 |
 |
|
Home |
Current Issue |
Past Issues |
In the Clinic |
ACP Journal Club |
CME |
Collections |
Audio/Video |
Mobile |
Subscribe |
Tools |
Help |
ACP Online
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
1 April 1995 | Volume 122 Issue 7 | Pages 514-520
Objective: To assess 1) the health values and health ratings of seriously ill hospitalized patients, their surrogate decision makers, and their physicians; 2) the determinants of health values; and 3) whether health values change over time.
Design: Prospective, longitudinal, multicenter study.
Setting: 5 academic medical centers.
Participants: 1438 seriously ill patients with at least one of nine diseases who had a projected overall 6-month mortality rate of 50%; their surrogates; and their physicians.
Measurements: Time-tradeoff utilities (reflecting preferences for a shorter but healthy life) and health ratings.
Results: At study day 3, patients had a mean time-tradeoff utility of 0.73 ±0.32 (median [25th, 75th percentile], 0.92 [0.63, 1.0]), indicating that they equated living 1 year in their current state of health with living 8.8 months in excellent health. However, scores varied widely; 34.8% of patients were unwilling to exchange any time in their current state of health for a shorter life in excellent health (utility, 1.0), and 9.0% were willing to live 2 weeks or less in excellent health rather than 1 year in their current state of health (utility, 0.04). Health rating scores averaged 57.8 ±24.0 (median [25th percentile, 75th percentile], 60 (50, 75) on a scale of 0 (death) to 100 (perfect health). The patients' mean time-tradeoff score exceeded that of their paired surrogates (n = 1041) by 0.08 (P < 0.0001). Time-tradeoff scores were related to psychosocial well-being; health ratings; desire for resuscitation and extension of life rather than relief of pain and discomfort; degree of willingness to live with constant pain; and perceived prognosis for survival and independent functioning. Scores of surviving patients increased by an average of 0.06 after 2 months (P < 0.0001) and 0.08 after 6 months (P < 0.0001).
Conclusions: Health values of seriously ill patients vary widely, are higher than patients' surrogates believe, are related to few other preference and health status measures, and increase over time.
Author and Article Information
From Harvard Medical School and Harvard School of Public Health, Boston, Massachusetts. Duke University Medical Center, Durham, North Carolina. MetroHealth Medical Center and Case Western Reserve University, Cleveland, Ohio. Marshfield Clinic, Marshfield, Wisconsin. Johns Hopkins University, Baltimore, Maryland. University of California, Los Angeles, Medical Center, Los Angeles, California.
ACADEMIA AND CLINIC
Health Values of the Seriously Ill
For The SUPPORT Investigators.
Requests for Reprints: Joel Tsevat, MD, MPH, Section of Outcomes Research, Division of General Internal Medicine, University of Cincinnati Medical Center, 231 Bethesda Avenue, Cincinnati OH 45267-0535.
Acknowledgments: The authors thank the late Marilyn Bergner, PhD, for her contributions and dedication to this project and the members of the SUPPORT Publications Committee for helpful comments.
Grant Support: By the Robert Wood Johnson Foundation's Program on the Care of Critically Ill Hospitalized Adults.
This article has been cited by other articles:
|
|
 |
|
  N. V. Dawson, M. E. Singer, L. Lenert, M. B. Patterson, S. A. Sami, I. Gonsenhouser, H. A. Lindstrom, K. A. Smyth, M. J. Barber, and P. J. Whitehouse Health State Valuation in Mild to Moderate Cognitive Impairment: Feasibility of Computer-Based, Direct Patient Utility Assessment Med Decis Making, April 1, 2008; 28(2): 220 - 232. [Abstract] [PDF]
|
|
|
|
|
|
W. L. Nelson, P. K. J. Han, A. Fagerlin, M. Stefanek, and P. A. Ubel Rethinking the Objectives of Decision Aids: A Call for Conceptual Clarity Med Decis Making, October 1, 2007; 27(5): 609 - 618. [Abstract] [PDF]
|
|
|
|
|
|
L. J. Damschroder, T. R. Roberts, B. J. Zikmund-Fisher, and P. A. Ubel Why People Refuse to Make Tradeoffs in Person Tradeoff Elicitations: A Matter of Perspective? Med Decis Making, May 1, 2007; 27(3): 266 - 280. [Abstract] [PDF]
|
|
|
|
|
|
D. M. Bravata, L. M. Nelson, A. M. Garber, and M. K. Goldstein Invariance and Inconsistency in Utility Ratings Med Decis Making, March 1, 2005; 25(2): 158 - 167. [Abstract] [PDF]
|
|
|
|
|
|
S. M. Shechter, C. L. Bryce, O. Alagoz, J. E. Kreke, J. E. Stahl, A. J. Schaefer, D. C. Angus, and M. S. Roberts A Clinically Based Discrete-Event Simulation of End-Stage Liver Disease and the Organ Allocation Process Med Decis Making, March 1, 2005; 25(2): 199 - 209. [Abstract] [PDF]
|
|
|
|
|
|
J. T. King Jr., J. Tsevat, and M. S. Roberts Positive Association between Current Health and Health Values for Hypothetical Disease States Med Decis Making, August 1, 2004; 24(4): 367 - 378. [Abstract] [PDF]
|
|
|
|
 |
|
 C. E. Cox, S. S. Carson, and A. K. Biddle Cost-effectiveness of Ultrasound in Preventing Femoral Venous Catheter-associated Pulmonary Embolism Am. J. Respir. Crit. Care Med., December 15, 2003; 168(12): 1481 - 1487. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E P Cherniack Increasing use of DNR orders in the elderly worldwide: whose choice is it? J. Med. Ethics, October 1, 2002; 28(5): 303 - 307. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. E. Meier and R. S. Morrison Autonomy Reconsidered N. Engl. J. Med., April 4, 2002; 346(14): 1087 - 1089. [Full Text] [PDF]
|
|
|
|
|
|
Understanding Costs and Cost-Effectiveness in Critical Care . Report from the Second American Thoracic Society Workshop on Outcomes Research Am. J. Respir. Crit. Care Med., February 15, 2002; 165(4): 540 - 550. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Beghe An advance directive programme in nursing homes reduced health services use without affecting patient satisfaction Evid. Based Med., November 1, 2000; 5(6): 182 - 182. [Full Text]
|
|
|
|
 |
|
 C. Beghe An advance directive programme in nursing homes reduced health services use without affecting patient satisfaction Evid. Based Nurs., October 1, 2000; 3(4): 125 - 125. [Full Text]
|
|
|
|
|
|
P. J. Neumann, E. A. Sandberg, S. S. Araki, K. M. Kuntz, D. Feeny, and M. C. Weinstein A Comparison of HU12 and HU13 Utility Scores in Alzheimer's Disease Med Decis Making, October 1, 2000; 20(4): 413 - 422. [Abstract] [PDF]
|
|
|
|
|
|
D. Postulart and E. M.M. Adang Response Shift and Adaptation in Chronically III Patients Med Decis Making, April 1, 2000; 20(2): 186 - 193. [Abstract] [PDF]
|
|
|
|
 |
|
 J. Tsevat, S. N. Sherman, J. A. McElwee, K. L. Mandell, L. A. Simbartl, F. A. Sonnenberg, and F. J. Fowler Jr. The Will To Live among HIV-Infected Patients Ann Intern Med, August 3, 1999; 131(3): 194 - 198. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. R. Treadwell and L. A. Lenert Health Values and Prospect Theory Med Decis Making, August 1, 1999; 19(3): 344 - 352. [Abstract] [PDF]
|
|
|
|
 |
|
 L. Goldman A 75-Year-Old Woman With an Abdominal Aortic Aneurysm and Emphysema JAMA, July 22, 1998; 280(4): 366 - 372. [Full Text] [PDF]
|
|
|
|
 |
|
 P. Jaagosild, N. V. Dawson, C. Thomas, N. S. Wenger, J. Tsevat, W. A. Knaus, R. M. Califf, L. Goldman, H. Vidaillet, A. F. Connors Jr, et al. Outcomes of Acute Exacerbation of Severe Congestive Heart Failure: Quality of Life, Resource Use, and Survival Arch Intern Med, May 25, 1998; 158(10): 1081 - 1089. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. M. Ellison Palliative chemotherapy American Journal of Hospice and Palliative Medicine, March 1, 1998; 15(2): 93 - 103. [PDF]
|
|
|
|
|
|
J. Tsevat, N. V. Dawson, A. W. Wu, J. Lynn, J. R. Soukup, E. F. Cook, H. Vidaillet, R. S. Phillips, and for the HELP Investigators Health Values of Hospitalized Patients 80 Years or Older JAMA, February 4, 1998; 279(5): 371 - 375. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
I. B. Wilson, M. L. Green, L. Goldman, J. Tsevat, E. F. Cook, and R. S. Phillips Is Experience a Good Teacher?: How Interns and Attending Physicians Understand Patients' Choices for End-of-life Care Med Decis Making, April 1, 1997; 17(2): 217 - 227. [Abstract] [PDF]
|
|
|
|
|
|
P. A. Dunn, N. L. Szaflarski, J. M. Clochesy, R. J. Leiser, T. F. Mitchell, J. A. Hahn, D. I. Abrams, J. W. Hoyt, M. A. Harvey, G. S. Wlody, et al. The Role of Critical Care Nurses in Euthanasia and Assisted Suicide N. Engl. J. Med., September 26, 1996; 335(13): 971 - 974. [Full Text]
|
|
|
|
|
|
A. M. Stiggelbout, J.C.J.M. De Haes, G. M. Kiebert, J. Kievit, and J.-W. H. Leer Tradeoffs between Quality and Quantity of Life: Development of the QQ Questionnaire for Cancer Patient Attitudes Med Decis Making, June 1, 1996; 16(2): 184 - 192. [Abstract] [PDF]
|
|
Article
