Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.

How Do Patients Approach Risk-Benefit Trade-Offs: A Qualitative Analysis Using a Think Aloud Protocol.

Fraenkel,  Liana, Falzer,  Paul, Mattocks,  Kristin


Eliciting patient preferences and incorporating them into treatment strategies can be beneficial for treatment adherence, patient empowerment, and clinical outcomes. Despite the importance of incorporating patient preferences into treatment strategies, little is known regarding the factors that influence how patients evaluate risk-benefit trade-offs. The purpose of this study was to gain a more complete understanding of how patients approach trade-offs using a think aloud protocol.


Patients with chronic pain were randomly drawn from primary care and women's clinics at a large medical center. Participants were audiotaped as they performed an Adaptive Conjoint Analysis survey and were instructed to: "Think out loud as you answer the questions on the computer. Just say out loud everything that comes into your head. Remember there is nothing right or wrong to say". Participants were reminded by the research assistant to say their thoughts aloud after silent periods of 15 or more seconds. Audiotapes were transcribed and two analysts independently read and coded the transcripts using the constant comparative method.


Ninety-eight transcripts were analyzed. Four themes emerged regarding how patients approach risk-benefit trade-offs: 1) Selection of a dominant attribute to guide decision-making: Some participants evaluated all risk and benefits against one dominant attribute: "When you are in pain and you want to get rid of it you make that your top priority and worry about the side effects later." 2) Leveraging values and worldviews: Many participants were influenced by personal values: "I am thinking...I have a son and I don't want to leave him without me." 3) Influence of personal experience: Personal experience with specific side effects had variable effects on risk aversion: "I have experienced nausea and dizziness and it is not a party. It really knocks you out and I want to avoid that if I can." Vs. "The nausea and the dizziness and trouble thinking clearly that is not that big of a deal. I know what that is like and it is not that big of a deal." 4) Use and manipulation of numerical information: Participants also varied significantly in their use of numbers: "The differences in pain and the improvement percentages were really close together and these were further apart being 3 out of 10 compared to 8 out of 10." Vs. "Well, it is the percentage: 3 in 10 as opposed to 1 in 10 which is a little bit less risky."


Our findings suggest that patients draw on a range of strategies and values to evaluate risk-benefit trade-offs. Understanding of how patients approach trade-offs may enable physicians to better understand how their patients consider competing treatment options in clinical practice.

To cite this abstract, please use the following information:
Fraenkel, Liana, Falzer, Paul, Mattocks, Kristin; How Do Patients Approach Risk-Benefit Trade-Offs: A Qualitative Analysis Using a Think Aloud Protocol. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :2249
DOI: 10.1002/art.30012

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