Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
J Alzheimers Dis. 2023;91(1):105-114. doi: 10.3233/JAD-220604.
Discrete choice experiments (DCEs) may facilitate persons with dementia and informal caregivers to state care preferences. DCEs can be cognitively challenging for persons with dementia.
This study aims to design a dementia friendly dyadic DCE that enables persons with dementia and informal caregivers to provide input individually and jointly, by testing the number of attributes and choice tasks persons with dementia can complete and providing insight in their DCE decision-making process.
This study included three DCE rounds: 1) persons with dementia, 2) informal caregivers, and 3) persons with dementia and informal caregivers together. A flexible DCE design was employed, with increasing choice task complexity to explore cognitive limitations in decision-making. Summary statistics and bivariate comparisons were calculated. A qualitative think-aloud approach was used to gain insight in the DCE decision-making processes. Transcripts were analyzed using thematic analysis.
Fifteen person with dementia, 15 informal caregiver, and 14 dyadic DCEs were conducted. In the individual DCE, persons with dementia completed six choice tasks (median), and 80% could complete a choice task with least three attributes. In the dyadic DCE persons with dementia completed eight choice tasks (median) and could handle slightly more attributes. Qualitative results included themes of core components in DCE decision-making such as: understanding the choice task, attribute and level perception, option attractiveness evaluation, decision rule selection, and preference adaptation.
Persons with dementia can use simple DCE designs. The dyadic DCE was promising for dyads to identify overlapping and discrepant care preferences while reaching consensus.
离散选择实验（DCE）可以帮助痴呆症患者和非专业照护者表达他们对护理的偏好。然而，DCE 对于痴呆症患者来说可能具有认知挑战性。
本研究旨在设计一种对痴呆症友好的双人 DCE，使痴呆症患者和非专业照护者能够单独和共同提供意见，通过测试痴呆症患者能够完成的属性和选择任务的数量，并深入了解他们的 DCE 决策过程。
本研究包括三个 DCE 轮次：1）痴呆症患者，2）非专业照护者，3）痴呆症患者和非专业照护者一起。采用灵活的 DCE 设计，增加选择任务的复杂性，以探索决策中的认知限制。计算了汇总统计数据和双变量比较。使用出声思维的定性方法深入了解 DCE 决策过程。使用主题分析对转录本进行分析。
共进行了 15 次痴呆症患者、15 次非专业照护者和 14 次双人 DCE。在个体 DCE 中，痴呆症患者完成了六个选择任务（中位数），80%的患者能够完成具有至少三个属性的选择任务。在双人 DCE 中，痴呆症患者完成了八个选择任务（中位数），并且能够处理稍微更多的属性。定性结果包括 DCE 决策中的核心组成部分的主题，例如：理解选择任务、属性和水平感知、选项吸引力评估、决策规则选择和偏好调整。
痴呆症患者可以使用简单的 DCE 设计。双人 DCE 有望在确定重叠和不同的护理偏好的同时达成共识。
