Background: end-of-life care is not always in line with end-of-life preferences, so patients do not always die at their preferred place of death (PPD). This study aims to identify factors associated with patients' PPD and changes in PPD. Methods: we prospectively collected data on PPD at four time points within 6 months from 230 acutely hospitalised older patients who were part of the control group in a stepped-wedge randomised controlled trial. Associations between patient characteristics and preferences were calculated using multivariable (multinomial) logistic regression analysis. Results: the mean age of participants was 80.7 years. 47.8% of the patients had no PPD at hospital admission. Patients previously admitted to hospital preferred to die at home (home versus no preference: odds ratio [OR] 2.38, 95% confidence interval [CI] 1.15-4.92; home versus healthcare facility: OR 3.25, 95% CI 1.15-9.16). Patients with more chronic diseases preferred the healthcare facility as their PPD (healthcare facility versus no preference: OR 1.33, 95% CI 1.09-1.61; healthcare facility versus home: OR 1.21, 95% CI 1.00-1.47). 32 of 65 patients changed their preference during follow-up, and most of these had no PPD at hospital admission (home versus no preference: OR 0.005, 95% CI ≤0.001-0.095) and poorer self-rated well-being (OR 1.82, 95% CI 1.07-3.08). Conclusions: almost half of the patients had no PPD at baseline. Previous hospital admission, having more chronic diseases and living alone are associated with having a PPD. Introducing PPD could make older people aware of PPD and facilitate optimal palliative care.
Purpose: Collaborative deliberation comprises personal engagement, recognition of alternative actions, comparative learning, preference elicitation, and preference integration. Collaborative deliberation may be improved by assisting preference elicitation during shared decision-making. This study proposes a framework for preference elicitation to facilitate collaborative deliberation in long-term care consultations. Methods: First, a literature overview was conducted comprising current models for the elicitation of preferences in health and social care settings. The models were reviewed and compared. Second, qualitative research was applied to explore those issues that matter most to clients in long-term care. Data were collected from clients in long-term care, comprising 16 interviews, 3 focus groups, 79 client records, and 200 online client reports. The qualitative analysis followed a deductive approach. The results of the literature overview and qualitative research were combined. Results: Based on the literature overview, five overarching domains of preferences were described: “Health”, “Daily life”, “Family and friends”, ”Living conditions”, and “Finances”. The credibility of these domains was confirmed by qualitative data analysis. During interviews, clients addressed issues that matter in their lives, including a “click” with their care professional, safety, contact with loved ones, and assistance with daily structure and activities. These data were used to determine the content of the domains. Conclusion: A framework for preference elicitation in long-term care is proposed. This framework could be useful for clients and professionals in preference elicitation during collaborative deliberation.
Supermarkets are essential urban household amenities, providing daily products, and for their social role in communities. Contrary to many other countries, including nearby ones, the Netherlands have a balanced distribution of supermarkets across villages and urban neighbourhoods. However, spatial supermarket patterns, are subject to influential developments. First, due to economies of scale, there is a tendency for supermarkets to increase their catchment areas and to disappear from peripheral villages. Second, supermarkets are now mainly located in residential areas, although the urban periphery appears to be attractive for the retail sector, perhaps including the rise of hypermarkets. Third, today, online grocery shopping is still lagging far behind on other online shopping products, but a breaks through will dilute population support for in-store supermarkets and can lead to dramatic ‘game changer’ shifts with major spatial and social effects. These three important trends will reinforce each other. Consequences are of natural community meeting places at the expense of social cohesion; reduced accessibility for daily products, leading to more travel, often by car; increasing delivery flows; real estate vacancies, and increasing suburban demand increase for retail and logistics. Expected changes in supermarket patterns require understanding, but academic literature on OGS is still scarce, and does hardly address household behaviour in changing spatial constellations. We develop likely spatial supermarket patterns, and model the consequences for travel demand, social cohesion and real estate demand, as well as the distribution between online and in-store grocery shopping, by developing a stated preference experiment, among Dutch households.
De toenemende verstedelijking levert grote uitdagingen op voor leefbaarheid, gezondheid en kwaliteit van leven in steden. Het is belangrijk dat de openbare ruimte voldoet aan de huidige eisen/wensen van gebruikers en de samenleving, zodat mensen zich veilig en comfortabel voelen en positieve ervaringen hebben in de stad. Er is daarom een groeiende interesse in de relatie tussen de openbare ruimte en de beleving ervan door bewoners, zowel in (wetenschappelijk) onderzoek als bij beleidsmakers. Eerder onderzoek heeft aangetoond dat natuurlijke elementen, zoals parken, groene stroken en bomen, bijdragen aan de subjectieve gezondheid (ontspanning) van gebruikers. Toch is er nog maar weinig bekend over de beleving van specifiek stadsparken en welke kenmerken het meest gewaardeerd worden door gebruikers. Studies die, door middel van innovatieve methodes, de beleving van stadparken analyseren zijn beperkt. Een betrouwbare techniek voor het bepalen van voorkeuren en indirect, beleving, is de stated preference methode. Meestal worden respondenten daarbij gevraagd om hypothetische situaties te beoordelen, gebaseerd op tekstuele beschrijvingen. Virtual reality maakt het echter mogelijk om hypothetische situaties echt te ervaren. Dit project heeft daarom als doel om te analyseren, door middel van een Virtual Reality (VR) Stated Preference experiment, hoe kenmerken van stedelijke parken bijdragen aan de beleving van gebruikers. Beleidsmakers, stedenbouwkundigen en beheerders van de openbare ruimte kunnen deze resultaten gebruiken bij het creëren van parken die aansluiten bij de huidige wensen en behoeften van gebruikers. Ook zal dit project inzicht geven in de bruikbaarheid van VR technologie bij onderzoek naar de beleving van de openbare ruimte.
