Novel assessment of risk tolerance in acute healthcare settings: a questionnaire-based study investigating risk tolerance of service users and staff in ambulatory care and front-door services (with Ciara Harris, Johannes Lohse and Daniel Lasserson), BMJ Open (2025), 15:11 [Link]
Objectives: When deciding acute healthcare delivery location, multiple factors should be considered, including risks associated with potential care locations and the willingness of decision stakeholders to take those risks. Individual risk tolerance potentially informs these choices. We therefore aimed to investigate the risk tolerance of staff, patients and carers in front-door and ambulatory care units.
Design: Several variants of the ‘multiple price list’ method of risk tolerance assessment were employed. The different variants covered financial and health outcomes, and known and unknown odds in the ‘risky’ options. For financial outcomes, participants made seven choices between a guaranteed (eg, £70) and risky (eg, chance of £20 or £160) outcome, with the higher quantity in the risky outcome increasing with each choice, in six ‘lottery sets’. For health outcomes, participants made choices between a guaranteed and risky outcome measured in number of healthy days.
Setting and participants Staff, patients and carers were recruited from front-door and ambulatory care units in the UK.
Outcome measures: Risk tolerance was the primary outcome measure and was established in two ways—number of times the guaranteed option was chosen, and the point where participants switched from the guaranteed to the risky option.
Results: Among 338 participants, a wide range of risk tolerance levels were demonstrated, and three key findings were identified—participants were less risk tolerant in health-based than financial decisions; older people had a more dichotomised approach to health risk-taking than younger people; and patients could engage in informed, structured discussions about risk, including when acutely unwell.
Conclusions: These findings suggest that, while stakeholders in location-of-care decisions may have different risk tolerance levels, they can engage in structured discussions about risk, which should inform shared decision-making. Additionally, older patients, who constitute a significant proportion of hospital attendees, may be more willing to take health-based risks than younger people. Future work may benefit from formal exploration of people’s rationale for their decisions and may be considered in other clinical settings.
Ageing, frailty and resilience in Botswana: rapid ageing, rapid change. Findings from a national working group meeting and literature review (with Barbara Lachana Onen, Ciara Harris, Agnieszka Ignatowicz, Justine Davies, Andrew Howes, Oathokwa Nkomazana, Churchill Lukwiya Onen, Elizabeth Sapey, Billy Tsima and Daniel Lasserson), BMC Proceedings (2019), 13 (Suppl 10):8 [Link]
Background: The demography of Botswana is rapidly changing. Successes in tackling communicable diseases and economic development increased life expectancy from 53.7 years in 2006 to 66.8 years in 2016. The prevalence of diseases associated with older age, especially chronic non-communicable diseases including diabetes, hypertension and cerebrovascular disease are suspected to have increased but accurate data are lacking. The country has high youth unemployment and national retirement is at the age of 60, which limits the opportunity to build pensions for prosperity in older age. Changes across health, social care and economic policy are needed to prepare for a future ageing population.
Methods: This article reports on the national working group meeting outputs on issues that face older people, their families, healthcare providers, and policy makers in Botswana. A collaborative working group meeting was convened in Gaborone, Botswana on 25th September 2018 by the University of Botswana and University of Birmingham, UK, to identify key challenges and opportunities for an ageing Batswana population.
Results: There was agreement across diverse stakeholders of a need for effective and rapid policy formation to prepare and protect the future health and economy of an ageing Batswana population with a high burden of NCDs. The main priorities for policy-makers must be social care, poverty reduction and healthcare provision, conducted in an evidence-based manner, as far as practicable. To effectively achieve this, research and high-quality data collection mechanisms are required.
Conclusions: Future policy in Botswana must focus on the challenges that an ageing population brings, and development of health and care system resilience for the demographic change could be a model for healthcare policy across Southern Africa.