development of attributes and levels is a critically important process. To identify attributes and levels patients with venous leg ulcers consider when making decisions about continued care services for venous leg ulcers. In this study, we employed four steps to devise service features (i.e., attributes) and their potential manifestations (i.e., levels). Firstly, we conducted a systematic literature search with articles screened and content compiled by two researchers to identify possible service attributes. Secondly, we conducted in-depth interviews with patients suffering from venous leg ulcers to gather personal experiences and expectations for quality care, and used Nvivo11.0 for data management. Thirdly, focus group discussions were held to assess general viewpoints from various perspectives. Finally, expert meetings were organized to refine our research tools further. To narrow down the attributes to a manageable number for the discrete choice experiment, focus groups and expert meetings performed ranking exercises, calculating the average importance scores by dividing the total score by the number of participants and ranking attributes from highest to lowest average scores. Through literature reviews, qualitative data acquisition, expert meetings, and ranking exercises, a total of six attributes were finalized, each with two to three levels. The attributes included: 1) service cost (Ave score: 4.7); 2) Mode of service delivery (Ave score: 4.5); 3) Service type (Ave score: 4.4); 4) Consistency of caregiver (Ave score: 4.4); 5) Category of service providers (Ave score: 4.3); and 6) Appointment scheduling (Ave score: 4.3). These attributes encompassed key aspects related to wound care in the continuous care services for patients with venous leg ulcers. The mixed-methods approach adopted in this study has proven particularly suitable for identifying, refining, and selecting attributes and levels for discrete choice experiments. By leveraging the advantages and limitations of the four steps, and especially through qualitative data analysis, a more profound and comprehensive understanding of the attributes and levels was achieved. This approach has facilitated the practicality and accuracy in attribute construction, enhancing the overall efficacy of the DCE design.