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Why People Refuse to Make Tradeoffs in Person Tradeoff Elicitations: A Matter of Perspective?

VA Health Services Research & Development Center for Practice Management and Outcomes Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, vancouvl{at}umich.edu

Todd R. Roberts

Division of General Internal Medicine, University of Michigan, Ann Arbor

Brian J. Zikmund-Fisher, PhD

Program for Improving Health Care Decisions, University of Michigan, Ann Arbor

Peter A. Ubel, MD

Department of Psychology, University of Michigan, Ann Arbor

Objective. Person tradeoff (PTO) elicitations assess people's values for health states by asking them to compare the value of treatment programs. For example, people might be asked how many patients need to be cured of health condition X to equal the benefit of curing 100 people of condition Y. However, when faced with PTO elicitations, people frequently refuse to make quantifiable tradeoffs, exhibiting 2 kinds of refusals: 1) They say that 2 treatment programs have equal value, that curing 100 of X is just as good as curing 100 of Y, even if X is a less serious condition than Y, or 2) they say that the 2 programs are incomparable, that millions of people need to be cured of X to be as good as curing 100 of Y. The authors explore whether people would be more willing to make tradeoffs if the focus was changed from trading off groups of patients to choosing the best decision or evaluating treatment benefits. Design. Two randomized trials used diverse samples (N=2400) via the Internet to test for the effect of perspective on refusal rates. The authors predicted that perspectives that removed people from decision-making roles would increase their willingness make tradeoffs. Results. Contrary to expectations, refusal rates increased when people were removed from decision-making roles. In fact, the more pressure put on people to make a decision, the less likely they were to refuse to make tradeoffs. Conclusion. To reduce PTO refusals, it is best to adopt a decision-maker perspective.

Key Words: person tradeoff • utility assessment • computer elicitation • cost-effectiveness • Internet survey • emotion in decision making.

Medical Decision Making, Vol. 27, No. 3, 266-280 (2007)
DOI: 10.1177/0272989X07300601


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