Exploring health and social care preferences for people with dementia and mild cognitive impairment: a systematic review of discrete choice experiments

Abstract

OBJECTIVES: Dementia is associated with behaviour change, and impaired ability to remember and think. This review focuses on key findings and methodological processes from discrete choice experiments (DCEs) to inform health and social care interventions for people living with dementia or mild cognitive impairment. METHOD: Six databases were searched to July 2023 using terms for DCEs, dementia and mild cognitive impairment. Titles, abstracts, and full texts were individually screened by two reviewers. PRISMA reporting guidelines were followed throughout. Study quality was assessed using the Lancsar and Louviere checklist. Results were summarised in a narrative synthesis. The study was PROSPERO registered (CRD42022368182). RESULTS: Nine studies were included. DCE attributes included service provision, setting characteristics, provider characteristics, availability, cost, and clinical outcomes. Studies predominantly included the general population or patient representatives with only two studies incorporating preferences of people living with dementia. CONCLUSION: Respondents preferred individualised home support, and to avoid relocation. Studies suggested benefit to day centres, and greater flexibility in dementia care provision. Authors noted relative preference could differ according to personal characteristics reinforcing the need for tailored provision. Future DCEs should include respondents with early-stage dementia and other cognitive impairments, taking care to ensure appropriate design for such populations.