What Do Patients Want from Otolaryngologists? A Discrete Choice Experiment

Naunheim, Matthew R.; Rathi, Vinay K.; Naunheim, Margaret L; Alkire, Blake C; Lam, Allen C.; Song, Phil Hyun; Shrime, Mark G.

doi:10.1177/0194599817717662

Cited by 13 publications

(12 citation statements)

References 24 publications

(42 reference statements)

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“…In otolaryngology, a field often dedicated to delivering quality‐of‐life interventions, it is particularly prudent to understand the individuals’ underlying valuations and preferences. Unfortunately, providers too often lack awareness of such values . This study helps delineate how the general public views the condition of dysphonia, evidence that may contribute toward measuring value in otolaryngology.…”

Section: Discussionmentioning

confidence: 99%

The health utility of mild and severe dysphonia

DeVore

Shrime

Wittenberg³

et al. 2019

The Laryngoscope

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Objectives/Hypothesis: The impact of disease states can be measured using health state utilities, which are values that reflect economic preferences for health outcomes. Utilities for dysphonia have not been studied using direct methods. The objective of this project was to establish the baseline health utilities of mild and severe dysphonia from a societal perspective.Study Design: Direct utility elicitation survey. Methods: Four health states (monocular blindness, binocular blindness, mild dysphonia, and severe dysphonia) were evaluated by a convenience sample of adults recruited from the general public with three computer-aided estimation techniques (visual analog scale [VAS], standard gamble [SG], and time trade-off [TTO]). Standardized descriptions and voice recordings from multiple dysphonic patients were employed. Perfect health was defined as a utility of 1, with death 0. Analysis of variance with post hoc pairwise comparison was used to calculate significant differences between health states.Results: Three hundred participants were surveyed, and 225 (75.0%) responses met quality thresholds. Severe dysphonia (VAS = 48.3, SG = 0.810, TTO = 0.798) was valued significantly worse than monocular blindness (VAS = 56.2, SG = 0.834, TTO = 0.839) on the VAS (P < .001) and equivalent on SG and TTO; it was preferred over binocular blindness (VAS = 25.7, SG = 0.631, TTO = 0.622; P < .001) with all methods. Mild dysphonia evaluated favorably with all methods to the other health states (VAS = 78.5, SG = 0.902, TTO = 0.908; P < .001).Conclusions: Voice disorders may have a measurable impact on utility, with severe dysphonia valued equivalently to monocular blindness. Mild dysphonia has a utility decrement from perfect health. These estimates are critical for quality-of-life assessment and could be used to assess cost-effectiveness of treatments for voice disorders.

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Section: Discussionmentioning

confidence: 99%

The health utility of mild and severe dysphonia

DeVore

Shrime

Wittenberg³

et al. 2019

The Laryngoscope

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“…Eight additional studies assessed understanding in both pretesting and within the DCE survey [43,[85][86][87][88][89][90][91]. These studies were similar to the other reported studies, with pretesting results used to refine the wording and formatting of the surveys, and the rationality tests using dominant or repeated choice tests and debriefing questions.…”

Section: Pilot Testingmentioning

confidence: 83%

Respondent Understanding in Discrete Choice Experiments: A Scoping Review

Pearce

Harrison

Watson

et al. 2020

Patient

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Introduction Despite the recognised importance of participant understanding for valid and reliable discrete choice experiment (DCE) results, there has been limited assessment of whether, and how, people understand DCEs, and how 'understanding' is conceptualised in DCEs applied to a health context. Objectives Our aim was to identify how participant understanding is conceptualised in the DCE literature in a health context. Our research questions addressed how participant understanding is defined, measured, and used. Methods Searches were conducted (June 2019) in the MEDLINE, EMBASE, PsychINFO and Econlit databases, as well as hand searching. Search terms were based on previous DCE systematic reviews, with additional understanding keywords used in a proximity-based search strategy. Eligible studies were peer-reviewed journal articles in the field of health, related to DCE or best-worst scaling type 3 (BWS3) studies, and reporting some consideration or assessment of participant understanding. A descriptive analytical approach was used to chart relevant data from each study, including publication year, country, clinical area, subject group, sample size, study design, numbers of attributes, levels and choice sets, definition of understanding, how understanding was tested, results of the understanding tests, and how the information about understanding was used. Each study was categorised based on how understanding was conceptualised and used within the study. Results Of 306 potentially eligible articles identified, 31 were excluded based on titles and abstracts, and 200 were excluded on full-text review, resulting in 75 included studies. Three categories of study were identified: applied DCEs (n = 52), pretesting studies (n = 7) and studies of understanding (n = 16). Typically, understanding was defined in relation to either the choice context, such as attribute terminology, or the concept of choosing. Very few studies considered respondents' engagement as a component of understanding. Understanding was measured primarily through qualitative pretesting, rationality or validity tests included in the survey, and participant self-report, however reporting and use of the results of these methods was inconsistent. Conclusions Those conducting or using health DCEs should carefully select, justify, and report the measurement and potential impact of participant understanding in their specific choice context. There remains scope for research into the different components of participant understanding, particularly related to engagement, the impact of participant understanding on DCE validity and reliability, the best measures of understanding, and methods to maximise participant understanding.

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“…Patient preference research continues to gain importance in otolaryngology and medicine at large . Along with other preference assessment methodologies, prospective assessment of health state utility values contributes both to a patient‐centric understanding of the disability resulting from voice disorders, and helps inform the economic evaluation of our interventions for the purpose of resource allocation at a societal level.…”

Section: Discussionmentioning

confidence: 99%

Measuring the impact of dysphonia on quality of life using health state preferences

et al. 2019

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Objectives Formal evaluation of health states related to dysphonia have not been rigorously evaluated in affected patients. The objective of this project was to evaluate the health states of mild, moderate, and severe dysphonia using formal health state preference evaluation, and to compare these outcomes with the degree of voice handicap. Design Prospective health state preference assessment. Methods A convenience sample of patients presenting with voice complaints were enrolled from an academic voice center. Demographic and voice handicap index (VHI‐10) data were obtained, and an assessment of preference for five health states (monocular blindness, binocular blindness, mild dysphonia, moderate dysphonia, and severe dysphonia) was performed. Utility scores were calculated on a scale from 0 (death) to 1 (perfect health). Analysis was performed with ANOVA testing with post‐hoc comparisons and correlation statistics. Results Of 209 assessments, 149 (75.6%) met quality criteria. Relative to monocular blindness (score 0.61 [CI 0.57–0.64]), moderate dysphonia (0.58 [0.54–0.62]) was rated equivalently, with severe dysphonia (0.33 [0.29–0.37]) ranking significantly worse and mild dysphonia (0.96 [0.95–0.98]) significantly better. Binocular blindness (0.18 [0.15–0.21]) was the worst‐ranked health state. There was a weak inverse correlation of VHI‐10 with dysphonia‐related preference scores; with worsening reported voice handicap, scores decreased. Conclusion This study demonstrated that dysphonia had a significant impact of quality of life, with moderate dysphonia ranking equivalently with monocular blindness. These numerical estimates may be used for ongoing research into the value and cost‐effectiveness of medical, therapeutic, and surgical interventions for voice disorders. Level of Evidence 2c (outcomes research) Laryngoscope, 130:E177–E182, 2020

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What Do Patients Want from Otolaryngologists? A Discrete Choice Experiment

Cited by 13 publications

References 24 publications

The health utility of mild and severe dysphonia

The health utility of mild and severe dysphonia

Respondent Understanding in Discrete Choice Experiments: A Scoping Review

Measuring the impact of dysphonia on quality of life using health state preferences

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