Methods: Three scenarios were developed to test the impact of loss vs gain framing on acceptability of active surveillance "AS": 1) immediate treatment and AS framed as losses (e.g., "May not be able to have erections or be able to control urine or bowels as a result of treatment," Cancer may progress," respectively); 2) immediate treatment and AS framed as gains (e.g., "Gets treatment over with," "Gives time for more medical advances," respectively); and 3) immediate treatment and AS framed as both losses and gains. Members of online localized prostate cancer support groups 6 months-5 years post diagnosis were randomized to receive one of three frames. The primary outcome variable for this study was ratings of the acceptability of AS for localized prostate cancer. Two previously validated measures for acceptability were adapted for this study: the Treatment Evaluation Inventory Short Form (TEI-SF) and an instrument for measuring perceived attributes of eHealth innovations developed by Atkinson.
Results: A total of 357 men participated in the online study. The majority were white (89%) and had at least some college (94%).
Overall, we found that no differences in ratings of the acceptability of AS across the three frames (P=.21).
Analysis of individual items from the acceptability scale showed least favorable attitudes towards AS for men receiving the combined gain-loss frame (AS being consistent with a general approach to health care, delaying treatment side effects, and being reversible decision) compared to the other frames, but these findings were not significant after adjusting for the overall type I error rate.
In general, men who chose AS were more favorable towards it regardless of which frame they received (P<.01). In addition, men who were treated and reported regret about their choice were more favorable toward active surveillance than other men (P<.01).
Conclusions: A behavioral economics intervention based on loss-gain frame manipulation, within the content of providing balance information about options, had no effect on the acceptability of AS among men with localized prostate cancer. More “powerful” behavioral economics interventions may be needed to increase the acceptability of AS.