Preferences of people with diabetes for diabetes care in Germany: a discrete choice experiment.

OBJECTIVES: The objective of this study is to elicit health care preferences of people with diabetes and identify classes of people with different preferences. METHODS: A discrete choice experiment was conducted among people with diabetes in Germany comprising attributes of role division in daily diabetes care planning, type of lifestyle education, support for correct medication intake, consultation frequency, emotional support, and time spent on self-management. A conditional logit model and a latent class model were used to elicit preferences toward diabetes care and analyze preference heterogeneity. RESULTS: A total of 76 people with diabetes, recruited in two specialized diabetes care centers in Germany (mean age 51.9 years, 37.3% women, 49.1% type 2 diabetes mellitus, 50.9% type 1 diabetes mellitus), completed the discrete choice experiment. The most important attributes were consultation frequency, division in daily diabetes care planning, and correct medication intake. The latent class model detected preference heterogeneity by identifying two latent classes which differ mainly with respect to lifestyle education and medication intake. CONCLUSION: While the majority of people with diabetes showed preferences in line with current health care provision in Germany, a relevant subgroup wished to strengthen lifestyle education and medication intake support with an aid or website.

Using a visual support package to facilitate independent leisure engagement and choice-making for individuals with moderate to severe autism in Taiwan.

LAY ABSTRACT: Self-determination encompasses various components, including decision-making and independence, making it a complex process. While the importance of self-determination for individuals with autism spectrum disorder has been explored in previous studies, there is limited research focusing on individuals with moderate to severe autism spectrum disorder. Evidence-based practices such as visual activity schedules and video modeling have shown effectiveness in promoting independence among individuals with autism spectrum disorder. To address the need for independence and choice-making among individuals with moderate to severe autism spectrum disorder, this study developed a visual support package incorporating visual activity schedules, video modeling, preference assessments, and prompt procedures. By investigating the intervention's effectiveness in three participants, this study contributes to the existing literature on the use of a visual activity schedule and video modeling in enhancing choice-making and independent leisure engagement. Following the intervention, all participants were able to select three leisure activities, develop their own visual schedules, and complete them. Notably, this study conducted preference assessments to determine participants' preferred leisure activities and did not provide additional reinforcement. Practical implications of this research include incorporating video prompting as needed and adjusting activity engagement time. Future research should explore the long-term effectiveness of the visual support package and its application in developing novel skills or vocational activities for individuals with moderate to severe autism spectrum disorder. This study fills a critical gap in the literature, providing important insights for practices and research in the field of autism spectrum disorder interventions.

Preference Phenotypes in Thyroid Nodule Management: A Patient Segmentation Approach.

OBJECTIVE: Patient preferences regarding thyroid nodules are poorly understood. Our objective is to (1) employ a discrete choice experiment (DCE) to explore risk tradeoffs in thyroid nodule management, and (2) segment respondents into preference phenotypes. STUDY DESIGN: DCE. SETTING: Thyroid surgery clinic, online survey. METHODS: A DCE including 5 attributes (cancer risk, voice concerns, incision/scar, medication requirement, follow-up frequency) was refined with qualitative patient and physician input. A final DCE including 8 choice tasks, demographics, history, and risk tolerance was administered to participants with and without thyroid disease. Analysis was performed with multinomial logit modeling and latent class analysis (LCA) for preference phenotyping. RESULTS: A total of 1026 respondents were included; 480 had thyroid disease. Risk aversion was associated with increasing age (P < .001), female gender (P < .001), and limited education (P = .038), but not previous thyroid disease. Cancer risk most significantly impacted decision-making. Of the total possible utility change from thyroid nodule decision-making, 47.8% was attributable to variations in cancer risk; 20.0% from medication management; 14.9% from voice changes; 12.7% from incision/scar; and 4.6% from follow-up concerns. LCA demonstrated 3 classes with distinct preference phenotypes: the largest group (64.2%) made decisions primarily based on cancer risk; another group (18.2%) chose based on aversion to medication; the smallest group (17.7%) factored in medication and cancer risk evenly. CONCLUSION: Cancer risk and the need to take medication after thyroid surgery factor into patient decision-making most heavily when treating thyroid nodules. Distinct preference phenotypes were demonstrated, reinforcing the need for individual preference assessment before the treatment of thyroid disorders.

A Continuum of Methods for Assessing Preference for Conversation Topics.

Among individuals with a diagnosis of autism spectrum disorders (ASD), conversation topic preference could influence social skills in many ways. For example, an individual with advanced vocal-verbal skills, but just learning to join a conversation, might be less inclined to participate if the topic chosen is not preferred. However, commonly used preference assessment procedures have not been applied to evaluating conversation-topic preferences. Therefore, the purpose of the current experiment was to conduct three different types of assessments that varied in efficiency, the degree of certainty they allow, and clients with whom they are likely to be applicable and acceptable. In particular, we conducted a self-report preference assessment, a multiple-stimulus-without-replacement (MSWO) preference assessment, and a response restriction conversation assessment (RRCA). Each assessment identified a preferred topic of conversation, but the RRCA was the only assessment that was able to differentiate which topics would maintain a conversation. Implications for assessment and intervention procedures related to complex social skills are discussed and directions for future research are proposed.

The multiple-stimulus-without-replacement preference assessment tool and its predictive validity.

This study demonstrates the use of two web-based programs, one to identify video preferences and the other to assess their reinforcing effects. We used the Multiple-Stimulus-Without-Replacement Preference Assessment Tool (MSWO PAT) to identify the video preference hierarchies of seven participants, ages 4-11 years old. We then used a customized reinforcer assessment program that arranged a concurrent-chains preparation with programmed conjugate schedules of reinforcement. Button presses emitted by participants modulated the quality (volume and opacity) of selected videos on a moment-to-moment basis, allowing us to identify the reinforcing effects of the videos in little time. The results showed that the preference assessment had predictive value for five of seven participants. We discuss the MSWO PAT, parameters that may affect the identification of preferences and the use of conjugate schedules to identify reinforcers.

Efficacy of Edible and Leisure Reinforcers with Domestic Dogs.

Preference assessments are often used to identify stimuli that function as potential reinforcers for training or intervention purposes. Specifically, various preference assessment formats have been used to identify preferred stimuli for humans, cockroaches, cotton-top tamarins, tortoises, and wolves, to name a few. However, to date, no study has evaluated the differential efficacy between food and leisure stimuli within domestic dogs. The current study aimed to compare the reinforcing value and efficacy between food and leisure stimuli for domestic dogs by comparing rates of behavior when receiving access to either their top-preferred food or leisure items. Overall results suggest (1) domestic dogs prefer food over leisure items, and (2) food is more likely to function as a reinforcer than leisure items for domestic dog's behavior. These results suggest that dog owners and trainers should consider using food reinforcers over leisure items as reinforcers when attempting to train dogs.

Single- vs. combined-category preference assessments for edible, leisure, and social-interaction stimuli.

A concern when conducting combined-category preference assessments is the potential for displacement effects, a shift in the preference ranking from highly preferred to moderately or less preferred for stimuli in two of three stimulus categories (e.g., edible, leisure, or social-interaction). In this study, we evaluated potential displacement effects in combined-category arrays of edible, leisure, and social-interaction stimuli for five individuals with autism. First, single-category paired-stimulus preference assessments were implemented to identify two highly preferred stimuli from each category. When these stimuli were included in a combined-category preference assessment, displacement effects were observed for three of five participants. During a subsequent reinforcer assessment, stimuli identified as less preferred in the combined-category preference assessment functioned as reinforcers for two participants. Additionally, although social interaction was not identified as highly preferred for three of the five participants, it functioned as a reinforcer for four participants.

Advancing Methods in Animal-Assisted Intervention: Demonstration of Starting Points in Clinical Practice for Children with Autism Spectrum Disorder.

Therapy animals have been frequently included in interventions for children with autism spectrum disorder (ASD); however, direct and systematic procedures such as assessing preference for and reinforcing efficacy of the animals are rarely conducted. Assessing preference for stimuli is valuable when determining how to make interventions for children with ASD most effective. We conducted paired-stimulus preference assessments and follow-up reinforcer assessments to determine if a therapy dog might be an effective reinforcer. We found one third of participants preferred the dog the least, one third of participants moderately preferred the dog, and one third of participants highly preferred the dog relative to other stimuli. Furthermore, we found preference predicted reinforcing efficacy for five of six participants. We suggest clinicians systematically conduct assessments to clearly identify the role of the therapy animal, to improve quality of, and demonstrate efficacy of interventions including animals for clinical populations.

A review of methods of assessing preference for social stimuli.

Research on preference and reinforcer assessments has historically focused on the evaluation of edible and leisure reinforcers, but the identification and use of individualized social reinforcers may be beneficial for several reasons. Recently, many studies have evaluated methods of assessing preference for social stimuli. The procedures and outcomes across these studies have varied greatly, and the current state of evidence for methods of assessing preference for social stimuli remains unclear. Thus, we conducted a review to synthesize all previous research in this area, evaluate the evidence for the utility of this general methodology, and identify factors that may influence its utility. Our results suggest that social preference assessments are likely to produce results that correspond with reinforcer assessment hierarchies. Preference assessment modality was one factor that influenced utility; video-based preference assessments had greater correspondence with reinforcer assessments than did other modalities. Directions for future research and implications for the use of social preference assessments in research and practices are discussed.

What If You Can't Ask Them? Psychometric Properties of a Behavioral Assessment of Sibling Relationship Quality.

Building on studies of preferences for social interaction in children with autism spectrum disorder (ASD) we sought to provide a way for siblings with ASD to express their perspective about the quality of their sibling relationships. We developed a behavioral assessment of sibling relationship preference (Sibling Relationship Assessment [SRA]) and examined the psychometric properties of test-retest reliability, inter-rater reliability, and convergent validity. The SRA was feasible to administer and revealed expected differences between sibling dyads with one sibling with ASD compared to typically-developing sibling dyads. We found strong positive correlations for inter-rater reliability and test-retest reliability and convergent validity. The SRA provides a way to assess the perspective of the sibling with ASD that taps one characteristic, preference for spending time with one's sibling, of the quality of sibling relationships.

An evaluation of the teach-back method for training new skills.

There are several effective training packages (e.g., behavioral skills training, video modeling, and self-instruction packages) available to train staff. Despite their efficacy, these training procedures require substantial time or preplanning and resources to create materials. Teach-back, an empirically validated method used in the healthcare setting to enhance communication between clinicians and patients, does not require any preplanning or materials. However, this method has yet to be investigated in the context of training and supervision. The purpose of this experiment was to evaluate the efficacy of teach-back in training participants to implement preference assessments and a token economy. The teach-back method improved procedural integrity to at least 88%, and the addition of vocal-verbal feedback resulted in all participants achieving 100% integrity in all skills. We discuss the implications of these findings.

Assessing Preference and Stability of Preference for Individuals with Neurocognitive Disorder.

Poor engagement can lead to a reduced quality of life for individuals with neurocognitive disorder (NCD). Research on determining preference and increasing engagement with this population is limited. The purpose of this study was to compare the accuracy of four preference assessment formats in identifying preferred activities and predicting engagement for six females with NCD and to measure the stability of preference and engagement over time. We compared the predictability of single-stimulus(SS) verbal and multimedia assessments, caregiver ranking (CR) assessments, and multiple-stimulus without-replacement (MSWO) assessments. Participants responded consistently on SS assessments, but we noted inconsistencies between the CR and MSWO assessments. SS assessments predicted engagement during engagement analyses, but rank-order assessments did not predict engagement for moderately ranked activities. The rank-order assessments predicted engagement for highly ranked activities for most participants and for low-ranked activities for two participants. We also evaluated the stability of preferences and engagement over time. Participants responded consistently on SS assessments and inconsistently on MSWO assessments across time. SS assessments consistently predicted engagement during engagement analyses for five participants, but when activity rank is considered, the MSWO was inconsistent in predicting engagement across time for most participants. These results suggest that SS assessments may be useful for identifying preferred activities and engagement, and preferences may remain stable for some individuals with NCD.

Reexamining nodality in equivalence classes.

Equivalence classes are defined according to the substitutability, or functional similarity, of the stimuli within a stimulus class. Several studies have demonstrated that the degree of functional similarity between stimuli in a class is dependent, in part, upon the number of nodes (intervening stimuli) between the stimuli. Higher nodal number is related to lower functional similarity. This effect is referred to as "nodality." There are three key factors that have not been simultaneously controlled for in the relevant studies: priming effects, reinforcement during training, and multiple stimulus functions of stimuli (sample, comparison, or both). In the present experiment, controlling for these factors, two 6-member, 4-node equivalence classes were established, and a within-class preference assessment was used to evaluate nodality. Of 12 participants, five achieved criterion accuracy (90%) during testing. These participants demonstrated nodality, showing preference for stimuli that were nodally proximal to a sample in the preference test. When distal comparisons were chosen, participants took longer, on average, to make the selection compared to selections of proximal stimuli. These findings are consistent with earlier studies demonstrating nodality, which suggests that nodality is a robust phenomenon and not an artifact of the factors that were controlled for in the present study.

Development of an Electronic Tool to Assess Patient Preferences in Geriatric Polypharmacy (PolyPref).

Purpose: Medical decision-making in older adults with multiple chronic conditions and polypharmacy should include the individual patient's treatment preferences. We developed and pilot-tested an electronic instrument (PolyPref) to elicit patient preferences in geriatric polypharmacy. Patients and Methods: PolyPref follows a two-stage direct approach to preference assessment. Stage 1 generates an individual preselection of relevant health outcomes and medication regimen characteristics, followed by stage 2, in which their importance is assessed using the Q-sort methodology. The feasibility of the instrument was tested in adults aged ≥70 years with ≥2 chronic conditions and regular intake of ≥5 medicines. After the assessment with PolyPref, the patients rated the tool with regard to its comprehensibility and usability and assessed the accuracy of the personal result. Evaluators rated the patients' understanding of the task. Results: Eighteen short-term health outcomes, 3 long-term health outcomes, and 8 medication regimen characteristics were included in the instrument. The final population for the pilot study comprised 15 inpatients at a clinic for geriatric rehabilitation with a mean age of 80.6 (± 6.0) years, a median score of 28 (range 25-30) points on the Mini-Mental State Examination, and a mean of 11.6 (± 3.6) regularly taken medicines. Feedback by the patients and the evaluators revealed ratings in favor of understanding and comprehensibility of 86.7% to 100%. The majority of the patients stated that their final result summarized the most important aspects of their pharmacotherapy (93.3%) and that its ranking order reflected their personal opinion (100%). Preference assessment took an average of 35 (± 8.5) min, with the instrument being handled by the evaluator in 14 of the 15 participants. Conclusion: Preference assessment with PolyPref was feasible in older adults with multiple chronic conditions and polypharmacy, offering a new strategy for the standardized evaluation of patient priorities in geriatric pharmacotherapy.

Increasing social time allocation and concomitant effects on mands, item engagement, and rigid or repetitive behavior.

Recent research has developed methods of assessing the function of generic, nonindividualized social interactions. The purpose of this type of assessment is to provide a measure of how an individual may respond to the types of interactions readily available in the natural environment. To date, no research has evaluated how the social time allocation of individuals for whom generic interactions are neutral or aversive could be improved. Moreover, no research has included additional dependent variables that may be functionally related to social time allocation. In the current study, we evaluated the effects of initiating preferred, individualized social interactions on the social time allocation of 3 participants for whom generic interactions functioned as neutral or aversive stimuli. The intervention increased social time allocation for all 3 participants. Next, we evaluated the relation between social time allocation and the occurrence of mands, item engagement, and rigid or repetitive behavior using the intervention data as well as secondary analyses of previously published datasets. The occurrence of mands and rigid or repetitive behaviors changed with improvements in social time allocation and were strongly correlated with social time allocation across participants. Implications for future research on, and the clinical use of, this type of assessment and intervention are discussed.

Corrigendum: Assessing Patient Preferences: Examination of the German Cooper-Norcross Inventory of Preferences.

[This corrects the article on p. 795776 in vol. 12, PMID: 35095681.].

Prospective preference assessment for the Comparison of Analgesic Regimen Effectiveness and Safety in Surgery (CARES) trial.

BACKGROUND: Clinical trials face major barriers such as under-enrollment and selective enrollment, which threaten study completion and undermine validity and generalizability. Thus, we conducted a prospective preference assessment (PPA) prior to commencing the Comparison of Analgesic Regimen Effectiveness and Safety in Surgery (CARES) trial-a randomized controlled study comparing the outcomes of managing acute postoperative pain between opioid-sparing and opioid-based therapies. This PPA aimed to (1) determine the patients' willingness to participate in the CARES trial, (2) identify the areas for improvement, and (3) assess the differences between willing and unwilling patients. METHODS: Patients undergoing elective laparoscopic cholecystectomy were recruited between August 2019 and February 2020 from two academic hospitals. A survey was administered to each patient consisting of (1) a vignette describing the trial, (2) an assessment of the patients' understanding of the trial, (3) open-ended questions assessing the attitudes towards the trial, and (4) patient-completed questionnaires. Data were analyzed qualitatively with thematic analysis and quantitatively with the Wilcoxon signed-rank and chi-square tests. RESULTS: Forty-two patients were enrolled and grouped based on the 6-point Likert scale into willing (4-6, 71%) and not willing (1-3, 29%) to participate in the CARES trial. There were no significant differences with respect to all variables: age, education, sex, visible minority status, previous research, previous surgery, regular use of pain medications, surgical concerns, previous discussions on pain management, significant pain within the past 3 months, and significant use of pain medication within the past month. Factors that motivated participation were contributing to scientific research (45%), altruism (29%), and improving personal pain (24%). Common discouraging factors were negative perceptions of opioids (29%), side effects (21%), being blinded to the study medication (21%), and poor pain management (19%). CONCLUSIONS: This PPA revealed that two key discouraging factors for patients were being blinded to the type of pain medication being taken and the potential for poor pain management as a consequence of participation. Modifications to improve patient acceptance of the CARES trial include ensuring sufficient rescue medicine and follow-up visits consistent with current standards of care for all patients, as well as patient education surrounding safe administration and side effects of the study medications.

Assessing Preference in a Paired-Stimulus Arrangement with Captive Vultures (Aegypius Monachus).

Vultures play an important role in our ecosystem by filtering out bacteria and viruses harmful to humans (e.g., rabies, botulism). However, many vultures remain in human care due to skill deficits and behavioral excesses, which can be treated using behavior-management practices that rely on effective (often edible) reinforcers. The current study replicated the forced-choice or paired-stimulus preference assessment with five birds of prey. Across all vultures, participants displayed a preference for animal (e.g., meat) over nonanimal stimuli (e.g., fruit), and mice meat was the most preferred edible for 4 of the 5 vultures. The application of this methodology to birds of prey might allow rehabilitators, conservationists, and other caretakers to make greater gains in training vultures to both acquire new skills and decrease problem behavior using highly preferred edible items.

Preference for Alternative Communication Modality Based on Reinforcer Quality and Availability.

Preference for augmentative or alternative communication (AAC) systems has received growing interest in work with individuals with developmental disabilities. An individual may choose a modality based on technological (e.g., auditory-output) or aesthetic features of a system; however, it is ideal that functional features (i.e., effectiveness in producing a reinforcer) affect preference to a much greater extent. Prior research has treated preference as a static variable and may commonly report a lack of preference for a modality or control by irrelevant features of the assessment (e.g., position of the modality in an array). The current study assessed the preference for AAC modalities of a teenager with autism spectrum disorder and intellectual disability using a concurrent-chains procedure. This study extended prior research by including additional methods to ensure accurate assessment of preference (i.e., a control condition) and a reinforcer manipulation to determine whether preference was controlled by non-functional (e.g., aesthetic) or functional (i.e., reinforcer quality and availability) variables. Preference was found to be functionally related to reinforcer availability, including when rapidly alternated between modalities. Moreover, the participant consistently allocated responding away from the control condition. Implications for self-determination and suggestions for future research on preference for AAC systems are considered.

Evaluating the effects of social interaction on the results of preference assessments for leisure items.

A variable that may influence the outcomes of stimulus preference assessments (SPAs) is whether social interaction is provided during the stimulus access period. In Experiment 1, we compared the outcomes of a Solitary paired stimulus preference assessment (PSPA) (toys only), Social PSPA (toys plus social interaction), and Combined PSPA (toys alone and toys plus social interaction) to determine whether the addition of social interaction influenced preference for toys in preschool children. In Experiment 2, we conducted a concurrent-operant reinforcer assessment to compare the reinforcing efficacy of stimuli with and without social interaction. Experiment 1 showed preference for toys was stable across assessments (Solitary and Social PSPAs) and most participants preferred toys plus social interaction when compared in a single assessment (Combined PSPA). Experiment 2 showed that results of the Combined PSPA in Experiment 1 predicted the outcome of most participants' reinforcer assessments.