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Framing the benefits of cancer treatment: How survival is described influences preferences for care.

6099 Background: To examine how the framing of survival benefit affects individuals' preferences for cancer therapies.


METHODS
Through an internet-based survey of 2,050 U.S. adults (50% with a prior episode of cancer), respondents were randomized to one of two sets of scenarios, each of which described survival benefit of a new treatment as either increased median survival time (median survival), or increased probability of survival for a given length of time (landmark survival). Each respondent answered questions about their inclination for new treatment and their willingness to pay (WTP) out-of pocket in hypothetical scenarios. In this study, WTP was used as a methodological approach for determining patient preferences for framing of clinical benefits. Each respondent was presented with two randomly selected scenarios with different baseline and improvement in survival. We used a double-bounded, dichotomous-choice bidding game to elicit their preferences for care. We estimated mean WTP values across scenarios and assessed whether message framing predicted WTP, adjusting for respondent characteristics.


RESULTS
Most respondents (65%-91%, depending on the scenario) preferred (as determined by WTP) treatments that conferred additional survival benefit. The predicted probability of willing to pay some amount was 5% to 13% higher, and the predicted mean WTP values were 34% to 45% higher when treatment benefit was framed as improvements in landmark survival probability as opposed to median survival time.


CONCLUSIONS
How survival benefits are described may strongly influence the perception of value of cancer treatment options. Our approach using WTP suggest that people may be more inclined to prefer therapy when the expected benefit is described as an increase in landmark survival probability, compared to an increase in median survival time. Further research is needed to better understand framing effects and to develop decision tools that help patients evaluate the risks and benefits of different treatment options and clarify their preferences for care.