HOW THE MANNER OF PRESENTATION OF DATA INFLUENCES OLDER PATIENTS IN DETERMINING THEIR TREATMENT PREFERENCES

Objective: To assess how the manner of presentation of graphic data to older patients influences their treatment preferences. Design: Cross-sectional structured interviews with patients. Setting: A university-based Department of Veterans Affairs Medical Center. Patients: One hundred sixty-six consecutive patients (mean age = 64.8 years, range of ages 29-82) seen in a Department of Veterans Affairs general medicine clinic. Measurements: Five pairs of 5-year survival curves were presented to patients. Each pair was composed of two survival curves for alternative unidentified treatments for an unidentified medical condition. Curve A (LT = better long-term, worse short-term survival) was fixed throughout all curve pairs. Curve B (ST = better short-term, worse long-term survival) changed in each curve pair, showing incrementally better chances of short-term survival across the five curve pairs. Patients were randomly assigned to view the curve pairs in forward (increasing short-term survival) or backward (decreasing short-term survival) order. Results: Order is a significant predictor of patients' initial preferences for the short-term survival curve (P = 0.0004) as well as their willingness to shift preferences during presentation of the five curve pairs. Patients greater-than-or-equal-to 65 were more likely to initially choose the ST curve in forward order presentation than patients <65. More educated patients generally were less likely to prefer the ST curve under both elicitation orders. Conclusions: The data indicate that the method of eliciting patients' preferences strongly influenced their expressed preferences, and that these preferences may have predictable relationships with demographic characteristics such as age.