Patients' Perceptions and Treatment Effectiveness

An extensive literature relating patients’ expectations to treatment outcomes has not addressed the determinants of these expectations. We argue that treatment history is part of a reference point that influences patients’ expectations of how effective further treatment might be, thus influencing whether to proceed with additional treatment or not. We hypothesize that those patients with unsuccessful prior treatments have diminished expected improvement from subsequent treatments. Prospect theory provides a theoretical foundation for reference frame effects, and the model is tested with data on patients diagnosed with idiopathic intracranial hypertension. Our results support the reference frame hypothesis.