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The Influence of Default Options on the Expression of End-of-Life Treatment Preferences in Advance Directives

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Abstract

Background

Advance directives promise to preserve patient autonomy, but research indicates that end-of-life preferences can be influenced by the way in which questions are posed.

Objective

To determine whether preferences expressed by geriatric patients on advance directives are influenced by the default response inherent in the question.

Design

Mailed survey containing 1 of 3 versions of an advance directive.

Setting

General internal medicine outpatient medical practice.

Participants

Outpatients aged 65 or older (n = 106, response rate = 27%).

Interventions

In the “withhold” version of the survey, participants indicated situations where they would want treatments withheld (i.e., the default preference was in favor of treatment). In the “provide” version, participants indicated situations where they would want treatment provided (i.e., the default preference was against treatment). In the forced-choice control version, participants made an explicit decision to withhold or provide treatment for each situation.

Main Outcome Measure

Participants’ treatment preferences.

Results

Preferences differed by condition, F(2, 103) = 3.61, MSE = 0.09, η 2 = .07, p = .03. Participants tended to express the default preference, and thus, were more likely to favor treatment in the “withhold” condition than in the “provide” condition. Preferences in the forced-choice control condition were intermediate.

Conclusions

The default inherent in a question can impact preferences for medical treatment. This default effect limits the utility of advance directives.

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Acknowledgments

This research was supported by NSF award SES-03-25080 to the second author. The funding agreement ensured the authors’ independence in designing the study, interpreting the data, writing, and publishing the report. A preliminary report of these results appeared as a poster presentation at the November 2006 annual meeting of the Society for Judgment and Decision Making in Houston, TX.

Conflicts of Interest

None disclosed.

Author information

Authors and Affiliations

  1. Department of Psychology, New York University, 6 Washington Place, New York, NY, 10003, USA

    Laura M. Kressel BA

  2. Psychology Department, Rutgers University, Piscataway, NJ, USA

    Gretchen B. Chapman PhD

  3. Department of Internal Medicine, Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, New Brunswick, NJ, USA

    Elaine Leventhal MD, PhD

Authors
  1. Laura M. Kressel BA
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  2. Gretchen B. Chapman PhD
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  3. Elaine Leventhal MD, PhD
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Corresponding author

Correspondence to Laura M. Kressel BA.

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Kressel, L.M., Chapman, G.B. & Leventhal, E. The Influence of Default Options on the Expression of End-of-Life Treatment Preferences in Advance Directives. J GEN INTERN MED 22, 1007–1010 (2007). https://doi.org/10.1007/s11606-007-0204-6

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  • DOI: https://doi.org/10.1007/s11606-007-0204-6

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