A Discrete Choice Experiment to Elicit Preferences for a Liver Screening Programme in Queensland, Australia: A Mixed Methods Study to Select Attributes and Levels

Abstract

Background In Australia, the overall prevalence of liver disease is increasing. Maximising uptake of community screening programmes by understanding patient preferences is integral to developing consumer-centred care models for liver disease. Discrete choice experiments (DCEs) are widely used to elicit preferences for various healthcare services. Attribute development is a vital component of a well-designed DCE and should be described in sufficient detail for others to assess the validity of outcomes. Hence, this study aimed to create a list of potential attributes and levels which can be used in a DCE study to elicit preferences for chronic liver disease screening programmes. Methods Key attributes were developed through a multi-stage, mixed methods design. Focus groups were held with consumers and health care providers on attributes of community screening programmes for liver disease. Stakeholders then prioritised attributes generated from the focus group in order of importance via an online prioritisation survey. The outcomes of the prioritisation exercise were then reviewed and refined by an expert panel to ensure clinically meaningful levels and relevance for a DCE survey. Results Fifteen attributes were generated during the focus group sessions deemed necessary to design liver disease screening services. Outcomes of the prioritisation exercise and expert panel stages recognised five attributes, with three levels each, for inclusion in a DCE survey to elicit consumer preferences for community screening for liver disease. This study also highlights broader social issues such as the stigma around liver disease that require careful consideration by policy makers when designing or implementing a liver screening programme. Conclusions The attributes and levels identified will inform future DCE surveys to understand consumer preferences for community screening programmes for liver disease. In addition, the outcomes will help inform the implementation of the LOCATE-NAFLD programme in real-world practice, and could be relevant for other liver and non-liver related chronic disease screening programmes.

Implementation of a nurse-delivered, community-based liver screening and assessment program for people with non-alcoholic fatty liver disease (LOCATE-NAFLD trial)

“…Overcoming a lack of awareness of liver disease in the community has been identi ed as a priority for screening programs (19,20). In addition to accuracy of assessments, factors related to ease and convenience of access, positive interactions between consumer and health care workers, and system level issues such as cost and wait time have all been highlighted as important factors for adoption of screening (19). This study supports these ndings with similar challenges to uptake and maintenance identi ed by GPs and patients.…”