Concordance Of Preferences Research Articles

COVID-19 Vaccine Preferences in China: A Comparison of Discrete Choice Experiment and Profile Case Best-Worst Scaling.

Little is known about the diversity of residents' preferences for COVID-19 vaccines during the time when COVID-19 management was downgraded in China. This study aims to investigate these preferences using discrete choice experiment (DCE) and profile case best-worst scaling (BWS-2), and to assess the concordance between these two methods. Chinese residents recruited for the online survey were asked to evaluate COVID-19 vaccine profiles through both DCE and BWS-2 from April to July 2023. Attributes included effectiveness, duration of protection, risk of severe adverse events (degree), the total out-of-pocket (OOP) cost, brand, and the vaccination method. We utilized conditional regression and mixed logit regression models to estimate the preferencelevels for potential attributes. To assess preference concordance between the two methods, re-scaling and the Spearman correlation test were used. Additionally, subgroup analysis was conducted to determine the most suitable method for different population groups, categorized by vaccine hesitancy and risk level. A total of 438 (71.22%) respondents were included. A similar pattern was found in the DCE and BWS-2 methods, with the respondents having a strong preference for 90% vaccine effectiveness. However, the methods diverged in other preferences; DCE favored domestic brands and low severe adverse event risk, while BWS-2 preferred moderate risk and three years of protection. Concordance assessment, including Spearman's correlation and linear regression, showed no significant correlation and poor concordance between the methods, underscoring these differences. Preference heterogeneity is revealed among different groups; however, effectiveness remained the most important attribute for all subgroups of the population. Oral vaccination was the preferred option for both the vaccine-hesitant and high-risk groups. This study offers new insights into the varying preferences for COVID-19 vaccines among Chinese residents following the downgrading of pandemic management measures. The findings underscore the need for diverse strategies in vaccine policy design. Special emphasis should be placed on vaccine attributes that align with public priorities, such as high effectiveness and low risk levels, to enhance vaccine uptake.

Patient Experiences of Receiving Stroke Discharge Information in Accordance With Preferences.

To examine survivors' experiences of discharge information including risk communication after hospitalisation for a stroke and the characteristics associated with receiving information in accordance with their preferences. With advances in acute stroke care and an ageing population, the number of survivors of stroke is increasing. It is important that healthcare providers ensure patients have adequate information after a stroke-related hospitalisation. Cross-sectional study. Adults recently discharged after a stroke from eight Australian hospitals were mailed a survey. Items examined risk and discharge care information, with participants asked to indicate both their preferences for and receipt of the information. Concordance with preferences was calculated, and characteristics associated with information preference concordance were assessed with binomial logistic regression. Study reported in accordance with STROBE Checklist. Of 1161 eligible patients invited, 403 (35%) completed the survey. All items were endorsed by 80% or more of respondents as being wanted. However, for all items, fewer respondents reported the care as received. Only 28% of participants received information on all five items according to their preferences. Hospital site, Body Mass Index and age were statistically significantly associated with participants receiving information in accordance with their preferences. Most participants indicated a preference to receive recommended discharge information. Findings suggest that patients may benefit from increased information provision prior to hospital discharge after stroke. Nurses have an important role in the provision of stroke care and information. The findings of this study may be used to improve the provision of post-hospital discharge care and support for survivors of stroke, and assist in identifying patients at lower odds of experiencing information aligned with their preferences and who may benefit from support. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for cross-sectional studies. No patient or public contribution.

Talking, not training, increased the accuracy of physicians’ diagnosis of their patients’ preferences for colon cancer screening

ObjectiveIdentify if primary care physicians (PCPs) accurately understand patient preferences for colorectal cancer (CRC) testing, whether shared decision making (SDM) training improves understanding of patient preferences, and whether time spent discussing CRC testing improves understanding of patient preferences. MethodsSecondary analysis of a trial comparing SDM training plus a reminder arm to a reminder alone arm. PCPs and their patients completed surveys after visits assessing whether they discussed CRC testing, patient testing preference, and time spent discussing CRC testing. We compared patient and PCP responses, calculating concordance between patient-physician dyads. Multilevel models tested for differences in preference concordance by arm or time discussing CRC. Results382 PCP and patient survey dyads were identified. Most dyads agreed on whether CRC testing was discussed (82%). Only 52% of dyads agreed on the patient's preference. SDM training did not impact accuracy of PCPs preference diagnoses (55%v.48%,p = 0.22). PCPs were more likely to accurately diagnose patient’s preferences when discussions occurred, regardless of length. ConclusionOnly half of PCPs accurately identified patient testing preferences. Training did not impact accuracy. Visits where CRC testing was discussed resulted in PCPs better understanding patient preferences. Practice implicationsPCPs should take time to discuss testing and elicit patient preferences.

Exploring decisional control preferences in older patients with cancer and their caregivers.

12042 Background: Shared decision making is preferred by many patients but it is often viewed from the lens of the patient and physician dyad only. Caregivers often support cancer decision-making, although their decision control preferences are not typically considered. We explored decisional control preferences of older patients with cancer and their caregivers, and examined concordance in preferences of the dyad, as well as patient, caregiver, physician factors associated with concordance. Methods: We utilized data from a national geriatric assessment (GA) cluster-randomized trial (NCT 02054741; PI: Mohile; funding NCI UG1CA189961) that recruited patients aged ≥70 with incurable cancer, their caregivers, and oncologists. Controlled Preferences Scale (CPS) was used to assess shared decision making preferences. Both patients and caregivers were asked about the role of patients (Patient-role CPS) and caregiver (Caregiver-role CPS) in the decision making process. Patient-role CPS options were 1) doctor makes the decisions, 2) doctor makes the decisions with patient’s input, 3) equally shared decision, 4) patient makes the decisions with doctor’s input, 5) patient makes the decisions. Caregiver-role CPS options were 1) doctor makes the decisions, 2) patient makes the decision with doctor, 3) patient and caregiver make the decisions with doctor, 4) caregiver makes the decisions with doctor. Matching responses of the dyads for each CPS question were considered concordant. We used descriptive statistics to summarize CPS for patients and caregivers and the concordance between them. We utilized logistic regression to assess dyads' sociodemographic information, patients' GA and physicians’ practice characteristics associated with patient-caregiver CPS concordance. Results: Enrolled dyads with completed CPS were included (N=332); mean age (SD) of patients and caregivers was 76.6 (5.3) and 66.6 (12.2). Women constituted 39% of patients and 76% of caregivers. Patient-role CPS for patients’ (and caregivers’) were 11% (6%) for doctor makes the decisions, 33% (28%) for doctor makes the decisions with patient’s input, 45% (49%) for equally shared, 9% (14%) for patient makes the decisions with doctor’s input, 2% (3%) for patient makes the decision. Patients’ (and caregivers’) answers on caregiver-role CPS were 20% (19%) for doctor makes the decisions, 18% (28%) for patient makes the decisions with doctor, 61% (52%) for patient and caregiver make the decisions with doctor and 1% (1%) for caregiver makes the decisions with doctor. Dyads concordance occurred in 46% of patient-role CPS and 54% of caregiver-role CPS, indicating moderate concordance. No baseline factors were associated in dyad concordance for either the patient-role or caregiver-role CPS. Conclusions: Clinicians should inquire about decisional control preferences of patients and caregivers in order to optimally support shared decision making. Clinical trial information: NCT02054741 .

Prevalence and Correlates of Preference-Concordant Care Among Hospitalized People Receiving Maintenance Dialysis.

Preference-concordant care is a cornerstone of high-quality medical decision-making, yet the prevalence and correlates of preference-concordant care have not been well-studied in patients receiving dialysis. We surveyed hospitalized people receiving maintenance dialysis to estimate the prevalence and correlates of preference-concordant care among this population. We assessed preference concordance by asking participants (223/380, 59% response rate), "How strongly do you agree or disagree that your current treatment plan meets your preference?" We assessed treatment plan preference by asking if patients preferred a plan that focused on (a) extending life, or (b) relieving pain and discomfort. We assessed shared dialysis decision-making using the 9-item Shared Decision-Making Questionnaire (SDM-Q-9). We examined the differences between those reporting lack of preference-concordant care to those reporting receipt of preference-concordant care using chi-square analyses. We also studied whether patients' treatment plan preferences or shared dialysis decision-making scores were correlated with their likelihood of receiving preference-concordant care. Of the 213 respondents who provided data on preference-concordance, 90 (42.3%) reported that they were not receiving preference-concordant care. Patients who preferred pain and discomfort relief over life extension were less likely {OR 0.15 (95% CI 0.08, 0.28) P =<0.0001} to report receiving preference-concordant care; patients with higher shared decision-making scores were more likely {OR 1.02 [95% CI 1.01, 1.03], P=0.02} to report preference-concordant care. A substantial proportion of this sample of hospitalized people receiving maintenance dialysis reported not receiving preference-concordant care. Efforts to improve symptom management and enhance patient engagement in dialysis decision-making may improve the patients' perceptions of receiving preference-concordant care.

Quantifying implementation strategy and dissemination channel preferences and experiences for pain management in primary care: a novel implementer-reported outcome.

Precision implementation science requires methods to evaluate and select implementation strategies. This study developed and evaluated a novel measure of concordance between current and preferred dissemination channels (DC) and implementation strategies (IS) to guide efforts to improve the adoption of evidence-based management strategies for chronic pain. We conducted a one-time electronic survey of Pennsylvania primary care practitioners (PCPs) about current vs. preferred chronic pain management DC and IS use. Survey items were selected based on preliminary data, the Model for Dissemination of Research, and the Evidence-Based Recommendations for Implementing Change taxonomy of implementation strategies. We used Cohen's kappa (κ) to assess the agreement between participant-level current and preferred DC/IS. We calculated % preferred minus % experienced for each DC/IS and assessed the equality of proportions to determine whether this difference significantly departed from zero. We categorized DC and IS based on the degree of use and preference, to evaluate alignment. The current sample included 101 Pennsylvania PCPs primarily in urban (94.06%), non-academic (90.10%) settings who self-identified as mostly female (66.34%) and white (85.15%). The greatest difference between preferred and experienced DCs, or "need," was identified by participants as workshops, clinical experts, seminars, and researchers. Similarly, participants reported the greatest IS gaps as multidisciplinary chronic pain workgroups, targeted support for clinicians, and a chronic pain clinical champion. Participating PCPs had moderate DC concordance (kappa = 0.45, 95% CI = 0.38-0.52) and low IS concordance (kappa = 0.18, 95% CI = 0.13-0.23). DC and IS concordance were both greater than that expected by chance. We further identified well-aligned DC and IS, including professional organizations, briefs, and guidelines. We identified a novel implementer-reported outcome of dissemination channel and implementation strategy concordance that allows implementation scientists to quantify the magnitude of the gap between the current and preferred experience of implementers. This quantitative measure can help with the selection and evaluation of dissemination channels and implementation strategies. Future research should leverage this measure to understand the degree to which preference concordance influences clinical outcomes and performance.

Patient-Reported Outcomes of Breast Reconstruction: Does the Quality of Decisions Matter?

Little is known about how the quality of decisions influences patient-reported outcomes (PROs). We hypothesized that higher decision quality for breast reconstruction would be independently associated with better PROs. We conducted a prospective cohort study of patients undergoing mastectomy with or without reconstruction. Patients were enrolled before surgery and followed for 18 months. We used BREAST-Q scales to measure PROs and linear regression models to explore the relationship between decision quality (based on knowledge and preference concordance) and PROs. Final models were adjusted for baseline BREAST-Q score, radiation, chemotherapy, and major complications. The cohort included 101 patients who completed baseline and 18-month surveys. Breast reconstruction was independently associated with higher satisfaction with breasts (β=20.2, p=0.0002), psychosocial well-being (β=14.4, p=0.006), and sexual well-being (β=15.7, p=0.007), but not physical well-being. Patients who made a high-quality decision had similar PROs as patients who did not. Among patients undergoing mastectomy with reconstruction, higher decision quality was associated with lower psychosocial well-being (β=-14.2, p=0.01). Breast reconstruction was associated with better PROs in some but not all domains. Overall, making a high-quality decision was not associated with better PROs. However, patients who did not have reconstruction had a trend toward better well-being after making a high-quality decision, whereas patients who did have reconstruction had poorer well-being after making a high-quality decision. Additional research on the relationship between decision quality and PROs is needed.

A Comparison of Caregiver and Patient Preferences for Treating Duchenne Muscular Dystrophy.

Background and ObjectivesCaregivers routinely inform medical and regulatory decision making in rare pediatric diseases. While differences in treatment preferences across caregivers and patients have been observed for Duchenne muscular dystrophy, this evidence was limited by small samples of patients and results were confounded by patient age and disease progression. We tested caregiver and patient preference concordance for treating Duchenne.MethodsPreferences and demographic/clinical information from 115 caregivers and 107 patients were collected in an international study (response = 80%) using a previously developed discrete-choice experiment consisting of 12 experimentally controlled choice tasks. Each task presented two profiles that varied across four attributes: disease progression, drug failure probability, kidney damage risk, and fracture risk. Caregivers and patients were matched 1:1 based on patient age. We tested for concordance across each task and by comparing caregivers’ and patients’ maximum acceptable risk of drug failure, kidney damage, and fracture for a slowing of disease progression.ResultsThe final analysis included 77 caregivers and 77 patients. No differences were observed in nationality (p = 0.969), disease stage (p = 0.180), or demographic/clinical factors (p = 0.093–0.857); however, patients were more optimistic (p = 0.030). Caregivers and patients chose similarly across tasks (p = 0.101–0.993). To slow disease progression by 1 year, caregivers and patients would tolerate a 9% and 11% increase in drug failure probability, respectively (p = 0.267). Alternatively, they would accept a 3% and 4% increase in the risk of kidney damage (p = 0.719) or a 15% and 20% increase in the risk of fracture (p = 0.534).ConclusionsCaregivers and patients had concordant preferences for treating Duchenne. Providers and regulators can trust both caregiver and patient report of preferences to inform medical decision making.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40271-022-00574-y.

Association of Advance Care Planning Visits With Intensity of Health Care for Medicare Beneficiaries With Serious Illness at the End of Life

Advance care planning (ACP) is intended to maximize the concordance of preferences with end-of-life (EOL) care and is assumed to lead to less intensive use of health care services. The Centers for Medicare & Medicaid Services began reimbursing clinicians for ACP discussions with patients in 2016. To determine whether billed ACP visits are associated with intensive use of health care services at EOL. This prospective patient-level cohort analysis of seriously ill patients included Medicare fee-for-service beneficiaries who met criteria for serious illness from January 1 to December 31, 2016, and died from January 1, 2017, to December 31, 2018. Analyses were completed from November 1, 2020, to March 31, 2021. Five measures of EOL health care services used (inpatient admission, emergency department visit, and/or intensive care unit stay within 30 days of death; in-hospital death; and timing of first hospice bill) and a measure of EOL expenditures. Analyses were adjusted for age, race and ethnicity, sex, Charlson Comorbidity Index, Medicare-Medicaid dual eligibility, and expenditure by hospital referral region (high, medium, or low). The primary exposure was receipt of a billed ACP service classified as none, timely (>1 month before death), or late (first ACP visit ≤1 month before death). Of the 955 777 Medicare beneficiaries who met criteria for serious illness in 2016 and died in 2017 or 2018, 522 737 (54.7%) were women, 764 666 (80.0%) were 75 years or older, and 822 684 (86.1%) were non-Hispanic White individuals. Among the study population, 81 131 (8.5%) had a timely ACP visit, and an additional 22 804 (2.4%) had a late ACP visit. After multivariable adjustment, compared with patients without any billed ACP visit, patients with a timely ACP visit experienced significantly less intensive EOL care on 4 of 5 measures, including in-hospital death (adjusted odds ratio [aOR], 0.85; 95% CI, 0.84-0.87), hospital admission (aOR, 0.84; 95% CI, 0.83-0.85), intensive care unit admission (aOR, 0.87; 95% CI, 0.85-0.88), and emergency department visit (OR, 0.83; 95% CI, 0.82-0.84). Only small or insignificant differences in late hospice use or mean total EOL expenditures were noted. Compared with patients without ACP, patients with late ACP experienced more intensive EOL care, including in-hospital death (aOR, 1.22; 95% CI, 1.19-1.26), hospital admission (aOR, 5.28; 95% CI, 5.07-5.50), intensive care unit admission (aOR, 1.57; 95% CI, 1.53-1.62), and emergency department visit (aOR, 3.87; 95% CI, 3.72-4.02). In this cohort study of US Medicare beneficiaries, billed ACP services during the EOL course of patients with serious illness were relatively uncommon, but if they occurred before the last month of life, they were associated with less intensive use of EOL services. Further research on the variables affecting hospice use and expenditures in the EOL period and the differential effect of late ACP is recommended to understand the relative role of ACP in achieving goal-concordant care.

Factors associated with concordance between POLST orders and current treatment preferences.

POLST is widely used to document the treatment preferences of nursing facility residents as orders, but it is unknown how well previously completed POLST orders reflect current preferences (concordance) and what factors are associated with concordance. To describe POLST preference concordance and identify factors associated with concordance. Chart reviews to document existing POLST orders and interviews to elicit current treatment preferences. POLST-using nursing facilities (n= 29) in Indiana. Nursing facility residents (n= 123) and surrogates of residents without decisional capacity (n= 152). Concordance was determined by comparing existing POLST orders for resuscitation, medical interventions, and artificial nutrition with current treatment preferences. Comfort-focused POLSTs contained orders for do not resuscitate, comfort measures, and no artificial nutrition. Overall, 55.7% (123/221) of residents and 44.7% (152/340) of surrogates participated (total n= 275). POLST concordance was 44%, but concordance was higher for comfort-focused POLSTs (68%) than for non-comfort-focused POLSTs (27%) (p< 0.001). In the unadjusted analysis, increasing resident age (OR 1.04, 95% CI 1.01-1.07, p< 0.01), better cognitive functioning (OR 1.07, 95% CI 1.02-1.13, p< 0.01), surrogate as the decision-maker (OR 2.87, OR 1.73-4.75, p< 0.001), and comfort-focused POLSTs (OR 6.01, 95% CI 3.29-11.00, p< 0.01) were associated with concordance. In the adjusted multivariable model, only having an existing comfort-focused POLST was associated with higher odds of POLST concordance (OR 5.28, 95% CI 2.59-10.73, p < 0.01). Less than half of all POLST forms were concordant with current preferences, but POLST was over five times as likely to be concordant when orders reflected preferences for comfort-focused care. Findings suggest a clear need to improve the quality of POLST use in nursing facilities and focus its use among residents with stable, comfort-focused preferences.

Patient's Cognitive Function and Attitudes towards Family Involvement in Cancer Treatment Decision Making: A Patient-Family Caregiver Dyadic Analysis.

PurposeOlder patient populations commonly have cognitive impairment, which might impact decisional capacity. We examined patients and family caregivers preferences for family involvement in treatment decision making assuming different level of cognitive impairment, and sought to explore the factors associated with the preferences and the degree to which patients and family members agree on preferences.Materials and MethodsA total of 358 elderly cancer patient and caregiver dyads were recruited from the 11 cancer centers in Korea andwere asked to express their preferences forfamily involvement in treatment decision making using hypothetical scenarios with three different levels of cognitive status (intact, mild impairment, and severe impairment).ResultsBoth patients and family caregivers preferred greater family dominance in treatment decision makingwith the increasing the level of cognitive impairment (39.7%, 60.9%, and 86.6% for patients and 45.0%, 66.2%, and 89.7% for caregivers in each scenarios). Patient and family caregiver concordance in decisional control preference was small for all three scenarios (weighted κ=0.32, κ=0.26, and κ=0.36, respectively). Higher patient education was associated with preference for patient dominance in treatment decision in conditions of both mild and severe cognitive impairment. The association of higher patient education and patient-caregiver preference concordance was positive with intact cognition, while it was negative with severe cognitive impairment.ConclusionDecision control preferences were affected by hypothesized cognitive status of the patients. Findings from our study would be helpful to develop effective strategy for optimizing family involvement in cancer treatment decision in the context of deteriorating cognitive function of the patients.

IteRank: An iterative network-oriented approach to neighbor-based collaborative ranking

Neighbor-based collaborative ranking (NCR) techniques follow three consecutive steps to recommend items to each target user: first they calculate the similarities among users, then they estimate concordance of pairwise preferences to the target user based on the calculated similarities. Finally, they use estimated pairwise preferences to infer the total ranking of items for the target user. This general approach faces some problems and the rank data is usually sparse as users usually have compared only a few pairs of items. Consequently, the similarities among users is calculated based on limited information and is not accurate enough for inferring true values of preference concordance and can lead to an invalid ranking of items.This article presents a novel framework, called IteRank, that models the data as a bipartite network containing users and pairwise preferences. It then simultaneously refines users’ similarities and preferences’ concordances using a random walk method on this graph structure. It uses the information in this first step in another network structure for simultaneously adjusting the concordances of preferences and rankings of items. Using this approach, IteRank can overcome some existing problems caused by the sparsity of the data. Experimental results show that IteRank improves the performance of recommendation compared to the state of the art NCR techniques that use the traditional NCR framework for recommendation.

Quality of Patient Decisions About Breast Reconstruction After Mastectomy

ImportanceBreast reconstruction has the potential to improve a person’s body image and quality of life but has important risks. Variations in who undergoes breast reconstruction have led to questions about the quality of patient decisions.ObjectiveTo assess the quality of patient decisions about breast reconstruction.Design, Setting, and ParticipantsA prospective, cross-sectional survey study was conducted from June 27, 2012, to February 28, 2014, at a single, academic, multidisciplinary oncology clinic among women planning to undergo mastectomy for stage I to III invasive ductal or lobular breast cancer, ductal carcinoma in situ, or prophylaxis. ExposuresMastectomy only and mastectomy with reconstruction.Main Outcome and MeasuresKnowledge, as ascertained using the Decision Quality Instrument; preference concordance, based on rating and ranking of key attributes; and decision quality, defined as having knowledge of 50% or more and preference concordance.ResultsDuring the 20-month period, 214 patients were eligible, 182 were approached, and 32 missed. We enrolled 145 patients (79.7% enrollment rate), and received surveys from 131 patients (72.0% participation rate). Five participants became ineligible. The final study population was 126 patients. Among the 126 women in the study (mean [SD] age, 53.2 [12.1] years), the mean (SD) knowledge score was 58.5% (16.2%) and did not differ by treatment group (mastectomy only, 55.2% [15.0%]; mastectomy with reconstruction, 60.5% [16.5%]). A total of 82 of 123 participants (66.7%) had a calculated treatment preference of mastectomy only; 39 of these women (47.6%) underwent mastectomy only. A total of 41 participants (32.5%) had a calculated treatment preference of mastectomy with reconstruction; 36 of these women (87.8%) underwent mastectomy with reconstruction. Overall, 52 of 120 participants (43.3%) made a high-quality decision. In multivariable analysis, white race/ethnicity (odds ratio [OR], 2.72; 95% CI, 1.00-7.38; P = .05), having private insurance (OR, 1.61; 95% CI, 1.35-1.93; P < .001), having a high school education or less (vs some college) (OR, 4.84; 95% CI, 1.22-19.21; P = .02), having a college degree (vs some college) (OR, 1.95; 95% CI, 1.53-2.49; P < .001), and not having a malignant neoplasm (eg, BRCA carriers) (OR, 3.13; 95% CI, 1.25-7.85; P = .01) were independently associated with making a high-quality decision.Conclusions and RelevanceA minority of patients undergoing mastectomy in a single academic center made a high-quality decision about reconstruction. Shared decision making is needed to support decisions about breast reconstruction.

Do patients and health care providers have discordant preferences about which aspects of treatments matter most? Evidence from a systematic review of discrete choice experiments

ObjectivesTo review studies eliciting patient and healthcare provider preferences for healthcare interventions using discrete choice experiments (DCEs) to (1) review the methodology to evaluate similarities, differences, rigour of designs and...

Balancing Inventory and Stockout Risk in Retail Supply Chains Using Fast‐Ship

In this study, we consider a two‐retailer, one‐supplier supply chain in which retailers satisfy excess demand by offering to directly ship out‐of‐stock items on an expedited basis at no extra cost to customers. This practice is referred to as the fast‐ship option. We consider two scenarios along with the fast‐ship option. In the first scenario, retailers transship when out of stock, whereas in the second scenario, they do not. If they do not transship, some customers may perform the search on their own. In each scenario, the wholesale prices are either exogenous, or chosen endogenously by the supplier. For both cases, we determine the supplier's and the retailers’ optimal decisions. The key research question we ask and answer is the following: which of the two scenarios is preferred by either player when all decisions are made optimally? We show that when fewer customers are willing to search on their own and wholesale prices are exogenous, both the supplier and the retailers prefer to transship. In addition, the decision maker in a centralized chain will have the exact same preference as that of players in a decentralized setting when the retailers’ and the supplier's preferences coincide and wholesale prices are exogenous. This preference concordance does not hold if wholesale prices are endogenous.

Default options in advance directives: study protocol for a randomised clinical trial

IntroductionAlthough most seriously ill Americans wish to avoid burdensome and aggressive care at the end of life, such care is often provided unless patients or family members specifically request otherwise....

Abstract A08: Concordance in patient and provider priorities and preferences to address behavioral risk factors for cancer health disparities interventions

Abstract Purpose: Actively engaging key stakeholders in the development of interventions is necessary to address cancer health disparities. While lay community residents are often included in these efforts, the preferences of patients and providers in primary care settings are often not elicited. We used focus groups and key informant interviews to identify priorities and preferences for lifestyle modification and health behavior change interventions among primary care patients and providers. Methods: Patients (n=35) and providers (n=18) from 3 rural and 5 urban primary care practices that were part of a practice-based research network were recruited to participate in a 60-90 minute focus group or 20-30 minute key informant interview, respectively. Focus groups and key informant interviews were facilitated using a semi-structured discussion guide that asked patients and providers to identify barriers and facilitators to lifestyle modification and health behavior change among patients and implementation of interventions in the practice, the interventions that are preferred by patients, and interventions that can be implemented in the practice. Data were analyzed using NVivo 10 to identify emergent themes. Results: There was concordance between patients and providers in terms of wanting interventions that address diet and physical activity to manage chronic conditions. Patients and providers also identified similar barriers to implementing interventions to address these behaviors: lack of patient motivation and knowledge and limited capacity and knowledge among providers to deliver intensive interventions. Both patients and providers indicated that tailored interventions are most likely to be effective, but resource constraints in the practice were potential barriers to implementation of these types of programs. Despite concordance in preferences for diet and physical activity interventions between patients and providers, there was disagreement about how the effects of these interventions should be monitored. Patients wanted to be held accountable to providers, but providers wanted patients to be accountable to themselves. Conclusions: Our findings emphasize the importance of actively engaging patient and provider stakeholders in efforts to develop interventions that address behavioral risk factors for cancer health disparities. While there is concordance between patients and providers in terms of the behavioral focus of interventions and barriers and facilitators to implementation, there may be discordance in terms of how the effects of interventions are monitored. Efforts to disseminate and implement evidence-based interventions into primary care should consider the preferences of both patients and providers. Citation Format: LaShanta J. Rice, Melanie Jefferson, Cathy L. Melvin, Chanita Hughes Halbert. Concordance in patient and provider priorities and preferences to address behavioral risk factors for cancer health disparities interventions. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr A08.

Parental feeding practices, food neophobia, and child food preferences: What combination of factors results in children eating a variety of foods?

Our aim was to describe food neophobia, parenting feeding practices, and concordance in food preferences between parent–child dyads using a cross-sectional on-line survey completed by parents of preschoolers (3–5y). Respondents (n=210) included mothers (89%) who were predominantly white (85%) and college educated (64%). Most children (mean age=41.7 mo±14.9), were perceived to be of a healthy weight (81%) and “good eaters” (60%). Parent (21.9±7.4) and child food neophobia (30.4±8.8) correlated significantly, though modestly (r=0.14, p=0.04). The parent practice of offering new foods to eat was inversely associated with child food neophobia (r=−0.40, p<.0001) and pressure to eat (r=−0.13, p=0.07). Parent–child dyads had >75% concordance in preferences for whole grains, fruit, starchy vegetables, and dairy. Lowest concordance (39–66%) was noted for sweetened beverages and entrees. Discordance occurred when parents had never offered their children a food (e.g., vegetables), and was uninfluenced by demographic factors. A child’s food neophobia and overweight status was associated with the child having a lower consumption of vegetables. Parent reports of giving the child more control of food-related decisions was associated with a higher number of healthy foods rated as liked by a child. Similarities in parent–child food preferences may be related to food neophobia and, consequently, the foods parents offer their children. Educating parents on the potential impact of feeding practices may be important for early intervention efforts to improve children’s food acceptance.

Food neophobia and food preference concordance among parent‐child dyads and parents' offering of new foods (252.1)

Our aim was to describe parent/child neophobia, parent offering of new foods, and concordance in food preferences between parent‐child dyads. University email listservs were used to recruit parents of preschoolers (2‐5 y) to complete an online REDCap survey about picky eating. Scales were selected from The Child Feeding Questionnaire+ (offering new foods and pressure to eat), the Child Food Neophobia Scale and 80 items to determine parent‐child food preferences. Concordance (% agreement) and Pearson correlations were calculated in SAS 9.4. The significance level was set at alpha = .05. Respondents (n=258) included mothers (86%), were white (83%), and college educated (65%). Most children (mean age = 40.6 mo ±13.8), were perceived to be of healthy weight (80%) and “good eaters” (60%). Parent (22.0 ± 7.3) and child neophobia (30.0 ± 9.2) correlated significantly (r=.41,p&lt;.01). Offering new foods to children was inversely associated with child (r=‐.52, p&lt;.01) and parent neophobia (r=‐.40, p&lt;.01) and pressure to eat (r=‐.24, p&lt;.01). Parent‐child dyads had &gt;75% concordance in preferences for whole grains, fruit, starchy vegetables and dairy. Lowest concordance (39‐66%) was noted for other vegetables, sweetened beverages, and specific entrees. Discordance occurred when parents had never offered their children a food (e.g. vegetables &amp; proteins), and was uninfluenced by demographic factors. Similarities in parent/child food preferences may be related to the trait of neophobia and, consequently, the specific foods parents offer their children. Educating parents on the potential impact their own neophobia has on their child’s food preferences may be important for early intervention efforts to improve children’s food acceptance.

Preferences for and experiences of family involvement in cancer treatment decision‐making: patient–caregiver dyads study

Despite the important role that family caregivers play in providing emotional and practical support to cancer patients, relatively little is known about the family caregiver's role in treatment decision-making (TDM). We sought to investigate patients' and family caregivers' preferences for and experiences of family involvement in TDM and factors associated with preference concordance. A national survey was performed with 990 patient-caregiver dyads (participation rate:76.2%). Questions examining preferences for and experiences of family involvement in TDM were administered independently to patients and family caregivers. Concordance was calculated with weighted kappa. Logistic regression analyses were used to identify predictors of patients' and caregivers' preferences for family involvement in TDM and concordance between them. Few patients or family caregivers expressed a preference for unilateral decision-making; however, there was considerable variation and poor agreement within dyads in regard to whether the patient or family caregivers should take the lead in decision-making with input from the other (weighted kappa between respondents for TDM preferences and experiences = 0.10 and κ = 0.18, respectively). Greater TDM preference concordance was associated with higher patient education, whereas lower levels of concordance were evident for younger patients, less educated caregivers, adult child patient dyads (as opposed to a spouse-patient dyads) and problematic family communication about cancer. Most patients and family caregivers valued and expected family involvement in TDM. However, there is little explicit agreement in regard to which party in the dyad should take decisional leadership and who should play a supporting role.