Comparing the health state preferences of older persons, informal caregivers and healthcare professionals: a vignette study.
BACKGROUND
The Older Persons and Informal Caregivers Survey-Minimum Dataset (TOPICS-MDS) collects uniform information from research projects funded under the Dutch National Care for the Elderly Programme. To compare the effectiveness of these projects a preference-weighted outcome measure that combined multidimensional TOPICS-MDS outcomes into a composite endpoint (TOPICS-CEP) was developed based on the health state preferences of older persons and informal caregivers.


OBJECTIVE
To derive preference weights for TOPICS-CEP's components based on health state preferences of healthcare professionals and to investigate whether these weights differ between disciplines and differ from those of older persons and informal caregivers.


METHODS
Vignette studies were conducted. Participants assessed the general wellbeing of older persons described in vignettes on a scale (0-10). Mixed linear analyses were used to obtain and compare the preference weights of the eight TOPICS-CEP components: morbidities, functional limitations, emotional wellbeing, pain experience, cognitive problems, social functioning, self-perceived health, and self-perceived quality of life (QOL).


RESULTS
Overall, 330 healthcare professionals, 124 older persons and 76 informal caregivers participated. The preference weights were not significantly different between disciplines. However, the professionals' preference weights differed significantly from those of older persons and informal caregivers. Morbidities and functional limitations were given more weight by older persons and informal caregivers than by healthcare professionals [difference between preference weights: 0.12 and 0.07] while the opposite was true for pain experience, social functioning, and self-perceived QOL [difference between preference weights: 0.13, 0.15 and 0.26].


CONCLUSIONS
It is important to recognize the discrepancies between the health state preferences of various stakeholders to (1) correctly interpret results when studying the effectiveness of interventions in elderly care and (2) establish appropriate healthcare policies. Furthermore, we should strive to include older persons in our decision making process through a shared decision making approach.
Radboud university medical center, Department of Geriatric Medicine (HP 925), Nijmegen, The Netherlands; Radboud university medical center, Department for Health Evidence (HP133), Nijmegen, The Netherlands.
Cynthia S
CS
Hofman
Radboud university medical center, Department of Geriatric Medicine (HP 925), Nijmegen, The Netherlands; Radboud university medical center, Department for Health Evidence (HP133), Nijmegen, The Netherlands.
Peter
P
Makai
Leiden University Medical Centre, Department of Public Health and Primary Care, Leiden, The Netherlands.
Jeanet W
JW
Blom
University of Groningen, University Medical Centre Groningen, Department of Epidemiology (FA41), Groningen, The Netherlands.
Han
H
Boter
Academic Medical Center, Department of Internal Medicine, section of Geriatric Medicine (F4-108), Amsterdam, The Netherlands.
Bianca M
BM
Buurman
Radboud university medical center, Department of Geriatric Medicine (HP 925), Nijmegen, The Netherlands.
Marcel G M
MG
Olde Rikkert
Radboud university medical center, Department for Health Evidence (HP133), Nijmegen, The Netherlands.
Rogier
R
Donders
Radboud university medical center, Department of Geriatric Medicine (HP 925), Nijmegen, The Netherlands.
René J F
RJ
Melis
D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers / Q000706:statistics & numerical data*; D005260:Female; D006282:Health Personnel / Q000706:statistics & numerical data*; D006304:Health Status; D006801:Humans; D008297:Male; D057240:Patient Preference / Q000706:statistics & numerical data*; D011788:Quality of Life; D011795:Surveys and Questionnaires