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Tuesday, October 21, 2008: 12:45 PM
Grand Ballroom B/C (Hyatt Regency Penns Landing)
Purpose:
The purpose was to determine if Medicare beneficiaries’ preferential attitudes towards elective health care options that differ in terms of their relative intensity tend to be “trait-like” (i.e., if individuals’ preference scores for the lower intensity health care option tend to remain the same across a range of different clinical scenarios) or “state-like” (i.e., if individuals’ preference scores for the lower intensity health care option tend to vary by scenario). If these attitudes are “trait-like”, then future studies characterizing the distributions of population attitudes towards the intensity of health care services need use only a few key scenarios during preference elicitation. If attitudes are “state-like”, then such future studies will need to use more tailored preference elicitation strategies.
Methods:
Medicare beneficiaries were interviewed in person by trained community interviewers using a standardized interview schedule. Participants considered 8 hypothetical clinical scenarios involving a choice between a relatively lower- or higher-intensity elective option: 3 scenarios involved seeking medical attention for non-urgent symptoms, and 5 involved end of life (EOL) care. For each scenario, participants were asked to (1) choose their preferred option, and (2) indicate on a 14-point Leaning Scale (LS) how strongly they preferred their chosen option relative to the alternative. For all scenarios, LS responses were uni-directionally scored so that lower/higher scores represent weaker/stronger preferential attitudes towards the lower-intensity option.
Results:
202 participants were interviewed (participation rate = 47%). (1) For the scenarios related to seeking medical attention, 3 participants (1.5%) consistently preferred the lower-intensity option. For the scenarios related to EOL care, 25 (12%) consistently preferred the lower-intensity option. (2) Mean uni-directional LS scores for the scenarios related to seeking medical attention ranged from 2.19 to 8.62 (Kendall's coefficient of concordance = 0.2111). The mean unidirectional LS scores for the scenarios related to EOL care ranged from 4.36 to 12.13 (Kendall's coefficient of concordance = 0.1123).
Conclusions:
In both the medical-attention and the EOL contexts, there was little across-scenario consistency in (1) the frequency with which participants initially chose the lower-intensity option, or (2) their uni-directional LS scores for the lower-intensity option. This implies that Medicare beneficiaries’ attitudes towards low-intensity health care options may be “state-like”; future investigators will need to use specific sets of clinical scenarios to study the distributions of preferential attitudes in large populations.
The purpose was to determine if Medicare beneficiaries’ preferential attitudes towards elective health care options that differ in terms of their relative intensity tend to be “trait-like” (i.e., if individuals’ preference scores for the lower intensity health care option tend to remain the same across a range of different clinical scenarios) or “state-like” (i.e., if individuals’ preference scores for the lower intensity health care option tend to vary by scenario). If these attitudes are “trait-like”, then future studies characterizing the distributions of population attitudes towards the intensity of health care services need use only a few key scenarios during preference elicitation. If attitudes are “state-like”, then such future studies will need to use more tailored preference elicitation strategies.
Methods:
Medicare beneficiaries were interviewed in person by trained community interviewers using a standardized interview schedule. Participants considered 8 hypothetical clinical scenarios involving a choice between a relatively lower- or higher-intensity elective option: 3 scenarios involved seeking medical attention for non-urgent symptoms, and 5 involved end of life (EOL) care. For each scenario, participants were asked to (1) choose their preferred option, and (2) indicate on a 14-point Leaning Scale (LS) how strongly they preferred their chosen option relative to the alternative. For all scenarios, LS responses were uni-directionally scored so that lower/higher scores represent weaker/stronger preferential attitudes towards the lower-intensity option.
Results:
202 participants were interviewed (participation rate = 47%). (1) For the scenarios related to seeking medical attention, 3 participants (1.5%) consistently preferred the lower-intensity option. For the scenarios related to EOL care, 25 (12%) consistently preferred the lower-intensity option. (2) Mean uni-directional LS scores for the scenarios related to seeking medical attention ranged from 2.19 to 8.62 (Kendall's coefficient of concordance = 0.2111). The mean unidirectional LS scores for the scenarios related to EOL care ranged from 4.36 to 12.13 (Kendall's coefficient of concordance = 0.1123).
Conclusions:
In both the medical-attention and the EOL contexts, there was little across-scenario consistency in (1) the frequency with which participants initially chose the lower-intensity option, or (2) their uni-directional LS scores for the lower-intensity option. This implies that Medicare beneficiaries’ attitudes towards low-intensity health care options may be “state-like”; future investigators will need to use specific sets of clinical scenarios to study the distributions of preferential attitudes in large populations.