Benign and Malignant Breast Disease

Llewellyn-Thomas, H.A.; Sutherland, Heather J.; Tritchler, David; Lockwood, Gina; Till, J. E.; Ciampi, Antonio; Scott, J.F.; Lickley, Lavina; Fish, Edward B.

doi:10.1177/0272989x9101100307

Cited by 29 publications

(2 citation statements)

References 17 publications

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“…Most women were initially opposed, most requested anesthesia at some point in labor and delivery, and most who were initially opposed and then requested and received anesthesia indicated they would not have anesthesia in their next pregnancy [32]. In a study of patients with laryngeal cancer, patients' utilities were relatively stable [33], but in a more recent study of patients with breast cancer, patients' values appeared to depend on their current health status [30].…”

Section: Valuing Outcomesmentioning

confidence: 99%

Subjectivity in decision making: Common problems and limitations

Ravitch

1989

World j. surg.

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Subjectivity is an inescapable part of the diagnostic and decision making process. Limitations on memory are compensated for by invoking "diagnoses" as devices for managing information during diagnosis. Thus, large amounts of information can be stored as confirmations and departures from the diagnostic hypotheses. Well-documented limitations in probabilistic reasoning interfere with diagnosis and patient management. Uncommon diagnoses may be invoked inappropriately. Misconceptions of chance may lead to erroneous conclusions about health care. Most perplexing is that physicians attempting to incorporate patient preference in decision making are confronted with problems of subjective inconsistencies in patient valuation of outcomes of health care. The major problems of quantification and analysis are amenable to management through education, computing, and better patient data management. Problems of utility elicitation will require further research.

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Section: Valuing Outcomesmentioning

confidence: 99%

Subjectivity in decision making: Common problems and limitations

Ravitch

1989

World j. surg.

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“…induces recalibration of their internal measurement scale. The direction and degree of actual change depend on whether raters are asked to evaluate their own experienced health state or a set of imagined health states and on whether the study design stimulates self-referenced comparisons or social comparisons (Llewellyn-Thomas et al, 1991;Redelmeier, Guyatt, & Goldstein, 1996).…”

mentioning

confidence: 99%

Response shift effects on patients' evaluations of health states: Sources of artifact.

Llewellyn‐Thomas¹,

Schwartz²

2000

Adaptation to Changing Health: Response Shift in Quality-of-Life Research.

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In health services research, the investigator often needs to obtain quantitative evaluations of different states of health from raters who are either experiencing or imagining these states. Such evaluations are used in health status indices, screening and monitoring care, clinical decision analysis, clinical trials, cost-utility analysis, or program evaluation (Berzon & Schumaker, 1994). First, descriptions of the relevant health states are prepared (Llewellyn-Thomas, 1996). A health state description is a paragraph consisting of different "attributes" (e.g., the ability to carry out self-care, the ability to carry out usual work activities, the intensity of a symptom like pain). Because each attribute can be represented at different levels, all the possible attribute and level combinations yield a set of different health state descriptions. In the full set, one description will approximate a particular individual's (or rater's) experienced health state, whereas the remaining descriptions represent imaginary health states.Then, for each health state, the investigator elicits an evaluative score representing the rater's judgment of its overall desirability, or relative position on the good health-death continuum. The most common elicitation techniques are the standard gamble (von Neumann & Morgenstern, 1953), the time trade-off (Torrance, 19761, and the linear analogue scale (Hoepfl & Huber, 1978; Llewellyn-Thomas, Sutherland, Ciampi et al., 1984). The theoretical rationale underlying these techniques, their procedural details, and the issues regarding their use are treated in depth elsewhere (Froberg & b e , 1989; Torrance, 1976). The focus of this chapter is on investigators who are interested primarily in the response shift

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Health Values of Hospitalized Patients 80 Years or Older

Tsevat

Dawson

et al. 1998

JAMA

267

114

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Context.-Health values (utilities or preferences for health states) are often incorporated into clinical decisions and health care policy when issues of quality vs length of life arise, but little is known about health values of the very old. Objective.-To assess health values of older hospitalized patients, compare their values with those of their surrogate decision makers, investigate possible determinants of health values, and determine whether health values change over time. Design.-A prospective, longitudinal, multicenter cohort study. Setting.-Four academic medical centers. Participants.-Four hundred fourteen hospitalized patients aged 80 years or older and their surrogate decision makers who were interviewed and understood the task. Main Outcome Measures.-Time-trade-off utilities, reflecting preferences for current health relative to a shorter but healthy life. Results.-On average, patients equated living 1 year in their current state of health with living 9.7 months in excellent health (mean [SD] utility, 0.81 [0.28]). Although only 126 patients (30.7%) rated their current quality of life as excellent or very good, 284 (68.6%) were willing to give up at most 1 month of 12 in exchange for excellent health (utility Ն0.92). At the other extreme, 25 (6.0%) were willing to live 2 weeks or less in excellent health rather than 1 year in their current state of health (utility Յ0.04). Patients were willing to trade significantly less time for a healthy life than their surrogates assumed they would (mean difference, 0.05; P=.007); 61 surrogates (20.3%) underestimated the patient's time-trade-off score by 0.25 (3 months of 12) or more. Patients willing to trade less time for better health were more likely to want resuscitation and other measures to extend life. Time-trade-off score correlated only modestly with quality-of-life rating (r=0.28) and inversely with depression score (r=−0.27), but there were few other clinical or demographic predictors of health values. When patients who survived were asked the time-trade-off question again at 1 year, they were willing to trade less time for better health than at baseline (mean difference, 0.04; P=.04). Conclusion.-Very old hospitalized patients who could be interviewed were able, in most cases, to have their health values assessed using the time-trade-off technique. Most patients were unwilling to trade much time for excellent health, but preferences varied greatly. Because proxies and multivariable analyses cannot gauge health values of elderly hospitalized patients accurately, health values of the very old should be elicited directly from the patient.

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Benign and Malignant Breast Disease

Cited by 29 publications

References 17 publications

Subjectivity in decision making: Common problems and limitations

Subjectivity in decision making: Common problems and limitations

Response shift effects on patients' evaluations of health states: Sources of artifact.

Health Values of Hospitalized Patients 80 Years or Older

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