Assessing patient preferences for medical decision making - a comparison of different methods

Patient preferences are a critical component of shared decision-making (SDM), particularly when choosing between treatment options with differing risks and outcomes. Many methods exist to elicit these preferences, but their complexity, usability, and acceptance vary.

We aim to gain insight into the acceptance, effort and preferences of participants regarding five different methods of preference assessment. Additionally, we investigate the influence of health status, experiences within the health system and of demographic factors on the results.

We conducted a cross-sectional online survey including five preference elicitation Methods: best-worst scaling, direct weighting, PAPRIKA (Potentially All Pairwise Rankings of all Possible Alternatives), time trade-off, and standard gamble. The questionnaire was distributed via academic and patient advocacy mailing lists, reaching both healthy individuals and those with acute or chronic illnesses. Participants rated each method using six standardized statements on a 5-point Likert scale. Additional items assessed general acceptance of algorithm-assisted preference assessments and the clarity of the questionnaire.

Of 258 initiated questionnaires, 123 (48%) were completed and included in the analysis. Participants were diverse in age, gender, and health status, but predominantly highly educated and digitally literate. Across all measures, the PAPRIKA method received the highest ratings for clarity, usability, and perceived ability to express preferences. Simpler methods (best-worst scaling, direct weighting) were rated as less useful for capturing nuanced preferences, while abstract utility-based methods (standard gamble, time trade-off) were seen as cognitively demanding. Subgroup analyses showed minimal variation across demographic groups. Most participants (82%) could imagine using at least one of the presented methods in real clinical settings, but also emphasized the importance of physician involvement in interpreting results.

The interactive PAPRIKA method best balanced cognitive demand and expressiveness and was preferred by most participants. Structured methods for preference elicitation may enhance SDM when integrated into clinical workflows and supported by healthcare professionals. Further research is needed to evaluate their use in real-world decisions and among more diverse patient populations.