ArticleBMC health services research2026
Preferences for advance care planning services among patients with recurrent stroke: a discrete choice experiment.
Article in BMC health services research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundStroke remains a major chronic condition in China, characterized by high incidence, frequent recurrence, and substantial disability. These challenges not only affect patients’ quality of life but also place a heavy burden on families and the healthcare system. Advance care planning provides a structured approach to help patients make informed decisions about their future medical care. However, little is known about how patients with recurrent stroke perceive and prioritize advance care planning services. Gaining insight into their needs and preferences is essential for designing interventions that are both responsive and clinically meaningful.
methodsFace-to-face questionnaires were administered, requiring participants to choose between two service options based on seven key attributes: service object, service frequency, service location, service content, service provider, service format, and cost. A mixed logit model estimated preference weights, and a latent class logit model identified preference heterogeneity among subgroups. Relative attribute importance, willingness to pay, and scenario predictions were calculated. Chi-square tests, Fisher’s exact tests, and Kruskal-Wallis tests compared demographic and clinical characteristics between latent classes.
resultsA total of 5,382 choice observations were generated. Among the seven advance care planning-related attributes for patients with recurrent stroke, their relative importance ranked as follows: service provider(30.72%), service frequency(24.20%), service content(18.81%), service format(11.85%), service location(6.24%), cost(5.88%), and service object(2.30%). Overall, participants preferred an advance care planning service model characterized by “twice per month, discussion of future care priorities(β = +0.425), and delivery by specialists or nurses(β = +0.975).” Willingness to pay decreased as out-of-pocket costs increased(β = − 0.186). Latent class analysis identified three preference groups, with statistically significant differences in sex, age, and education level.
conclusionsPatients with recurrent stroke in China, particularly in Shiyan City, place emphasis on professional service providers, comprehensive medical support, and personalized advance care planning service models, suggesting a strong influence of cultural context. As out-of-pocket costs increase, their willingness to pay decreases. There are significant differences in preferences among different subgroups of patients, indicating the need to establish stratified and personalized advance care planning service models to account for differences in residence, socioeconomic status, and education level.
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