WHAT MAKES A TUMOR DIAGNOSIS A CALL TO ACTION? ON THE PREFERENCE FOR ACTION VS. INACTION

Purpose: To explore the extent which the preference for active treatments previously found with hypothetical cancer scenarios is due to the explicit exclusivity between the treatment options; specifically, comparing active treatment to watchful waiting that can or cannot be followed by active treatment. Also, we investigated what feature of the tumor diagnosis is critical to the preference for action.
   Method: 282 students participated in an Internet survey. They were presented with hypothetical scenarios and had to choose between two options: a) watchful waiting, and b) surgery. Each option had a 5% probability of life threatening consequences. Participants received one of five scenarios: 1) diagnosis of malignant tumor with explicitly excluding options; 2) diagnosis of malignant tumor with options not explicitly excluding each other; 3) diagnosis of benign tumor that can degenerate into a malign tumor; 4) diagnosis of benign tumor that can grow leading to life threatening conditions; and 5) non-tumor pathology that can lead to similar life threatening conditions.
   Results: When participants chose between two treatment options that were explicitly described as excluding each other (scenario 1), they preferred action (66.67%) to inaction (33.33%), χ2=5.45, p=.02. In contrast, when participants were free to interpret the treatment options as possibly overlapping (scenario 2), they were indifferent to the choice between the treatments (49.12% vs. 50.87). Additionally, while participants presented with a malign tumor diagnosis did not prefer a treatment option to the other, those presented with the three other non malignant diagnoses (benignant tumor that can degenerate or can lead to severe consequences, or non tumor pathology with similar consequences) showed a clear preference for inaction, respectively χ2=8.33, p=.004; χ2=10.29, p=.001; and χ2=13.24, p<.001.
   Conclusions: Results showed that the critical feature of the tumor diagnosis as a call to action was the malignity of the tumor diagnosed. Moreover, the preference for action was dependent on the exclusivity of the two options. In particular, participants favored the action option only when the inaction option did not allow for a future action. Thus, though the probability of life threatening consequences was held constant between the options and the scenarios, this study highlighted the relevance of both the kind of diagnosis and whether the watchful waiting can be followed by the surgery in determining people’s treatment preferences.