Abstract
Discounting is a description of the devaluing of an outcome based on increased delay or decreased probability of that outcome. This framework can be extended to virtually any choice situation, including preventive medical procedures. One third of Americans will be diagnosed with cancer in their lifetimes. Identifying how key factors affect decisions to engage in preventive care could inform interventions that are designed to promote equitable access to care. Therefore, the purpose of this study was to better understand how individuals would weigh key factors in the decision to have surgery to remove a premalignant tumor. Two experiments were conducted. In each experiment, participants (n = 50) were provided with hypothetical situations in which they were faced with the decision to undergo surgery to remove a premalignant tumor. Probability of cancer, delay to onset of cancer, frame, and cost of surgery were varied across questions. Surgical cost and probability of malignancy had the most effect on tumor removal. Delay of cancer onset and the question being framed as malignant or benign also had a small effect on tumor removal. Most participants also reported having delayed a real medical procedure due to cost, indicating that cost is a major factor in health-related decision making. Likelihood of cancer and cost of health care is a major determinant of decision making when removing a premalignant tumor. Changes in the U.S. health-care system that decrease direct costs to patients could encourage important preventative procedures, and lower potentially worse long-term cancer outcomes and increased costs due to treatment.
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Data Availability
The datasets generated and analysed during the current study are available in the OPENICPS repository, 10.3886/E138762V1.
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Appendices
Appendix 1
Percentage Comprehension Test
[] indicates correct position for slider.
For the test and training questions, participants could only select options of 0 (100% A), 25 (75% A), 50 (50% A, 50% B), 75 (75% B), and 100 (100% B)
Appendix 2
Open-Ended Questions
For avoiding/delaying a medical procedure due to cost.
If yes to any of:
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Have you ever delayed a medical procedure due to cost?
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Have you ever refused a medical procedure due to cost?
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Have you ever avoided going to a doctor for an illness due to cost?
“Please describe in more detail your experience of delaying/refusing/avoiding some medical procedure/visit due to cost.”
Open-ended optional question regarding how participants responded to the monetary or medical decision-making questions:
“Please comment on your decision-making processes during the previous tasks.”
Appendix 3
Example Questions.
[] indicates default position of slider
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Rzeszutek, M.J., DeFulio, A. & Brown, H.D. Risk of Cancer and Cost of Surgery Outweigh Urgency and Messaging in Hypothetical Decisions to Remove Tumors. Psychol Rec 72, 331–352 (2022). https://doi.org/10.1007/s40732-021-00489-4
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DOI: https://doi.org/10.1007/s40732-021-00489-4