Conclusions
This study is the first of its kind to experimentally examine the effect of framing comfort care as a refusal of treatment on people’s choices between comfort or life-prolonging care. While the majority of participants still chose comfort care and personal preferences played a role, this framing made people significantly more likely to choose life-prolonging care. This could have important policy implications, as it may be a factor explaining the unusually low rates of ADRT completion in the United Kingdom. This effect was exacerbated by priming participants to think about COVID-19, which suggests that living through a pandemic could paradoxically make people less likely to engage with advance care planning. If this is the case, it is crucial to find ways to better engage people in this area, particularly during health crises. While the effect of the UK frame also influenced choices for specific illnesses, the effect disappeared and preferences reversed when it came to specific treatments; participants in all conditions were more likely to accept aggressive treatments than to refuse. However, there are some important limitations of the study, particularly that the sample was not representative of the UK population in pertinent ways, such as education, religion, and especially age. Future work must be conducted with a more representative sample to explore how patients make decisions about their treatment and what influences the decisions of clinicians about their patients’ care.