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Can a moral reasoning exercise improve response quality to surveys of healthcare priorities?
  1. M Johri1,
  2. L J Damschroder2,
  3. B J Zikmund-Fisher3,
  4. S Y H Kim4,
  5. P A Ubel5
  1. 1
    Department of Health Administration, Faculté de Médicine, Université de Montréal, Montréal, Quebec, Canada
  2. 2
    Veteran Affairs Ann Arbor Healthcare System R&D Center of Excellence
  3. 3
    Center for Behavioral and Decision Sciences in Medicine, Veteran Affairs Ann Arbor Healthcare System & University of Michigan
  4. 4
    Bioethics Program, Department of Psychiatry, Center for Behavioral and Decisions Sciences in Medicine, Veteran Affairs Ann Arbor Healthcare System & University of Michigan
  5. 5
    Center for Behavioral and Decisions Sciences in Medicine, Veteran Affairs Ann Arbor Healthcare System & University of Michigan, Ann Arbor, Michigan, USA
  1. Mira Johri, Associate Professor, Department of Health Administration, Faculté de Médicine, Université de Montréal, CP 6128, succ. Centre-Ville, Montréal, Quebec, Canada H3C 3J7; mira.johri{at}umontreal.ca

Abstract

Objective: To determine whether a moral reasoning exercise can improve response quality to surveys of healthcare priorities

Methods: A randomised internet survey focussing on patient age in healthcare allocation was repeated twice. From 2574 internet panel members from the USA and Canada, 2020 (79%) completed the baseline survey and 1247 (62%) completed the follow-up. We elicited respondent preferences for age via five allocation scenarios. In each scenario, a hypothetical health planner made a decision to fund one of two programmes identical except for average patient age (35 vs 65 years). Half of the respondents (intervention group) were randomly assigned to receive an additional moral reasoning exercise. Responses were elicited again 7 weeks later. Numerical scores ranging from –5 (strongest preference for younger patients) to +5 (strongest preference for older patients); 0 indicates no age preference. Response quality was assessed by propensity to choose extreme or neutral values, internal consistency, temporal stability and appeal to prejudicial factors.

Results: With the exception of a scenario offering palliative care, respondents preferred offering scarce resources to younger patients in all clinical contexts. This preference for younger patients was weaker in the intervention group. Indicators of response quality favoured the intervention group.

Conclusions: Although people generally prefer allocating scarce resources to young patients over older ones, these preferences are significantly reduced when participants are encouraged to reflect carefully on a wide range of moral principles. A moral reasoning exercise is a promising strategy to improve response quality to surveys of healthcare priorities.

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Footnotes

  • ▸ Additional data are published online only at http://jme.bmj.com/content/vol35/issue1

  • Funding: The study was supported by the Department of Veterans Affairs, Veterans Health Administration, Ann Arbor Veteran Affairs Healthcare System R&D Center of Excellence, and by grants from the Canadian Institutes of Health Research (CIHR), (Project number 43817) and the US National Institutes of Health (NIH) (R01-HD40789 and R01-HD38963). Dr Johri is a recipient of a New Investigator Award from the CIHR. Dr Zikmund-Fisher is supported by a career development award from the American Cancer Society (MRSG-06-130-01-CPPB). The funding agreements ensured the authors’ full independence in designing the study, interpreting the data, and writing and publishing the report.

  • Competing interests: None.

  • Ethics approval: Exemption from ethics approval was granted by the Institutional Review Boards of the University of Michigan Medical School (IRBMED).

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