Eliciting preferences of persons with dementia and informal caregivers to support ageing in place in the Netherlands:a protocol for a discrete choice experiment

Introduction:Ageing in place (AIP) for persons with dementia is encouraged by European governments and societies. Healthcare packages may need reassessment to account for the preferences of care funders, patients and informal caregivers. By providing insight into people's preferences, discrete choice experiments (DCEs) can help develop consensus between stakeholders. This protocol paper outlines the development of a Dutch national study to cocreate a healthcare package design methodology built on DCEs that is person-centred and helps support informal caregivers and persons with dementia to AIP. A subpopulation analysis of persons with dementia with a migration background is planned due to their high risk for dementia and under-representation in research and care. Methods and analysis:The DCE is designed to understand how persons with dementia and informal caregivers choose between different healthcare packages. Qualitative methods are used to identify and prioritise important care components for persons with dementia to AIP. This will provide a list of care components that will be included in the DCE, to quantify the care needs and preferences of persons with dementia and informal caregivers. The DCE will identify individual and joint preferences to AIP. The relative importance of each attribute will be calculated. The DCE data will be analysed with the use of a random parameters logit model. Ethics and dissemination:Ethics approval was waived by the Amsterdam University Medical Center (W23_112 #23.137). A study summary will be available on the websites of Alzheimer Nederland, Pharos and Amsterdam Public Health institute. Results are expected to be presented at (inter)national conferences, peer-reviewed papers will be submitted, and a dissemination meeting will be held to bring stakeholders together. The study results will help improve healthcare package design for all stakeholders.</p

Exploring the relationships between participatory decision-making, visit duration, and general practitioners' provision of argumentation to support their medical advice: Results from a content analysis

Objective: General practitioners' medical recommendations are not always accepted by their patients. As patients bring their own beliefs, knowledge, and preferences to the medical encounter, their opinions concerning diagnosis and treatment may deviate from their doctors'. Aiming to convince their patients of the acceptability of their advice, doctors can advance arguments.Few quantitative studies have been conducted focusing on general practitioners' provision of argumentation and little is known about the relationship between the use of argumentation and characteristics of the medical visit, such as (participatory) decision-making and visit duration. This study seeks to explore these relationships. Methods: An observational study of seventy, randomly drawn videos of general practice consultations was conducted. A theory-based codebook was developed. Two independent coders analyzed doctors' provision of argumentation, their decision-making style, and the duration of each visit. Results: General practitioners' provision of argumentation was found to be associated with lengthier visits and a more participatory decision-making style. In addition, visit duration and participatory decision-making appeared associated. Conclusion: These results suggest that the use of argumentation may contribute toward achieving patient-centered care through communication. Practice implications: As a result, the findings underscore the potential relevance of developing courses focusing on doctors' argumentation skills

The effects of general practitioners’ use of argumentation to support their treatment advice:results of an experimental study using video-vignettes

In recent years, general practice consultation has often been characterized as an argumentative activity. It has been argued that, guided by the ethical and legal principle of informed consent and the ideal standards of participatory and evidence-based medicine, doctors should provide argumentative support for their recommendations in order to encourage patients to actively take part in the treatment decision-making discussion. Thus far, however, it has remained unclear what causal effect general practitioners’ provision of argumentation may have on consultation outcomes, such as patients’ perceptions of their doctors’ decision-making style and credibility, their acceptance and recall of the medical advice, and subsequently their intention to adhere to the advice. In this study, therefore, the effect of general practitioners’ argumentative support for their treatment recommendations is studied experimentally using scripted video-vignettes. Moreover, rather than focusing merely on the presence of argumentation, the role of the pragma-dialectical reasonableness of general practitioners’ argumentation is also taken into account

The effects of reasoned shared decision-making on consultation outcomes:Results of a randomized controlled experiment among a student population

Shared decision-making (SDM) has been promoted as an ideal model for doctor-patient communication. Additionally, several studies have advocated doctors' use of argumentation to support their treatment recommendations. Therefore, this experiment explores the effects of doctors' use of SDM indicators and argumentation on patients' advice recall, intended adherence, and satisfaction (2 × 2 factorial design). The findings suggest that doctors' combined use of argumentation and SDM results in significantly higher satisfaction with the consultation than SDM and argumentation alone. These results shed a new light on the relevance of argumentative discourse in the specific context of contemporary medical communication

Application of the theory of regulatory fit to promote adherence to evidence-based breast cancer screening recommendations: Experimental versus longitudinal evidence

Objectives To reduce overtreatment caused by overuse of screening, it is advisable to reduce the demand for mammography screening outside the recommended guidelines among women who are not yet eligible for inclusion in systematic screening programmes. According to principles of regulatory fit theory, people make decisions motivated by either orientation to achieving and maximising gains or avoiding losses. A study developed in two phases investigated whether video messages, explaining the risks and benefits of mammography screening for those not yet eligible, are perceived as persuasive Design Phase 1 was an experimental study in which women's motivation orientation was experimentally induced and then they were exposed to a matching video message about mammography screening. A control group received a neutral stimulus. Phase 2 introduced a longitudinal component to study 1, adding a condition in which the messages did not match with the group's motivation orientation. Participants' natural motivation orientation was measured through a validated questionnaire Participants 360 women participated in phase 1 and another 292 in phase 2. Participants' age ranged from 30 to 45 years, and had no history of breast cancer or known BReast CAncer gene (BRCA) 1/2 mutation. Results In phase 1, a match between participants' motivation orientation and message content decreased the intention to seek mammography screening outside the recommended guidelines. Phase 2, however, did not show such an effect. Fear of breast cancer and risk perception were significantly related to intention to seek mammography screening Conclusions Public health researchers should consider reducing the impact of negative emotions (ie, fear of breast cancer) and risk perception when promoting adherence to evidence-based breast cancer screening recommendations

Mammography perceptions and practices among women aged 30–49:The role of screening programme availability and cultural affiliation

Objective: To explore the role of systematic screening programme availability and cultural affiliation as drivers of mammography perceptions/practices among women aged 30–49, who are not eligible for screening. Methods: Cross-sectional survey about mammography perceptions/practices among N = 918 Swiss women (30–49), across three cultural-linguistic regions (Swiss-German, Swiss-French, Swiss-Italian) and 26 cantons. Results: In cantons offering systematic screening programmes, women appeared more likely to ask for a mammogram, felt more susceptible to breast cancer, and perceived more benefits to screening. Swiss-German women engaged less in screening and felt less susceptible to breast cancer than women in other cultural-linguistic regions. Within the Swiss-German region, women living in cantons with programmes were more likely to ask for a mammogram than in cantons without. Conclusions: Programme availability and cultural affiliation both appear related to young women's screening perceptions/practices. While the interaction between these factors should be further explored, this study provides some preliminary evidence that cultural affiliation is the more important driver. Practice Implications: Health communication efforts should consider the impact of these drivers on women's intentions to have a mammogram, prior to the recommended age. Tailored communication – public and interpersonal - should be directed towards facilitating informed decision-making and avoidance of mammography overuse