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

Author

Listed:
  • Laura J. Damschroder

    (VA Health Services Research & Development Center for Practice Management and Outcomes Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, vancouvl@umich.edu)

  • Todd R. Roberts

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

  • Brian J. Zikmund-Fisher

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

  • Peter A. Ubel

    (Department of Psychology, University of Michigan, Ann Arbor)

Abstract

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.

Suggested Citation

  • Laura J. Damschroder & Todd R. Roberts & Brian J. Zikmund-Fisher & Peter A. Ubel, 2007. "Why People Refuse to Make Tradeoffs in Person Tradeoff Elicitations: A Matter of Perspective?," Medical Decision Making, , vol. 27(3), pages 266-280, May.
    • Handle: RePEc:sae:medema:v:27:y:2007:i:3:p:266-280
    DOI: 10.1177/0272989X07300601
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    References listed on IDEAS

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    1. McKie, John & Richardson, Jeff, 2003. "The Rule of Rescue," Social Science & Medicine, Elsevier, vol. 56(12), pages 2407-2419, June.
    2. William Hollingworth & Richard A. Deyo & Sean D. Sullivan & Scott S. Emerson & Darryl T. Gray & Jeffrey G. Jarvik, 2002. "The practicality and validity of directly elicited and SF‐36 derived health state preferences in patients with low back pain," Health Economics, John Wiley & Sons, Ltd., vol. 11(1), pages 71-85, January.
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    Cited by:

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    2. Judith Covey & Angela Robinson & Michael Jones-Lee & Graham Loomes, 2010. "Responsibility, scale and the valuation of rail safety," Journal of Risk and Uncertainty, Springer, vol. 40(1), pages 85-108, February.
    3. Victoor, Aafke & Hansen, Johan & van den Akker-van Marle, M. Elske & van den Berg, Bernard & van den Hout, Wilbert B. & de Jong, Judith D., 2014. "Choosing your health insurance package: A method for measuring the public's preferences for changes in the national health insurance plan," Health Policy, Elsevier, vol. 117(2), pages 257-265.

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