Exploring Decisional Conflict With Measures of Numeracy and Optimism in a Stated Preference Survey

Abstract

Objectives Low optimism and low numeracy are associated with difficulty or lack of participation in making treatment-related health care decisions. We investigated whether low optimism and low self-reported numeracy scores could help uncover evidence of decisional conflict in a discrete-choice experiment (DCE). Methods Preferences for a treatment to delay type 1 diabetes were elicited using a DCE among 1501 parents in the United States. Respondents chose between two hypothetical treatments or they could choose no treatment (opt out) in a series of choice questions. The survey included a measure of optimism and a measure of subjective numeracy. We used latent class analyses where membership probability was predicted by optimism and numeracy scores. Results Respondents with lower optimism scores had a higher probability of membership in a class with disordered preferences ( P value for optimism coefficient = 0.032). Those with lower self-reported numeracy scores were more likely to be in a class with a strong preference for opting out and disordered preferences ( P = 0.000) or a class with a preference for opting out and avoiding serious treatment-related risks ( P = 0.015). Conclusions If respondents with lower optimism and numeracy scores are more likely to choose to opt out or have disordered preferences in a DCE, it may indicate that they have difficulty completing choice tasks.

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“…Third, the preference for current therapy by those with lower educational attainment could be influenced by current therapy being the opt-out alternative in this DCE; indeed, past evidence on DCE design has shown that choosing to opt-out is associated with lower educational attainment [ 20 ]. Finally, decisional conflict, defined as uncertainty experienced when making treatment-related medical decisions, is more common for those with lower educational attainment, and this conflict is also associated with greater likelihood of choosing the opt-out option in DCEs [ 21 ].…”