Nancy Devlin Nancy Devlin, Clara Mukuria, Philip Powell, Tessa Peasgood
The EQ-VT (EQ-VT) protocol is widely used in the evaluation of the EUROQOL device, including the evaluation of the EQ-5D-Y-3L in the form of an adaptive type of over 25 national EQ-5D-5L values. The adapted version of the IT is currently used for the evaluation of EQ health and well-being (EQ-HWB). The depth of experience using EQ-VT means mature skills.
However, like scientific efforts, there is a range of strengthening existing approaches. EUROQOL Group is open to ideas for improvement and is dedicated to transparency on the advantages and disadvantages of evaluation approaches.
In this blog post, we set up a case of deleting ‘wheelchair example’, one side of EQ-VT. The catalyst for this post was a detailed discussion with members of the UK National Health and Medical Institute for Excellence in the UK in January 2022. Members were interviewed individually using EQ-VT as part of their ongoing work in EQ-HWB using individual brief interviews, group briefings and focus group discussions.
What is a ‘wheelchair example’?
‘Wheelchair example’ is a warm-up work used when the EQ-VT interview with the respondents begins. Its role is to introduce the TTO (Time Trade-Off) work to be used in the interview to draw the preferences of respondents for health status described as a given tool. In order to focus on the description of the operation of the TTO, the initial state is an exemplary example of the initial state, which is introduced in the wheelchair, which is not described by the general narrative system, but rather a “mobility that the wheelchair is needed”. In this warm -up work, the reason for the ‘in wheelchair’ is that everyone can easily imagine it. As far as we know, wheelchair examples and how to recognize respondents have never been systematically evaluated. The wheelchair example is included as part of the EQ-VT from the beginning of the method, which supports the use in version 1 of development and protocols.
In version 1, STOLK et al (2019) pointed out that the interviewer had to show TTO work on the Lord better and worse than dying using a wheelchair example, but it was “easy to forget and difficult.” In Version 2 of the protocol, the wheelchair example is accompanied by additional tasks. After completing the TTO work on the wheelchair example, if it is considered to be ‘better than dead’ living in a wheelchair, the respondents should imagine the Lord that it is much worse than in the wheelchair.
The time spent by the interviewer in the practice wheelchair example is an indicator of interview quality included in the Quality (QC) process.
What is the problem with using a wheelchair example?
There are three reasons why it is a problem to use a wheelchair example.
It does not explain the state of health.
Wheelchair users are often identified as disabled and can be caused or accompanied by health problems. In a wheelchair, it is not healthy. In addition, focusing on describing the state in relation to the use of wheelchairs, focuses on the role of wheelchair as a means of supporting and adapting physical disorders. For example, for example, in the evaluation task of warming up, it is not helpful for for example because people ignore the interventions that can be used to modify the condition by directly contrasting the work to do in the valuation task.
It is possible.
Performanceism is defined as discrimination and social prejudice against people with disabilities or those who are recognized as disabilities. Ableism is characterized by people defined by their disability and inferior to those who are not spleen (Linton, 1998). The discussions conducted by our research team with members of the NICE PUBLICE INTORVEMENT Program and the EQ-VT interviews with them individually represented in a powerful term in a powerful term.
In the group discussion on January 25, 2022, a participant said:
“I am one of the people who have found the initial example. I feel you chosen. But there’s something in the wheelchair. It feels that people in the wheelchair think that it is bad.
Another participant agreed to this view, and the second participant mentioned:
“I’m a wheelchair user, so I sincerely agree with the use of the wheelchair point of view. I can’t necessarily find it as a limited thing about the quality or essence of my life.”
This view was reversed in the focus group debate on January 27, 2022, and the first participant summarized the point.
“You have seen an example of the first trade off. I chose life in a wheelchair or life as a healthy person. I think it reflects the ideas of the terrible things in the wheelchair.
This opinion came from several participants in both individual briefings and focus groups. For example, the participant mentioned in an individual briefing.
“I think it’s actually competent, I don’t think it’s a positive message about the disability, and it’s clear that you want to live in a wheelchair for 10 years mentally for 10 years.
Wheelchair cases reflect the researcher’s judgment on people in wheelchairs who are less quality of life than people in wheelchairs, and implicit this message to respondents. Even if this is a widely distributed view in society, it is unpleasant to represent the important parts of society that considers preferences and views in such a study. It is also considered a competent person by people who know or work on disability. Therefore, as a warm -up example, it can be reflected in the researchers who use it and the respected organizations that recommend it. Given the difficult nature of the TTO task, it is important for all participants to be treated for caring and sympathy, including requests to imagine living in a very poor health and thinking about death.
It may not be suitable for the purpose in a different way.
In order for a wheelchair example to work as a warm -up operation, using a wheelchair must be universally considered to damage the quality of life. If people with a wheelchair use do not share their views, the wheelchair example is not suitable for the important parts and purpose of the general public looking for a perspective.
There may be additional problems related to wheelchair examples. For example, in Egypt, the report on the use of EQ-VT is SHABASY et al (2022).
“In many developing countries and many other developing countries, independent life in wheelchairs is struggling due to lack of public transportation and wheelchair -friendly infrastructure, which lack public transportation.In most buildings, there is a lack of infrastructure such as ramps and elevators, so most participants will be worse than death in wheelchairs. Can.
For this reason, the researchers replaced the wheelchair example with a migraine.
Is there an alternative?
As you can see in the shabase et al (2022), there are other or short disposable vinetting that can be used to replace the wheelchair example. This provides an example of the caution that avoids the above -mentioned problems and can easily imagine the respondents. For example, it is possible to ask the respondents to imagine some pains for the respondents (everyone has experienced and is universally associated with reducing quality of health -related life). If you do not mention a particular state or disorder, the respondent may remove the possibility that the example may alienate or promote certain negative value judgments associated with the condition, which may not be resonated with all respondents. Reduces the likelihood of a prejudice on the specified example.
There may be problems in all examples used, but this is a matter of how the explanation is specific and how others affect the way of imagining and conceptualizing the state. The purpose of the warm -up task is to introduce people to the TTO and to introduce the tasks for a better state than to die. One of the potential problems that may need to explore is whether the state selection has a frame effect in the subsequent tasks in the warmup -up work (e.g., whether the focus on mobility or pain affects the evaluation of the condition that includes the problem). This can be easily dealt with with a method of method in future studies, and if it is true, it can be a problem that exists with a wheelchair example (ie, with a focus on respondents on mobility issues).
conclusion
Wheelchair examples are a long-standing function of EQ-VT evaluation research, and researchers, including us, are familiar with being convicted of the suspension of the question about the use. However, the feedback received from the Nice Public INVELMELMENTVEMENT program panel member raises a problem, which should stimulate serious reflection. There is an opportunity to explore alternatives to ‘wheelchair yes’, which provides the basis of this warm -up work. The data in the wheelchair example does not form some of the results reported in the study. This means that the loss of comparative possibilities should be a minimum result in the future evaluation study, but the loss of comparative possibilities should be a minimum result. We recommend that the Euroqol group considers this problem and identifies the steps needed to explore as soon as possible.
I was kindly posted with permission AHE blog
