title: The importance of measuring strength-of-preference scores for health care options in preference-sensitive care.
abstract: OBJECTIVE
  The objective was to determine whether a paired-comparison/Leaning Scale (LS) method: 1) could feasibly be used to elicit strength-of-preference scores for elective health care options in large community-based survey settings and 2) could reveal preferential subgroups that would have been overlooked if only a categorical-response format had been used.
  
  
  METHODS
  Medicare beneficiaries in four different regions of the United States were interviewed in person. Participants considered eight clinical scenarios, each with two to three different health care options. For each scenario, participants categorically selected their favored option, then indicated how strongly they favored that option relative to the alternative on a paired-comparison bidirectional LS.
  
  
  RESULTS
  Two hundred two participants were interviewed. For seven of the eight scenarios, a clear majority (>50%) indicated that, overall, they categorically favored one option over the alternative(s). However, the bidirectional strength-of-preference LS scores revealed that, in four scenarios, for half of those participants, their preference for the favored option was actually "weak" or "neutral."
  
  
  CONCLUSIONS
  Investigators aiming to assess population-wide preferential attitudes toward different elective health care scenarios should consider gathering ordinal-level strength-of-preference scores and could feasibly use the paired-comparison/bidirectional LS to do so.
authors.affiliation: Centre for Health Services and Policy Research, University of British Columbia, 201-2206 East Mall, Vancouver, British Columbia V6T 1Z3, Canada. tcrump@chspr.ubc.ca
authors.forename: R Trafford
authors.initials: RT
authors.lastname: Crump
authors.forename: Hilary A
authors.initials: HA
authors.lastname: Llewellyn-Thomas
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D003625:Data Collection / Q000379:methods; D003695:Delivery of Health Care / Q000379:methods / Q000592:standards*; D005260:Female; D019538:Health Care Surveys / Q000379:methods; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D010342:Patient Acceptance of Health Care / Q000523:psychology; D057240:Patient Preference / Q000523:psychology / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000523:psychology