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General Practice

Understanding controlled trials: What is a patient preference trial?

BMJ 1998; 316 doi: (Published 31 January 1998) Cite this as: BMJ 1998;316:360
  1. David Torgerson, senior research fellowa,
  2. Bonnie Sibbald, reader in health services researchb
  1. a National Primary Care Research and Development Centre, Centre for Health Economics, University of York, York YO1 5DD
  2. b National Primary Care Research and Development Centre, University of Manchester, Manchester M13 9PL
  1. Correspondence to: Dr Torgerson

    A common problem in randomised controlled trials arises when patients (or their clinicians) have such strong treatment preferences that they refuse randomisation.1 The absence of these patients from trials may restrict generalisation of the results, as participants may not be representative. A further potential source of bias exists when patients with strong treatment preferences are recruited and randomised. When it is not possible to blind patients to their treatment allocation they may suffer resentful demoralisation2 if they do not receive their preferred treatment and may comply poorly. On the other hand, patients receiving their preferred treatment may comply better than average. There may therefore be a treatment effect which results from patient preferences and not from therapeutic efficacy. The effects of resentful demoralisation are …

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