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Purpose: Person trade-off (PTO) elicitations measure people’s preferences by asking them to choose between different health care treatments. For example, people might be asked how many patients need to be cured of chronic pain to bring as much benefit as curing 100 patients of paraplegia. Many people refuse to make trade-offs in PTO elicitations for reasons that are not well understood. In this study, we test whether refusals to make trade-offs are caused by people protesting against the "need" to make such rationing choices.
Methods: We explored whether willingness to make tradeoffs would increase and outrage about the task would be lessened by eliminating the need for people to make rationing choices. We presented half of our subjects with a traditional rationing task: "Imagine you can fund only one of two treatment programs…which one would you choose to fund?" and half with a non-rationing task: "Imagine two groups received treatment…which group received the greatest benefit?" We described three health conditions (mild, moderate, and severe shortness of breath), and subjects made choices between curing these conditions, two at a time, in three PTO elicitations within the assigned context.
Results: 1,754 subjects participated in our randomized trial via the Internet. As expected, subjects who expressed more outrage about their task were more likely to refuse to trade-off, regardless of task type. In addition, as expected, subjects given the rationing task reported more outrage than subjects given the non-rationing task (p=0.002). Surprisingly, however, subjects given the non-rationing task had nearly six times higher odds for refusing to trade-off compared to those receiving the rationing task (p<0.0001). Also, subjects with low subjective numeracy and those who thought the survey was relatively easy had higher odds for refusing to make tradeoffs (p's<0.004).
Conclusion: Relieving people of the need to make rationing decisions reduced the level of outrage associated with PTO elicitations, but at the same time made them even less willing to make tradeoffs. Across all subjects, level of outrage was associated with unwillingness to make tradeoffs. Given that unwillingness to make tradeoffs plagues other preference elicitations, including standard gamble and TTO elicitations, further research is needed to clarify why people refuse to make tradeoffs and what should be done to rectify this problem.
See more of Oral Concurrent Session B - Clinical Effectiveness and Quality of Life
See more of The 26th Annual Meeting of the Society for Medical Decision Making (October 17-20, 2004)