Designing a discrete choice experiment involves a process of developing, testing and optimizing the experiment questionnaire. This process is important for the success of the experiment but is often not reported. In the field of healthcare one sometimes faces challenges in relation to what makes sense both for the respondent and has clinical relevancy – especially in areas of low evidence and unclear choices, e.g., in degenerative spine diseases where the selection of candidates for surgical rather than non-surgical treatment has been widely discussed and where surgery rates accordingly vary across settings.

In order to elicit relevant attributes a field-work in clinical departments on Danish hospitals has taken place and been supplemented by qualitative interviews with patients and doctors. Systematic and thorough qualitative investigation of the decision context, relevant attributes and levels, and appropriate framing, among others, appears valuable in the process of designing a DCE for quantitative pilot testing. In the present work it was demonstrated how the qualitative process significantly impacted and guided the design and it was clear that a less thorough qualitative process would have resulted in a less valid design.