Zhou Panpan, Wang Xian, Gu Fei, Huang Zheng, Yu Jinzhi, Li Meng
Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
Vascular. 2024 Dec 16:17085381241307911. doi: 10.1177/17085381241307911.
Patients suffering from lower extremity venous ulcers typically undergo prolonged dressing changes, entailing extended treatment cycles and significant costs, creating an urgent need for effective continuous care. There is scarce literature reporting on the preferences and requirements for wound care within continuous care services for such conditions. Discrete choice experiments serve as an innovative method to elicit patient preferences, where the development of attributes and levels is a critically important process.
To identify attributes and levels patients with venous leg ulcers consider when making decisions about continued care services for venous leg ulcers.
In this study, we employed four steps to devise service features (i.e., attributes) and their potential manifestations (i.e., levels). Firstly, we conducted a systematic literature search with articles screened and content compiled by two researchers to identify possible service attributes. Secondly, we conducted in-depth interviews with patients suffering from venous leg ulcers to gather personal experiences and expectations for quality care, and used Nvivo11.0 for data management. Thirdly, focus group discussions were held to assess general viewpoints from various perspectives. Finally, expert meetings were organized to refine our research tools further. To narrow down the attributes to a manageable number for the discrete choice experiment, focus groups and expert meetings performed ranking exercises, calculating the average importance scores by dividing the total score by the number of participants and ranking attributes from highest to lowest average scores.
Through literature reviews, qualitative data acquisition, expert meetings, and ranking exercises, a total of six attributes were finalized, each with two to three levels. The attributes included: 1) service cost (Ave score: 4.7); 2) Mode of service delivery (Ave score: 4.5); 3) Service type (Ave score: 4.4); 4) Consistency of caregiver (Ave score: 4.4); 5) Category of service providers (Ave score: 4.3); and 6) Appointment scheduling (Ave score: 4.3). These attributes encompassed key aspects related to wound care in the continuous care services for patients with venous leg ulcers.
The mixed-methods approach adopted in this study has proven particularly suitable for identifying, refining, and selecting attributes and levels for discrete choice experiments. By leveraging the advantages and limitations of the four steps, and especially through qualitative data analysis, a more profound and comprehensive understanding of the attributes and levels was achieved. This approach has facilitated the practicality and accuracy in attribute construction, enhancing the overall efficacy of the DCE design.
下肢静脉溃疡患者通常需要长时间更换敷料，治疗周期长且费用高昂，因此迫切需要有效的持续护理。关于此类病症持续护理服务中伤口护理的偏好和需求的文献报道很少。离散选择实验是一种引出患者偏好的创新方法，其中属性和水平的确定是一个至关重要的过程。
确定下肢静脉溃疡患者在决定下肢静脉溃疡持续护理服务时考虑的属性和水平。
在本研究中，我们采用四个步骤来设计服务特征（即属性）及其潜在表现形式（即水平）。首先，我们进行了系统的文献检索，由两名研究人员筛选文章并汇编内容，以确定可能的服务属性。其次，我们对下肢静脉溃疡患者进行了深入访谈，以收集他们对优质护理的个人经历和期望，并使用Nvivo11.0进行数据管理。第三，举行了焦点小组讨论，以评估不同角度的总体观点。最后，组织了专家会议以进一步完善我们的研究工具。为了将属性数量减少到离散选择实验可管理的数量，焦点小组和专家会议进行了排序练习，通过将总分除以参与者人数来计算平均重要性得分，并按平均得分从高到低对属性进行排序。
通过文献综述、定性数据收集、专家会议和排序练习，最终确定了六个属性，每个属性有两到三个水平。这些属性包括：1）服务成本（平均得分：4.7）；2）服务提供方式（平均得分：4.5）；3）服务类型（平均得分：4.4）；4）护理人员的一致性（平均得分：4.4）；5）服务提供者类别（平均得分：4.3）；6）预约安排（平均得分：4.3）。这些属性涵盖了下肢静脉溃疡患者持续护理服务中与伤口护理相关的关键方面。
本研究采用的混合方法已证明特别适合于确定、完善和选择离散选择实验的属性和水平。通过利用这四个步骤的优点和局限性，特别是通过定性数据分析，对属性和水平有了更深刻和全面的理解。这种方法提高了属性构建的实用性和准确性，增强了DCE设计的整体效果。
