MEDICATION ACTIVATION INFLUENCES DECISIONS REGARDING TREATMENT ESCALATION

Purpose: In this study, we sought to test a published conceptual model describing the influence of disease activation (DA) and medication activation (MA) on treatment preference (treat, or wait) and willingness to trade-off (i.e. choose an alternative course of action given a change in the expected disease or medication related outcomes) in an experimental study design.

Methods: We recruited 147 adults from the U.S. on a web-based portal (MTurk). Participants were told to imagine they were just diagnosed with psoriasis, and randomized to vignettes in a 2 (High DA vs. Moderate DA) X 2 (High MA vs. Moderate MA) factorial design. Participants were either given a picture of severe psoriasis (High DA) vs. no picture (Moderate DA). Participants were told the medication was either an inflammation reducing pill (Moderate MA) or an immune suppressing injection accompanied by an injection picture (High MA). Participants completed three questions: Treatment Choice (treat now or wait), Willingness to Trade-Off (WTO) if Disease Risk Changed (yes, no), and WTO if Medication Risk Changed (yes, no). A series of logistic regressions examined the influence of DA, MA, and their interaction on Treatment Choice, and DA, MA, Treatment Choice, and their interactions on WTO if Disease or Medication Risk Changed.

Results: The majority of participants chose to treat (61.2%). High MA was associated with choosing to wait (e.g., defer treatment) (OR = 2.89, p = .002). Treatment Choice (OR = .14, p = .005), MA (OR = .24, p = .046), and the interaction between these two variables (OR = 8.46, p = .011) were associated with WTO if the risk of disease progression was changed (see Figure). People randomized to the high MA condition were less willing to trade off if medication risk changed (OR = .43, p = .019).

Conclusions: These results have significant implications for patient decisions regarding treatment escalation. People who approach a treatment decision highly activated by a treatment are likely to refuse treatment escalation. Further, people who are highly activated by a treatment, and therefore more likely to refuse treatment escalation, are also unlikely to reconsider their decision in light of new information about the risks associated with either the disease or the treatment.