The Role of Personality in Treatment-Related Outcome Preferences Among Pharmacy Students

Ernest H. Law, PharmD, PhD; Ruixuan Jiang, PharmD; Anika Kaczynski, MS; Axel Mühlbacher, PhD; A. Simon Pickard, PhD


Am J Pharm Educ. 2019;83(7) 

In This Article


The results of this study suggest that certain personality traits among health care providers influence their preferences for health outcomes in treatment decision making. Specifically, pharmacy students (future pharmacists) who had higher levels of conscientiousness valued a patient having "no problems" with pain or discomfort or with usual activities more positively and "lots of problems" with pain or discomfort more negatively compared to those with lower levels of conscientiousness in the context of cancer clinical decision-making. These findings imply that future pharmacists place greater importance on alleviating pain or discomfort and restoring usual activities as treatment-related outcomes. In addition, while not significant, a large magnitude of effect was noted where pharmacy students who rated high in agreeableness were more likely to prefer a treatment approach that would favor the patient living in a moderately poor health state over death, while the more conscientious pharmacy students were more likely to select death over living in a health state with moderate problems.

This study may have important implications for clinical practice and shared decision-making. Future clinicians who are less agreeable or conscientious may be more likely to make decisions that are different from those made by clinicians who are more agreeable or conscientious, which may not best reflect their patient's treatment-related outcome preferences. Therefore, it may be helpful to understand how pharmacy students' personalities are related to their beliefs about meaningful patient outcomes. Much like how a new manager attends workshops to ascertain how their tendencies or biases influence their management style, understanding how personality traits affect future clinicians' preferences has implications for education and patient-centered care. However, it is unclear whether health professionals having knowledge of their personality type and predispositions towards health outcomes and treatment preferences would help those involved in the decision-making process come to an agreement.

Few studies have explored the relationship between specific personality traits and health preferences (operationalized in this study as treatment-related outcomes) using a choice-based approach. Previous work in this area investigated the association between personality traits and health state choices in adolescents and adults and found that different levels of conscientiousness were associated with differences in choosing between health states with extreme deficits in at least one health dimension and choosing death over the worst health state. Increased levels of openness to experience were also found to be associated with increased odds of preferring a health state with extreme pain over extreme dysmobility.[22] In another study by Chapman and colleagues, personality traits were evaluated as predictors of individual and societal valuations of health state among adult patients with chronic disease.[23] They demonstrated that individuals with higher levels of conscientiousness had less disutility associated with poor health, with the highest importance placed in the anxiety/depression dimension. In contrast, the present study did not find significant differences in preference weights between conscientiousness tertiles for anxiety/depression. The discordant results may be because of the differences in the populations assessed (ie, patients with chronic disease vs pharmacy students). Another reason could be the way the participants' preferences were obtained. Chapman and colleagues applied scores from another three-level version of the EQ-5D, the EQ-5D-3L, to self-reported health states. The present study directly elicited preferences for health states using hypothetical scenarios. Therefore, the perspective of the respondents and the approach to preference measurement in each study were different.

This study also found that a high level of conscientiousness or a low level of agreeableness may be associated with a greater willingness to select death over a poor or extremely poor health state. While these results were not significant, the magnitude of the point estimate was substantial (eg, OR four to five times that of low levels of conscientiousness for choosing death over having moderate health), and the study may have been underpowered to detect a difference. If such a relationship does exist, then it may have important implications for clinical practice, especially in areas such as palliative and hospice care. In such settings, clinicians and patients may find it more appropriate to favor treatment decisions that place greater importance on increasing health-related quality of life than gains in quantity of life. Future studies with larger sample sizes are required to explore this issue adequately.

This study should be considered in the context of several limitations. First, the generalizability of these findings to other health care professionals is limited by the small and relatively homogenous sample of pharmacy students. Moreover, our sample included second-year pharmacy students who had not formally participated in practice rotations, including those in the oncology setting. Therefore, our respondents may not have fully comprehended the role of the pharmacist described in our questionnaire. It remains unclear in the literature whether these preferences, which we quantified in students who were relatively early in their pharmacy career path, are "stable" relative to more advanced students or practicing pharmacists. Second, the scope of treatment-related attributes was limited to generic (or universal) health outcomes; non-health attributes such as cost of care were excluded. Third, the best-worst scaling experimental design assumed only main effects for each attribute level, and therefore interaction effects between attribute levels could not be explored. Finally, another possible explanation for the difference observed between conscientiousness tertiles is that individuals with high levels of conscientiousness are more likely to pay attention to the best-worst scaling tasks.[9] More attention to the task may reduce measurement noise to a point where the differences noted are significant. However, the point estimates (ie, average best-worst scores) differed by more than 20%, which supports the conclusion that an actual dissimilarity in preferences existed.