Valuing Health At The End Of Life: An Examination Of Framing Effects And Study Design Considerations

Abstract

A number of recent studies have examined the extent of public support for an ‘end-of-life premium’ – that is, whether people place greater weight on a unit of health gain for end-of-life patients than on that for other types of patients. The objective of this study is to assess whether any observed preferences regarding an end-of-life premium are affected by framing effects and study design considerations, such as the perspective used to elicit preferences and whether or not visual aids and indifference options are included in the survey. Preferences were elicited from a representative sample of the UK general public using an online survey (n=2401). Respondents were randomly allocated to one of six study arms, each of which applied a different framing. The study design was informed by the National Institute for Health and Care Excellence's supplementary policy appraising life-extending end-of-life treatments. The choice tasks involved asking respondents which of two hypothetical patients they would prefer to treat, assuming there were enough funds to treat only one of them. Respondents were also asked a series of attitudinal questions examining their support for general health care priority setting policies. Comparisons between arms and between tasks were assessed using the Pearson’s chi-squared test. The overall results were not consistent with an end of life premium. Respondents’ choices were found to be sensitive to the choice of perspective, and to the inclusion of indifference options and (to a lesser extent) visual aids. However, in none of the study arms did a majority of respondents choose to prioritise the treatment of the end of life patient. The findings demonstrate the influence of framing effects and study design considerations in stated preference research. Researchers should seek to control for such effects when seeking to examine people’s health care priority setting preferences.