LETTER
Eliciting Patient Preferences
Hillary A. Llewellyn-Thomas, PhD;
C. David Naylor, MD, DPhil; and
Annette M. O'Connor, PhD
1 January 1993 | Volume 118 Issue 1 | Pages 76-77
TO THE EDITOR:
An interesting contribution by Levine and colleagues [1] describes a bedside decision board to teach patients with node-negative breast cancer about adjuvant chemotherapy and to elicit their treatment preferences. However, for validation, the stability of preferences should be measured by subtly changing risks and benefits as well as the wording of the decision board [2]. The preferred validation of such an approach is a randomized trial where several specific outcomes are measured including measures of anxiety, regret, and other indices of decisional conflict or uncertainty; intergroup differences in actual treatment choices; compliance with chosen treatments; and direct measures of patient and family satisfaction with the quality of medical care.
We have used both decision boards and treatment trade-offs to determine whether potential participants and nonparticipants in a hypothetical cancer trial differ systematically in their attitudes toward the trial arms [3, 4]. Our experience leads us to hypothesize that the combination of a decision board and probability trade-off might be a more effective teaching tool at the decision point. This approach emphasizes to the patient that a risk–benefit trade-off exists and that the probabilities used in the decision board are point estimates with elements of uncertainty. These two strategies should be compared in a randomized trial before the decision board alone is disseminated into the clinical setting.
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Author and Article Information
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University of Toronto; Sunnybrook Health Sciences Centre; Toronto, Ontario, Canada
University of Ottawa; Ottawa, Ontario, Canada
1. Levine MN, Gafni A, Markham B, MacFarlane D. A bedside decision instrument to elicit a patient's preference concerning adjuvant chemotherapy for breast cancer. Ann Intern Med. 1992; 117:53-8.
2. O'Connor AMC, Boyd NF, Warde P, Stolbach L, Till JE. Eliciting preferences for alternative drug therapies in oncology: influence of treatment outcome description, elicitation technique, and treatment experience on preferences. J Chron Dis. 1987; 40:811-8.
3. Llewellyn-Thomas HA, McGreal MJ, Thiel EC, Fine S, Erlichman C. Patients' willingness to enter clinical trials: measuring the association with perceived benefit and preference for decision participation. Soc Sci Med. 1991; 32:35-42.
4. Llewellyn-Thomas HA, Thiel EC, Clark RM. Patients versus surrogates: whose opinion counts on ethics review panels? Clin Res. 1989; 37:501-5.
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