Background/Purpose: Patients’
preferences for competing treatment options can be measured using stated
preference methods which require subjects to make trade-off between specific
attributes. Responses can then be used to calculate the importance of specific
attributes on patients’ choices. Previous marketing research has found that the
extent of negative emotions elicited by specific trade-offs is related to
choice. Given the known literature that choice difficulty increases the likelihood
of opting out or deferring, the objective of this study was to examine whether
emotional trade off difficulty impacts choices after accounting for the
importance of each attribute.

Methods: Women between the
ages of 20 and 49 years, admitted to the hospital or infusion center, completed
a discrete choice experiment (DCE) to examine preferences for a hypothetical
medication for a standardized patient with joint pain, migraines and fatigue.
The DCE included 4 attributes each having 3 levels: route (oral, sc, iv),
benefit (35%, 45%, 75% benefit), risk of TB (1 in 1,000, 10,000, and 100,000)
and cost (easy, moderately hard, or hard to afford). Subjects then rated how
threatening, stressful and risky they found choices involving each attribute
(measured on 7-point scales). Emotional trade off difficulty was defined as the
average of these 3 items. We used multiple linear regression models to examine
whether emotional trade off difficulty is associated with preference to opt out
of treatment after controlling for the importance of each attribute (which sum
to 100), as well as numeracy (the only characteristic found to be associated
with preference in bivariate analyses).

Results: Subjects’ (N=271)
mean (SD) age was 34 (8) years; 94 (35%) were non-Hispanic White, 95 (35%) non-Hispanic
Black, and 82 (30%) were Hispanic; 27% of all subjects had a college degree,
and 45% rated their health as being fair or poor. The mean (SD) importances
were; route = 16.3 (10.4), benefit = 31.3 (15.1), risk of TB = 17.6 (10.1), and
cost = 34.8 (15.3). The mean (SD) emotional trade-off difficulty ratings were:
route = 3.2 (1.6), benefit = 3.6 (1.5), and 4.2 (1.8) for both risk of TB and
cost. The strength of preference (SE) to opt out of treatment was 24.6% (2.2) for
an IV drug (with moderate benefit, risk and cost), 27.5% (2.3) for a low
benefit pill (with moderate risk and cost); 28.3% (2.3) for a high TB risk pill
(with moderate benefit and moderate cost), and 36.5% (2.5) for an expensive
pill (with moderate benefit and moderate risk of TB). The association of
emotional trade-off difficulty for each of these choices is presented in the
Table.

Conclusion: Negative emotions
associated with making tradeoffs predict treatment preferences even after
taking into account the importance weights of each attribute. Moreover,
patients experiencing greater emotional trade off difficulty are more likely to
opt out of treatment.