CHOICE EXPERIMENTS IN OLDER PEOPLE WITH ADVANCED RENAL DISEASE: A ‘THINK ALOUD’ STUDY

G KIMPTON1, B HOLE1, F CASKEY1,2, J COAST1, R MORTON3

1University Of Bristol, Bristol, United Kingdom, 2North Bristol NHS Trust, Bristol, United Kingdom, 3University of Sydney, Sydney, Australia

Aim: To understand how older people with advanced chronic kidney disease understand and complete a choice experiment.
Background: Deciding between dialysis and comprehensive conservative care is challenging. Healthcare professionals need to understand which aspects of these treatments are important to patients. Choice experiments quantify the relative importance of treatment components and health outcomes. A previous study suggested patients with kidney disease trade up to 15 months of life expectancy for the freedom to travel.
No choice experiments have studied the preferences of older patients with kidney disease in isolation. Prevalent cognitive impairment might make this difficult.
Methods: We invited patients over 65 years with an eGFR of under 30mL/min/1.73m2 to complete the Montreal Cognitive Assessment (MoCA). A purposive sample completed a choice experiment from a study examining dialysis treatment preferences in best worst scaling or discrete choice format. Participants were interviewed using a ‘think aloud’ process, where they described their reasoning and thought processes.
We assessed transcripts for misunderstandings, misinterpretations and contradictory choices referred to as errors and developed a coding framework.
Results: Twenty-six participants completed the MoCA and 13 were interviewed . Median age was 80 (IQR 79 to 86). Mean eGFR was 17 mL/min/1.732 (9-26). Six participants (46%) had a MoCA score of <26, suggesting cognitive impairment (20-30).
Errors varied with format of choice experiment completed and cognition, predominantly relating to comprehension of the task or terms used. Participants questioned the validity of presented survival statistics, or had difficulty conceptualising the presented treatments.
Conclusions: Older people with advanced renal disease can complete a choice experiment but have high error rates. Choice experiments developed for this group must be well designed and comprehensively tested.


Biography:
I am a fifth year postgraduate clinical researcher and geriatrics trainee with an interest in older persons healthcare delivery and decision making. In 2019 I was awarded a University of Bristol Elizabeth Blackwell Institute Clinical Primer Fellowship which allowed me to lead my first research project. I have also worked on clinical trials management and recruitment. I am currently on ‘temporary’ secondment to RHH, Hobart.

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