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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 …
Torgerson et al. (Sat,) studied this question.
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