Appendix 1: Vignettes on diseases and treatment options used in the questionnaire

In the last 2 weeks you have been bothered by scaly, itchy skin between the toes. The spots are spreading gradually. Your family physician examines your feet and diagnoses athlete's foot. It is not a serious disorder but rather a bothersome one, which will not disappear spontaneously. Two remedies are available, both in the form of an ointment. Ointment A is known to cure most cases of athlete's foot within a week. There is, however, a very small chance of an allergic reaction to the ointment, including symptoms such as a rash, fever and serious itching all over the body that need to be controlled by medication. The alternative treatment is ointment B. It does not cause any allergic reactions, but the chances of the athlete's foot disappearing within a week are smaller.

For some time you have known that you have gallstones, but you have no symptoms. The surgeon tells you that there are 2 treatment options. The first is to wait and see. Experience shows that many patients with gallstones never have any symptoms, but a small percentage do. If there are symptoms they usually take the form of biliary colic, and emergency surgery is needed. For every surgical procedure, including this one, there is a chance of complications. The alternative is surgery while you are still free of symptoms. The surgery involves removing the gallbladder. This type of surgery has a lower risk of complications than the emergency surgery.

Assume you receive a diagnosis of cancer of the larynx. The doctor tells you that in your case 2 treatment options exist. The first is surgery, which involves removal of the larynx, including the tumour. Because this procedure removes the vocal cords as well, this means that you would lose your voice. At the bottom of your neck an opening (tracheostomy) would be made in your windpipe. From then on, breathing in and out would take place through this opening, not through your nose and mouth. In principle you could learn to speak through your esophagus, or a voice prosthesis could be implanted, but your voice would never be as it was before. The other treatment is radiotherapy. The advantage of this type of treatment is that you would not lose your voice. However, your voice might be less clear as a result of the radiotherapy. Radiotherapy takes place in the hospital, 4 or 5 times a week for 5 weeks. You would not have to be admitted to hospital. Assume that the chances of cure are higher for surgery than for radiotherapy.

Assume that skin cancer has been diagnosed. The tumour is on your back, just below the shoulder blade. Although it is malignant, the chances of cure are very high. The doctor tells you that 2 options exist. One is a small operation under local anesthetic in which the tumour is cut away. The other is a new form of treatment in which the tumour is frozen and dies off. In both cases the intervention is simple, but both carry a risk of complications such as temporary problems with wound healing and persisting problems with moving the shoulder. The risk related to the surgery is greater, but the chance of cure with this treatment is also greater.

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