Date of Award

May 2020

Document Type


Degree Name

Doctor of Philosophy (PhD)



Committee Member

Leo J Gugerty

Committee Member

Kaileigh Byrne

Committee Member

James McCubbin

Committee Member

Fred Switzer


In shared decision-making, doctors provide patients with information about difficult trade-off treatment decisions so the patient can make an informed choice. Many models of decision-making assume that patients make decisions based on long-term, stable preferences, but research suggests that people dynamically construct preferences for each decision. Affect plays at least two roles in preference construction. First, coherence shifting, or altering preferences prior to choice to make one alternative more attractive, may regulate emotion. Difficult decisions, imagining unpleasant outcomes, and threats to closely held goals produce general negative affect, and coherence shifting may reduce this. Second, preferences for alternatives may be constructed from immediate affective reactions, driving choice.

Two dichotomous trade-off health decision scenarios were produced that are highly conflicted on outcome unpleasantness. Experiment 1 compared a serious disease trade-off decision with a job selection task used in prior research on preference construction. Experiment 2 compared decision-making between serious and mild disease treatment decisions differing in outcome severity, also including a physiological affect measure. In both experiments, choice was best predicted by a model including only affect towards alternatives within a decision context. Prediction was not improved by including outcome and attribute ratings independent of decision context, providing support for preference construction over revealed preferences. Coherence shifting of outcome affect and attribute importance ratings was fully or partially supported in all four tasks. Tasks with more severe outcomes or threatening higher-level goals (e.g., survival) produced more aversive feelings but did not lead to stronger coherence shifting.



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