How psychological distance of a study sample in discrete choice experiments affects preference measurement: a colorectal cancer screening case study

Jorien Veldwijk,1–3 Catharina GM Groothuis-Oudshoorn,4 Ulrik Kihlbom,2,5,6 Sophie Langenskiöld,2,5,6 Evelien Dekker,7 Frank GJ Kallenberg,7 G Ardine de Wit,3,8 Mattijs S Lambooij3 1Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, the Netherlands; 2Centre for Research Ethics & Bioethics, Uppsala University, Uppsala, Sweden; 3Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, the Netherlands; 4Health Technology and Services Research, University of Twente, Enschede, the Netherlands; 5Department of Health Economics, Uppsala University, Uppsala, Sweden; 6Department of Learning, Informatics, Management and Ethics, Karolinska Institute, Stockholm, Sweden; 7Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, the Netherlands; 8Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands Purpose: The purpose of this study was to investigate to what extent the outcomes of a discrete choice experiment (DCE) differ based on respondents’ psychological distance to the decision at hand.Methods: A DCE questionnaire regarding individuals’ preferences for genetic screening for colorectal cancer (CRC) within the Dutch national CRC screening program was created. The DCE contained nine D-efficient designed choice tasks and was distributed among two populations that differ in their psychological distance to the decision at hand: 1) a representative sample of the Dutch general population aged 55–65 years, and 2) a sample of Dutch individuals who attended an information appointment regarding colonoscopies following the detection of blood in their stool sample in the CRC screening program. The DCE consisted of four attributes related to the decision whether to participate in genetic screening for CRC: 1) risk of being genetically predisposed, 2) risk of developing CRC, 3) frequency of follow-up colonoscopies, and 4) survival. Direct attribute ranking, dominant decision-making behavior, and relative importance scores (based on panel MIXL) were compared between the two populations. Attribute level estimates were compared with the Swait and Louviere test.Results: The proportion of respondents who both ranked survival as the most important attribute, and showed dominant decision-making behavior for this attribute, was significantly higher in the screened population compared to the general population. The relative importance scores of the attributes significantly differed between populations. Finally, the Swait and Louviere test also revealed significant differences in attribute level estimates in both the populations.Conclusion: The study outcomes differed between populations depending on their psychological distance to the decision. This study shows the importance of adequate sample selection; therefore, it is advocated to increase attention to study sample selection and reporting in DCE studies. Keywords: discrete choice experiment, preferences, stated preferences, sample, psychological distance, genetic screening