Construction of Health Preferences: A Comparison of Direct Value Assessment and Personal Narratives

Abstract

Background. Most terminally ill patients prefer to die at home rather than at an institution. However, patients are often insufficiently aware of the downsides of staying at home, which signals a need for effective decision aids. Objectives. The main purpose of the present study was to compare indirect methods of value elicitation (personal narratives [``stories''] in text or video) with a direct method (assessment of the subjective importance of each attribute). Methods . The authors asked 183 participants to evaluate 3 possible places to die: home, hospice, and nursing home. The participants received 1 of 3 value elicitation methods. The main dependent variable was participants' evaluations of the choice options before and after value elicitation, measured on a 100-point scale. Results . A shift occurred between pre- and posttest, F(4, 342) = 4.11, P = 0.003, only with the indirect methods. When text and videos were used, participants became more positive about a hospice (text: 41.9 to 49.1; video: 52.9 to 60.3). In the video condition, participants also became more positive about a nursing home (from 20.9 to 24.9). Conclusion . Stories have more impact in shaping people's preferences than merely asking for an assessment of attribute importance. The most straightforward explanation for this effect is that stories, particularly when presented in video, provide a better image of potential consequences.