Preferences for care and treatment in advanced Chronic Obstructive Pulmonary Disease (COPD) patients: results from a discrete choice experiment

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The problem

COPD is a chronic progressive condition with high symptom burden accounting for 26,000 deaths annually in England alone. Little is known about patients' preferences for care and how they change in advanced disease. This study aims to identify patients' preferences for care in advanced COPD, and explore how these preferences change with deterioration in condition. The approach: A discrete choice experiment was developed and included in a postal questionnaire. 305 patients with advanced COPD, recruited from GP practices in Eastern England and South London, participated in a three-wave six-monthly postal survey. In the choice experiment, each respondent considered five different vignettes describing different health states, and for each indicated their preferences for source and place of care should they experience an exacerbation. Both the health states and the care options available were varied within the survey. Twelve different versions of the questionnaire were used, enabling coverage of sixty different care choice contexts. Findings: The discrete choice model estimated from this data provides insight into the weight that respondents put on different aspects of care: whether to receive care at home or at hospital; who leads the care decisions in each setting; the support available outside of routine appointments; and the time to access this support. Respondents' demographics, exacerbation history and quality of life, are incorporated into the model, revealing that these factors have a statistically significant influence on patients' preferences for both whom makes the care decisions and the location where the care is provided. Consequences: This research provides new evidence enabling appropriate patient-centred care and support of advanced COPD patients living in rural-urban and inner-city regions. It will help health service providers to identify possible service modifications to meet COPD patients' needs.


  • Peter Burge, King's College London, London, UK
  • Hui Lu, King's College London, London, UK
  • Patrick White, University of Cambridge, Cambridge, UK
  • Gail Ewing, Cambridge University Hospitals NHS Foundation Trust
  • Sara Booth, Cambridgeshire Community Services
  • Sophie Howson
  • Ravi Mahadeva, Cambridgeshire Community Services
  • Caroline Moore, Cambridge University Hospitals NHS Foundation Trust
  • Morag Farquhar, Cambridge University Hospitals NHS Foundation Trust