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.

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.

Staff, patients and carers were recruited from front-door and ambulatory care units in the UK.

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.

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.

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.

Cellulitis is a common bacterial skin infection causing significant pain, swelling and impact on daily activities, frequently leading to emergency department presentations and hospital admissions. While antibiotics are the mainstay of treatment, they do not directly address inflammation, often resulting in persisting or worsening symptoms in the initial days. Corticosteroids, with their potent anti-inflammatory effects, have shown benefit in other acute infections but are not currently standard care for patients with cellulitis. This trial aims to determine if adjunctive oral dexamethasone can reduce pain and improve outcomes in adults with cellulitis presenting to UK urgent secondary care settings.

This is a pragmatic, multicentre, double-blind, placebo-controlled, randomised, parallel group, phase 3 superiority trial, with an internal pilot and parallel health economic evaluation. Adult patients (≥16 years) with a clinical diagnosis of cellulitis (at any body site except the orbit) presenting to urgent secondary care will be screened for eligibility. 450 participants will be randomised (1:1) to receive either two 8 mg doses of oral dexamethasone or matched placebo, administered approximately 24 hours apart, in addition to standard antibiotic therapy. The primary outcome is total pain experienced over the first 3 days postrandomisation, calculated using the standardised area under the curve from pain scores (Numerical Rating Scale 0–10) across up to seven timepoints. Secondary outcomes include health-related quality of life (EuroQol 5 Dimension 5 Level), patient global impression of improvement, analgesia and antibiotic usage, hospital (re)admissions, complications, unscheduled healthcare use, cellulitis recurrence and cost-effectiveness at 90 days. The primary estimand will apply a treatment policy approach to intercurrent events.

The trial has received ethical approval from South Central—Oxford B Research Ethics Committee (reference: 24/SC/0289) and will be conducted in compliance with Good Clinical Practice and applicable regulations. Informed consent will be obtained from all participants. A model consent form can be seen in . Findings will be disseminated through peer-reviewed publications and conference presentations, and to patient groups and relevant clinical guideline committees.

ISRCTN76873478.