Abstract
BACKGROUND: A theoretical interpretation of factors influencing time tradeoff (TTO) scores is lacking. In this conceptual study, we use a sociopsychological theory, terror management theory (TMT), to explain how death thoughts may play a role in the TTO method. TMT describes how respondents suppress death thoughts by invoking psychological defenses, such as self-esteem, and by bolstering cultural values. RESEARCH QUESTION: What is the relation between TMT and TTO scores? METHODS: A framework is developed to link TMT to TTO scores. Predictions of the framework pertain to the directionality of relations between characteristics (e.g., being religious) affecting TTO scores. These predictions are then tested against the findings in the literature. RESULTS: The value "prolonging life" can be used as a linking pin between TTO and TMT as it is relevant for both TMT and TTO. It is argued that the value "prolonging life" is related to TTO scores but also to TMT defense strengths. Thus, TMT defense strengths become associated with trading. Directionality predictions of the framework were confirmed in 34 out of 39 retrospective tests (P < 0.001). CONCLUSION: Directionalities of relations between TTO scores and socioeconomic characteristics, euthanasia, subjective life expectancy, and religion were explained in terms of TMT defense strengths. Our framework offers a theory-based and parsimonious framework to think about characteristics influencing TTO scores. HIGHLIGHTS: Terror management theory (TMT) is a sociopsychological theory about death thoughts.Several factors are known to influence TTO scores.A new framework applies TMT to TTO scores to interpret such factors.Our framework is mostly of importance to health economists studying the TTO.