Hospice patients' participation in choice experiments to value supportive care outcomes

Research output: Contribution to journalArticlepeer-review


  • Christina Radcliffe
  • Terry Nicholas Flynn
  • Elizabeth Huynh
  • Joanna Coast

Colleges, School and Institutes

External organisations

  • School of Nursing, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK c.bailey.2@bham.ac.uk.
  • Institute of Applied Health Research, University of Birmingham
  • School of Nursing, Institute of Clinical Sciences, College of Medical & Dental Sciences, University of Birmingham, Edgbaston, Birmingham, West Midlands, B15 2TT, UK.
  • Birmingham St Mary's Hospice
  • TF Choices Ltd, Nottingham, UK.
  • Institute for Choice, University of South Australia Business School, Adelaide, South Australia, Australia.
  • University of Bristol


BACKGROUND: Values used in economic evaluation are typically obtained from the general public, which is problematic when measures are to be used with people experiencing a life-course stage such as the end of life.

OBJECTIVE: To assess the feasibility of obtaining values for the ICECAP-Supportive Care Measure (SCM) from patients receiving advanced supportive care through a hospice.

METHODS: Participants completed eight best-worst scaling questions in a think-aloud interview to explain choices in different hypothetical end-of-life scenarios. Three independent raters identified errors in completion of the best-worst scaling task, and thematic analysis of associated qualitative data was undertaken to explore task difficulty and choices.

RESULTS: Twelve hospice patients were recruited. Most were able to complete the task and prioritise aspects of supportive care with either no difficulty (n=50%) or difficulty in just one of the eight scenarios (n=25%). Two patients (n=17%) were unable to comprehend the hypothetical nature of the task. The qualitative data confirmed there was good engagement with the task and identified the importance the respondents attached to maintaining dignity.

CONCLUSION: The findings suggest that people at the end of life will be able to complete a short, interviewer-administered, best-worst scaling task. To maximise engagement, it is recommended that the task is short and initiated with an example. Scenarios are best presented on show-cards in large print. A full evaluation of the ICECAP-SCM with those at the end of life is feasible.


Original languageEnglish
JournalBMJ Supportive & Palliative Care
Early online date12 Nov 2018
Publication statusE-pub ahead of print - 12 Nov 2018