{
  "abstract": "Overdiagnosis is a key issue in healthcare decision-making. Despite being well known, it may cause doubts among patients and families involved in these decisions. Understanding their views and preferences is essential for implementing diagnostic interventions effectively. Discrete Choice Experiments (DCE) help measure stakeholders’ preferences and aid implementation. However, DCE instruments are designed from professionals’ perspectives, which may affect their accuracy in capturing the intended construct. This study explores classical and innovative approaches to developing and validating a DCE to assess patients’ and families’ preferences regarding caries diagnostic strategies for children. A DCE focused on users’ preferences used a previous experiment applied to dental professionals as a reference. Then, sequential phases were followed: (i) multidisciplinary panel, including dentists and non-dentists, to refine attributes and levels; (ii) pilot testing with the target audience (parents/caregivers) to assess face and content validity; and (iii) pilot testing of the instrument with the target audience for assessing its usability. In different stages, the internal validity regarding attributes and levels and the internal consistency and usability of the complete tool were tested. Ultimately, the goal was to create a valid and appropriate tool capable of measuring parents’ preferences regarding their choices for caries diagnosis in their children. The multidisciplinary panel comprised 11 participants from different areas with complete higher education. Disapproval rates per attribute ranged from 0% to 81%. Language adjustments were made for all attributes, and one new attribute was added. Twenty-one parents/caregivers composed the pilot stage for refining attributes. Two attributes demonstrated low levels of general understanding: ‘Probability of errors with the strategy’ (28.5%) and ‘Overdiagnosis’ (47.6%). Graphic representations were decided to be excluded due to insufficient participants’ comprehension (57% of cases). Besides, in this stage, it was observed that the preferred levels of attributes defined by users differed greatly from those set by the multidisciplinary panel and tended to valorize the harms (overdiagnosis, false positives, unnecessary treatment) more than the actual benefits. Some users were invited to contribute innovatively to co-creating the problematic attributes using citizen science principles. The main difficulty in this phase was the user’s understanding of overdiagnosis since they intuitively assumed the need to detect and treat all caries lesions. After understanding, they suggested a non-technical manner to enhance the general users’ comprehension of the attribute. Finally, the prior classification of preferred levels was redefined for experimental design, generating a final DCE version, which was tested with 22 other participants (pilot stage). All participants completed the DCE task, spending, on average, 7 minutes. The majority (68%) reported no difficulties doing it. Appropriate tests confirmed the instrument’s consistency. Even with a pilot sample, the trend of users’ preference towards diagnostic strategies leading to more interventionist approaches (more unnecessary treatment, increase in overdiagnosis, more false positive results, additional diagnostic tests) was confirmed. In conclusion, developing and validating specific instruments focused on and co-created by the target audience is essential for accurately capturing the preferences to improve the further implementation process and for permitting the methodological adaptations needed during this process.",
  "authors": [
    {
      "affiliations": [
        "Dental School, University of São Paulo, São Paulo, Brazil"
      ],
      "name": "Ana Clara Falabello de Luca"
    },
    {
      "affiliations": [
        "Dental School, University of São Paulo, São Paulo, Brazil"
      ],
      "name": "Renata Paz Leal Pereira"
    },
    {
      "affiliations": [
        "Dental School, University of São Paulo, São Paulo, Brazil"
      ],
      "name": "Gabriela Manco Machado"
    },
    {
      "affiliations": [
        "Dental School, University of São Paulo, São Paulo, Brazil"
      ],
      "name": "Daniela Prócida Raggio"
    },
    {
      "affiliations": [
        "Federal University of Goias, Goiania, Brazil"
      ],
      "name": "Matheus Perazzo"
    },
    {
      "affiliations": [
        "Dental School, University of São Paulo, São Paulo, Brazil"
      ],
      "name": "Mariana Gabriel"
    },
    {
      "affiliations": [
        "Dental School, University of São Paulo, São Paulo, Brazil"
      ],
      "name": "Laura Regina Antunes Pontes"
    },
    {
      "affiliations": [
        "Dental School, University of São Paulo, São Paulo, Brazil"
      ],
      "name": "Fausto Medeiros Mendes"
    },
    {
      "affiliations": [
        "Dental School, University of São Paulo, São Paulo, Brazil"
      ],
      "name": "Mariana Minatel Braga"
    }
  ],
  "title": "058 Is overdiagnosis in caries diagnosis comprehended by patients? – A need for understanding such issue, tailoring and validating tools for assessing patients’ and families’ preferences",
  "uid": "3689d2a6-be0b-5da2-a8a8-e82e7366cf42"
}