Identifying preferred features of weight loss programmes for adults with, or at risk of, type 2 diabetes: a discrete choice experiment with 3,960 adults in the UK

Objective: To understand preferences for features of weight loss programmes among adults with, or at risk of, type 2 diabetes in the UK. Research Design and Methods: A discrete choice experiment with 3,960 UK adults living with overweight, (675 with type 2 diabetes). Preferences for seven characteristics of weight loss programmes were analysed. Simulations from choice models using the experimental data predicted uptake of available weight loss programmes. Patient groups comprising those who have experience with weight loss programmes, including from minority communities, informed the experimental design. Results: Preferences did not differ between people with or without type 2 diabetes. Preferences were strongest for the type of diet. Healthy eating was most preferred relative to total diet replacement (TDR) (OR=2.24, 95%CI: 2.04-2.44). Individual interventions were more popular than groups (OR=1.40, 95%CI: 1.34-1.47). People preferred programmes offering weight loss of 10-15 kg (OR=1.37, 95%CI: 1.28-1.47) compared with 2-5kg. Online content was preferred over in-person contacts (OR=1.24, 95%CI: 1.18-1.30). There were few differences in preferences by gender and ethnicity though weight loss was more important for women than for men, and individuals from ethnic minority populations identified more with programmes where others shared their characteristics. Modelling suggested that tailoring programmes to individual preferences could increase participation by around 17 percentage points (68% in relative terms). Conclusions: Offering a range of weight loss programmes targeting the preferred attributes of different patient groups could potentially encourage more people to participate in weight loss programmes and support people living with overweight to reduce their weight

Toward the diagnosis of rare childhood genetic diseases: what do parents value most?

Genomic testing is becoming routine for diagnosing rare childhood genetic disease. Evidence underlying sustainable implementation is limited, focusing on short-term endpoints such as diagnostic yield, unable to fully characterize patient and family valued outcomes. Although genomic testing is becoming widely available, evidentiary and outcomes uncertainty persist as key challenges for implementation. We examine whether the current evidence base reflects public tolerance for uncertainty for genomics to diagnose rare childhood genetic disease. We conducted focus groups with general population parents in Vancouver, Canada, and Oxford, United Kingdom, to discuss expectations and concerns related to genomic testing to diagnose rare childhood genetic disease. Applying a purposive sampling technique, recruitment continued until thematic saturation was reached. Transcripts were analysed using thematic analysis. Thirty-three parents participated across four focus groups. Participants valued causal diagnoses alongside management strategies to improve patient health and wellbeing. Further, participants valued expanding the evidence base to reduce evidentiary uncertainty while ensuring security of information. Willingness to pay out of pocket for testing reflected perceived familial health benefit. Diagnostic yield fails to fully capture valued outcomes, and efforts to resolve uncertainty better reflect public priorities. Evaluations of genomic testing that fully integrate valued endpoints are necessary to ensure consistency with best practices and public willingness to accept the uncertain familial benefit