Title : Multidimensional preferences in COPD health management: A scoping review of discrete choice experiments
Abstract:
Background: Chronic obstructive pulmonary disease (COPD), the third leading cause of death globally, faces critical challenges in health management including insufficient prevention and suboptimal therapeutic outcomes. These issues stem from the inability to precisely identify multidimensional preferences of patients and stakeholders. While preferences are pivotal for optimizing clinical decision-making, traditional research methods fail to quantify attribute importance and dynamic interactions. Discrete choice experiments (DCEs) effectively simulate multi-attribute decision-making in real-world healthcare scenarios. However, existing COPD studies predominantly focus on unidimensional preferences, with methodological inconsistencies leading to fragmented evidence. Systematic analysis of multidimensional preferences is essential for developing targeted interventions in COPD health management.
Purpose: This scoping review aims to examine and compare studies employing DCEs to quantify preferences in COPD health management, addressing three questions: 1) What are the global distribution characteristics of these studies? 2) What multidimensional preference outcomes have been identified? 3) What methodological features characterize DCE designs in this field?
Methods: We systematically searched Chinese and English databases from inception to June 2025. Articles meeting predefined criteria were included and assessed using the PREFS checklist. General characteristics, DCE design features, and multidimensional preference outcomes were synthesized through narrative analysis.
Results: Eighteen English-language studies were included, with a mean PREFS score of 3.6 (SD=0.5). The reviewed preferences spanned three key COPD management phases (prevention, treatment, and care), covering six domains: clinical communication, non-specific treatment, inhaler selection, symptom improvement, early discharge, and pulmonary rehabilitation. Participants primarily included COPD patients (n=16), with single studies involving informal caregivers, COPD nurses, and high-risk smokers. Attribute numbers ranged 4-11 with 2-5 levels per attribute. Most studies (n=17) adopted fractional factorial designs, with only one incorporating an opt-out option. Mixed logit models were predominant (n=6).
Conclusion: This scoping review synthesizes applications of discrete choice experiments (DCEs) in COPD health management, revealing multidimensional preferences across health management phases. High-risk populations prioritized symptom interpretation, authoritative information sources, and hope-oriented messaging during prevention, while significant preferences emerged for symptom relief, sleep quality improvement, low-cost interventions, and minimized side effects in non-specific treatment. Attributes including dose counters, user-friendly inhalers, and soft mist devices were strongly preferred in therapeutic device selection. Patients and stakeholders emphasized early discharge models with low care burden and out-of-pocket costs, alongside pulmonary rehabilitation programs with exercise training as the foundational component. Future studies should prioritize prevention and rehabilitation dimensions, particularly exploring screening adherence and rehabilitation protocols through original DCEs. Methodological standardization is warranted to refine attribute-level development processes, integrate opt-out options for ecological validity, and select context-specific analytical models. These strategies will optimize patient-centered COPD health management.
Keywords: Chronic obstructive pulmonary disease; Discrete choice experiment; Health management; Patient preferences
Registration Number: The scoping review was registered with the Open Science Framework (OSF) on 26 May 2025 (https://doi.org/10.17605/OSF.IO/SKF5X).
