Cardiac Transplant Disorder
Conditions
Keywords
Heart Transplant, Transplant Survival, Applied Ethics, Decision Psychology, Human Behavior
Brief summary
Publicly available outcome assessments for transplant programs do not make salient that some programs tend to reject many of the hearts they are offered, whereas other programs accept a broader range of donor offers. The investigators use empirical studies to test whether transplant center performance data (i.e. transplant and waitlist outcome statistics) that reflect center donor acceptance rates influence laypersons to evaluate centers with high organ decline rates less favorably than centers with low organ decline rates. 1000 lay participants will be recruited from Amazon Mechanical Turk and randomized to one of five different information presentation conditions. Participants will be given an introduction to the donor organ match process, then asked to view the table of transplant outcomes corresponding to the condition they were randomized to. Each participant is asked to choose between two hospitals: one hospital with an non-selective, "accepting" strategy (takes all donor heart offers), and one hospital with a more selective, "cherrypicking" strategy (tends to reject donor offers that are less than "excellent" quality).
Detailed description
Publicly available outcome assessments for transplant programs do not make salient that some programs tend to reject many of the hearts they are offered, whereas other programs accept a broader range of donor offers. The investigators use empirical studies to test whether transplant center performance data (i.e. transplant and waitlist outcome statistics) that reflect center donor acceptance rates influence laypersons to evaluate centers with high organ decline rates less favorably than centers with low organ decline rates. 1000 lay participants will be recruited from Amazon Mechanical Turk and randomized to one of five different information presentation conditions: 1. Condition 1 ("baseline" condition): view only combined transplant survival (e.g. transplant survival rate not stratified by number and quality of donor hearts accepted at each center) 2. Condition 2: view combined transplant survival + total survival (e.g. overall survival rate at each center, computed from survival rates of both transplant and waitlist patients) 3. Condition 3: view only stratified transplant survival (e.g. transplant survival rate stratified into patients who received excellent donor organs and patients who received less than optimal donor organs) 4. Condition 4: view stratified transplant survival + total survival 5. Condition 5: view only total survival Participants will be given an introduction to the donor organ match process, then asked to view the table of transplant outcomes corresponding to the condition they were randomized to. Each participant is asked to choose between two hospitals: one hospital with an non-selective, "accepting" strategy (takes all donor heart offers), and one hospital with a more selective, "cherrypicking" strategy (tends to reject donor offers that are less than "excellent" quality). In order to identify the decision process that underlies this choice pattern, the investigators will examine a putative mediator. Specifically, participants will be asked to rate the extent to which they considered patients' chances of getting an excellent heart, avoiding a less-than-optimal heart, and getting any type of heart when making their choice between the two hospitals.
Interventions
OTHERTotal Survival
The overall or "total" survival rate at each center is displayed in the table of outcome statistics. Total survival is computed from survival rates of both transplant and waitlist patients: \[(number of patients surviving after transplant at end of year + number of patients alive on waitlist at end of year)\] / \[number of patients alive on waitlist at start of year\].
The transplant survival rate in the table of outcome statistics is stratified into two groups: (i) patients who received excellent donor organs and (ii) patients who received less than optimal donor organs. Stratified transplant survival is computed from survival rates of transplant patients who received each quality category of organ. excellent transplant survival = \[number of patients surviving after transplant with excellent organ\]/\[number of patients for whom excellent organ was accepted for transplant\] marginal transplant survival = \[number of patients surviving after transplant with marginal organ\]/\[number of patients for whom marginal organ was accepted for transplant\]
Sponsors
Carnegie Mellon University
Study design
Allocation
RANDOMIZED
Intervention model
FACTORIAL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
SINGLE (Subject)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
Participants who are already qualified mTurk workers with Worker Accounts meeting the above criteria will be asked to participate if they confirm the following inclusion criteria in the consent form. 1. 18 years of age or older 2. must read and understand the information in the consent form 3. must want to participate in the research and continue with the survey 4. must live in United States
Exclusion criteria
1. Participants on mTurk will not be allowed to participate if they fail to pass the initial "bot screening", a multiple-choice question that asks, "What phone number should you dial when there is an emergency?" The obvious correct response in this screening question is "911", so participants who select one of the incorrect responses (i.e. "1-800-ANTIBOT", "1-877-MTURKER", "123") are filtered out and not allowed to complete the survey. 2. Participants on mTurk will be allowed to participate, but excluded from data analysis, if they submit a nonsense response to the free-response question which reads, "In your own words, why do you think patients should choose the hospital you picked?" This question takes place after the participant has viewed the choice stimuli and selected their response. If participants input nonsense in the text response box, they will be permitted to complete the survey and paid, but filtered out from the data analysis.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Hospital Choice | 1 day | The outcome variable will be a measure of binary choice between two hospitals: one with a selective donor-heart acceptance strategy and one with a non-selective donor heart acceptance strategy. Participants will respond to the question "Which Hospital is a better choice for patients? Please click on one of the two tables below to indicate which hospital is the better choice." Participants will choose been two outcome tables featuring the selective and non-selective hospital (counterbalanced, such that each of the two choices is equally likely to be presented at top of the choice scenario in each condition). The number of participants that choose each hospital will be the measured outcome variable used in analyses. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Mediator of Hospital Choice | 1 day | Participants responded to the question, "There are many reasons why one transplant hospital might outperform another. Which reasons were most important in your decision? Please move the slider to indicate how much you considered each of the reasons below (0=reason was not important, 100=reason was extremely important). Patients were more likely to receive any type of donor heart at the hospital I picked. |
Countries
United States
Contacts
PRINCIPAL_INVESTIGATORAlison E Butler, BS
Carnegie Mellon University
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Condition 1: Combined Only Participants randomized to baseline (control) arm Condition 1 will view only combined transplant survival outcome information (e.g. transplant survival rate not stratified by number and quality of donor hearts accepted at each center) when making a choice between the two hospitals. | 183 |
| Condition 2: Combined Plus Total Participants randomized to Condition 2 will view combined transplant survival and total survival outcome information when making a choice between the two hospitals.
Total Survival: The overall or total survival rate at each center is displayed in the table of outcome statistics.
Total survival is computed from survival rates of both transplant and waitlist patients: \[(number of patients surviving after transplant at end of year + number of patients alive on waitlist at end of year)\] / \[number of patients alive on waitlist at start of year\]. | 194 |
| Condition 3: Stratified Only Participants randomized to Condition 3 will view only stratified transplant survival outcome information when making a choice between the two hospitals.
Stratified Transplant Survival: The transplant survival rate in the table of outcome statistics is stratified into two groups: (i) patients who received excellent donor organs and (ii) patients who received less than optimal donor organs.
Stratified transplant survival is computed from survival rates of transplant patients who received each quality category of organ.
excellent transplant survival = \[number of patients surviving after transplant with excellent organ\]/\[number of patients for whom excellent organ was accepted for transplant\] marginal transplant survival = \[number of patients surviving after transplant with marginal organ\]/\[number of patients for whom marginal organ was accepted for transplant\] | 192 |
| Condition 4: Stratified Plus Total Participants randomized to Condition 4 will view stratified transplant survival and total survival outcome information when making a choice between the two hospitals.
Total Survival: The overall or total survival rate at each center is displayed in the table of outcome statistics.
Total survival is computed from survival rates of both transplant and waitlist patients: \[(number of patients surviving after transplant at end of year + number of patients alive on waitlist at end of year)\] / \[number of patients alive on waitlist at start of year\].
Stratified Transplant Survival: The transplant survival rate in the table of outcome statistics is stratified into two groups: (i) patients who received excellent donor organs and (ii) patients who received less than optimal donor organs.
Stratified transplant survival is computed from survival rates of transplant patients who received each quality category of organ.
excellent transplant survival = \[number of patients surviving after transplant with excellent organ\]/\[number of patients for whom excellent organ was accepted for transplant\] marginal transplant survival = \[number of patients surviving after transplant with marginal organ\]/\[number of patients for whom marginal organ was accepted for transplant\] | 209 |
| Condition 5: Total Only Participants randomized to Condition 5 will view only total survival outcome information when making a choice between the two hospitals.
Total Survival: The overall or total survival rate at each center is displayed in the table of outcome statistics.
Total survival is computed from survival rates of both transplant and waitlist patients: \[(number of patients surviving after transplant at end of year + number of patients alive on waitlist at end of year)\] / \[number of patients alive on waitlist at start of year\]. | 241 |
| Total | 1,019 |
Baseline characteristics
| Characteristic | Condition 1: Combined Only | Condition 2: Combined Plus Total | Condition 3: Stratified Only | Condition 4: Stratified Plus Total | Condition 5: Total Only | Total |
|---|---|---|---|---|---|---|
| Age, Categorical <=18 years | 1 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 1 Participants |
| Age, Categorical >=65 years | 1 Participants | 2 Participants | 2 Participants | 2 Participants | 2 Participants | 9 Participants |
| Age, Categorical Between 18 and 65 years | 181 Participants | 192 Participants | 190 Participants | 207 Participants | 239 Participants | 1009 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 2 Participants | 2 Participants | 1 Participants | 0 Participants | 1 Participants | 6 Participants |
| Race (NIH/OMB) Asian | 9 Participants | 7 Participants | 10 Participants | 11 Participants | 11 Participants | 48 Participants |
| Race (NIH/OMB) Black or African American | 13 Participants | 10 Participants | 14 Participants | 19 Participants | 16 Participants | 72 Participants |
| Race (NIH/OMB) More than one race | 6 Participants | 11 Participants | 9 Participants | 10 Participants | 13 Participants | 49 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 2 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 2 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 9 Participants | 10 Participants | 17 Participants | 12 Participants | 10 Participants | 58 Participants |
| Race (NIH/OMB) White | 142 Participants | 154 Participants | 141 Participants | 157 Participants | 190 Participants | 784 Participants |
| Region of Enrollment United States | 183 participants | 194 participants | 192 participants | 209 participants | 241 participants | 1019 participants |
| Sex/Gender, Customized Sex/Gender (customized) Female | 82 Participants | 97 Participants | 87 Participants | 102 Participants | 119 Participants | 487 Participants |
| Sex/Gender, Customized Sex/Gender (customized) Male | 97 Participants | 90 Participants | 96 Participants | 106 Participants | 115 Participants | 504 Participants |
| Sex/Gender, Customized Sex/Gender (customized) Unknown/Other | 4 Participants | 7 Participants | 9 Participants | 1 Participants | 7 Participants | 28 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk | EG003 affected / at risk | EG004 affected / at risk |
|---|---|---|---|---|---|
| deaths Total, all-cause mortality | 0 / 183 | 0 / 194 | 0 / 192 | 0 / 209 | 0 / 241 |
| other Total, other adverse events | 0 / 183 | 0 / 194 | 0 / 192 | 0 / 209 | 0 / 241 |
| serious Total, serious adverse events | 0 / 183 | 0 / 194 | 0 / 192 | 0 / 209 | 0 / 241 |
Outcome results
Primary
Hospital Choice
The outcome variable will be a measure of binary choice between two hospitals: one with a selective donor-heart acceptance strategy and one with a non-selective donor heart acceptance strategy. Participants will respond to the question Which Hospital is a better choice for patients? Please click on one of the two tables below to indicate which hospital is the better choice. Participants will choose been two outcome tables featuring the selective and non-selective hospital (counterbalanced, such that each of the two choices is equally likely to be presented at top of the choice scenario in each condition). The number of participants that choose each hospital will be the measured outcome variable used in analyses.
Time frame: 1 day
| Arm | Measure | Category | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Condition 1: Combined Only | Hospital Choice | Proportion choosing non-selective center | 64 Participants |
| Condition 1: Combined Only | Hospital Choice | Proportion choosing selective center | 119 Participants |
| Condition 2: Combined Plus Total | Hospital Choice | Proportion choosing selective center | 69 Participants |
| Condition 2: Combined Plus Total | Hospital Choice | Proportion choosing non-selective center | 125 Participants |
| Condition 3: Stratified Only | Hospital Choice | Proportion choosing selective center | 29 Participants |
| Condition 3: Stratified Only | Hospital Choice | Proportion choosing non-selective center | 163 Participants |
| Condition 4: Stratified Plus Total | Hospital Choice | Proportion choosing non-selective center | 192 Participants |
| Condition 4: Stratified Plus Total | Hospital Choice | Proportion choosing selective center | 17 Participants |
| Condition 5: Total Only | Hospital Choice | Proportion choosing selective center | 17 Participants |
| Condition 5: Total Only | Hospital Choice | Proportion choosing non-selective center | 224 Participants |