End-of-Life Preferences: A Randomized Trial of Framing Comfort Care as Refusal of Treatment in the Context of COVID-19

Juliet S. Hodges, Lilia V. Stoyanova and Matteo Galizzi
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Juliet S. Hodges: Department of Psychological and Behavioural Science, London School of Economics, London, UK
Lilia V. Stoyanova: Department of Psychological and Behavioural Science, London School of Economics, London, UK

Medical Decision Making, 2023, vol. 43, issue 6, 631-641

Abstract: Background Rates of advance directive (AD) completion in the United Kingdom are lower than in the United States and other western European countries, which is especially concerning in light of the COVID-19 pandemic. UK residents typically complete an advance decision to refuse care (ADRT), whereas US versions of ADs present a more neutral choice between comfort-oriented or life-prolonging care. The purpose of this study is to test whether this framing affects decision making for end-of-life care and if this is affected by exposure to information about the COVID-19 pandemic. Methods In an online experiment, 801 UK-based respondents were randomly allocated to document their preferences for end-of-life care in a 2 (US AD or UK ADRT) by 2 (presence or absence of COVID-19 prime) between-subjects factorial design. Results Most (74.8%) of participants across all conditions chose comfort-oriented care. However, framing comfort care as a refusal of treatment made respondents significantly less likely to choose it (65.4% v. 84.1%, P  

Keywords: advance directive; COVID-19; nudge; behavioral economics; defaults; framing; priming (search for similar items in EconPapers)
Date: 2023
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Persistent link: https://EconPapers.repec.org/RePEc:sae:medema:v:43:y:2023:i:6:p:631-641

DOI: 10.1177/0272989X231171139

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