Damschroder Laura J, Roberts Todd R, Zikmund-Fisher Brian J, Ubel Peter A
VA Health Services Research & Development Center for Practice Management and Outcomes Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.
Med Decis Making. 2007 May-Jun;27(3):266-80. doi: 10.1177/0272989X07300601.
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.
. 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.
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.
To reduce PTO refusals, it is best to adopt a decision-maker perspective.
个人权衡（PTO）诱导法通过要求人们比较治疗方案的价值来评估人们对健康状态的重视程度。例如，可能会询问人们需要治愈多少患有X疾病的患者，才能等同于治愈100名患有Y疾病的患者所带来的益处。然而，当面对PTO诱导法时，人们常常拒绝做出可量化的权衡，表现出两种拒绝方式：1）他们表示两种治疗方案具有同等价值，即治愈100名患有X疾病的患者与治愈100名患有Y疾病的患者效果相同，即使X疾病不如Y疾病严重；或者2）他们表示这两种方案无法比较，即需要治愈数百万名患有X疾病的患者，才能等同于治愈100名患有Y疾病的患者。作者探讨了如果将重点从权衡患者群体转变为选择最佳决策或评估治疗益处，人们是否会更愿意做出权衡。
两项随机试验通过互联网使用不同样本（N = 2400）来测试视角对拒绝率的影响。作者预测，使人们脱离决策角色的视角会增加他们做出权衡的意愿。
与预期相反，当人们脱离决策角色时，拒绝率上升。事实上，给人们施加的做决策压力越大，他们拒绝做出权衡的可能性就越小。
为了减少PTO拒绝情况，最好采用决策者视角。
