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Assessing preferences about the DNR order: does it depend on how you ask?
M E Percy1, H Llewellyn-Thomas
1Clinical Epidemiology Unit, Sunnybrook Health Science Centre, Toronto, Ontario, Canada.
Summary
Assessing preferences for do not resuscitate (DNR) orders requires careful methodology. Framing effects in probability-trade-off tasks can influence DNR attitudes, impacting the reliability of preference assessments.
Area of Science:
- Medical Ethics
- Health Psychology
- Clinical Research Methodology
Background:
- Advance directives are increasingly emphasized in healthcare.
- However, limited methodologic research exists for assessing preferences regarding do not resuscitate (DNR) orders.
Purpose of the Study:
- To evaluate a probability-trade-off task for assessing DNR attitudes in a non-patient group.
- To examine framing effects and preference stability in DNR order assessments.
Main Methods:
- 105 female nursing students completed one of two versions of a probability-trade-off task assessing DNR preferences.
- Version I involved increasingly negative outcome descriptions; Version II used increasingly positive descriptions.
- Repeat assessments were conducted one week later.
Main Results:
- DNR preference scores were lower and more stable when the task used increasingly positive descriptions.
- This suggests the positive framing may reduce risk aversion.
- Potential for artefactual effects in DNR preference assessment was identified.
Conclusions:
- Care must be taken when applying probability-trade-off tasks for DNR preference assessment.
- Framing effects can significantly influence and potentially distort DNR attitude measurements.
- Further research is needed to refine methods for reliable DNR preference evaluation.