Veterans' preferences for tobacco treatment in primary care: A discrete choice experiment

Patient Educ Couns. 2020 Mar;103(3):652-660. doi: 10.1016/j.pec.2019.10.002. Epub 2019 Oct 4.

Abstract

Objective: To evaluate US veterans' preferences for smoking cessation counseling and pharmacotherapy.

Methods: A discrete choice experiment (DCE) was conducted in 123 Veterans Health Administration primary care outpatients who planned to quit smoking within 6 months. Key attributes of tobacco cessation treatment were based on literature review and expert opinion. We used a hierarchical Bayesian approach with a logit model to estimate the part-worth utility of each attribute level and used latent class logit models to explore preference heterogeneity.

Results: In the aggregate, participants valued counseling options with the following attributes: higher quit rate at 1 year, emphasis on autonomy, familiarity of the counselor, counselor's communication skills, and inclusion of printed materials on smoking cessation. Participants valued pharmacotherapy options with the following attributes: higher quit rate at 1 year, lower risk of physical side effects, zero copayment, monthly check-in calls, and less weight gain. Latent class analysis revealed distinct clusters of patients with a unique preference "phenotype."

Conclusions: Veterans have distinct preferences for attributes of cessation counseling and pharmacotherapy.

Practice implications: Identifying patients' preferences provides an opportunity for clinicians to offer tailored treatment options that better engage veterans in their own care and boost adherence to guideline-recommended counseling and pharmacotherapy.

Keywords: Conjoint analysis; Discrete choice experiment; Preferences; Smoking cessation; Veterans.

Publication types

  • Evaluation Study
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Aged
  • Counseling / methods*
  • Cross-Sectional Studies
  • Decision Making*
  • Decision Support Techniques*
  • Female
  • Hospitals, Veterans
  • Humans
  • Male
  • Middle Aged
  • Patient Preference / psychology*
  • Primary Health Care / organization & administration*
  • Smoking Cessation / methods
  • Smoking Cessation / psychology*
  • United States
  • United States Department of Veterans Affairs
  • Veterans / psychology*
  • Veterans / statistics & numerical data
  • Veterans Health Services