Public Preferences for Autonomy-Enhancing Dementia Care in Ireland: A Protocol for a Discrete Choice Experiment.

Background Dementia is a leading cause of death and disability among older people worldwide with countries supporting people to remain at home for as long as possible. Autonomy is widely recognised as a key principle of person-centred dementia care and is increasingly emphasised in national and international dementia policies, including Ireland. Recent studies reconceptualise autonomy as relational and supported, recognising that people with dementia can exercise choice when supported by appropriate relationships, environment and services. Evidence on public preferences and willingness to pay for autonomy enhancing dementia care remains scarce in Ireland, where dementia care is largely publicly funded. Objective This protocol describes the systematic development process of a discrete choice experiment (DCE) to elicit public preferences and willingness to pay for autonomy enhancing supports for people with mild-to-moderate dementia living at home in Ireland. Methods This study adopts a two-phase design. The first phase involves a comprehensive attribute and level development process informed by relational theory and DCE best practices. Attribute development followed a review of academic and policy literature, patient and public involvement activities with people with dementia and carers, and focus groups with Irish public, attribute synthesis and prioritisation, and pre-pilot and pilot testing. This process is grounded in relational theory and have five attributes for the DCE: Housing adaptations, community inclusion, home care support, Assistive and digital technology and an additional yearly tax contribution. In the second phase, the survey will be administered to a nationally representative sample of 750 Irish adults using an online survey panel. Bayesian efficient experimental design will be used to generate choice sets and econometric analysis will estimate the preferences and willingness to pay. Discussion This study is one the first to account of attribute development for a DCE examining the public preferences for autonomy enhancing dementia care in Ireland.