• Open Access

Agreement between prostate cancer patients and their clinicians about utilities and attribute importance

Authors

  • Arthur S. Elstein PhD,

    1. Professor Emeritus, Department of Medical Education, University of Illinois at Chicago, Chicago, II, USA
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  • Gretchen B. Chapman PhD,

    1. Associate Professor, Department of Psychology, Rutgers University, Piscataway, NJ, USA
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  • Joan S. Chmiel PhD,

    1. Professor, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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  • Sara J. Knight PhD,

    1. Research Health Science Specialist, San Francisco VA Medical Center and Assistant Adjunct Professor, University of California at San Francisco, San Francisco, CA, USA
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  • Cheeling Chan MS,

    1. Statistical Analysis, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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  • Robert B. Nadler MD,

    1. Associate Professor of Urologic Surgery, Head Section of Endourology, Laparoscopy and Stone Disease, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
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  • Timothy M. Kuzel MD,

    1. Associate Professor of Medicine and Associate Director of Clinical Affairs, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
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  • Amy K. Siston PhD,

    1. Assistant Professor, Department of Psychiatry and Behavioural Sciences, Northwestern University, Chicago, Il, USA
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  • Charles L. Bennett MD PhD

    1. Associate Director, Midwest Center for Health Services Research and Policy Studies, VA Chicago Healthcare System; Professor of Medicine, Division of Hematology/Oncology, Feinberg School of Medicine, Northwestern University; Co-director, Cancer Control Program of the Robert H. Lurie Comprehensive Cancer Centre of Northwestern University; Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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  • Supported in part by grant IIR 95-120 to the last author from the Department of Veterans Affairs, Division of Health Services Research & Development.

Arthur S. Elstein
338 Brookside Dr.
Wilmette
IL 60091
USA
E-mail: aelstein@uic.edu

Abstract

Purpose  To examine the agreement between prostate cancer patients’ utilities for selected health states and their rankings of the importance of six attributes of the health states and the clinicians’ judgements of what would be in the patients’ best interests.

Method  Patients with newly diagnosed localized prostate cancer individually completed a time trade-off utility assessment shortly after being diagnosed. The health states evaluated were constructed from a multi-attribute utility model that incorporated six aspects of living with the disease and outcomes of treatment. Each patient assessed his current health state and three hypothetical states that might occur in the future, and provided rankings of the importance of the six attributes. The clinicians caring for each patient independently provided their views of what utilities and importance rankings would be in the patient's best interest.

Results  The across-participant correlations between patients’ and clinicians’ utilities were very low and not statistically significant. Across-participant correlations between patient and clinician importance rankings for the six attributes were also low. Across-health state and across-attribute correlations between utilities or importance rankings were highly variable across patient–clinician pairs.

Conclusion  In the clinical settings studied, there is not a strong relationship between valuations of current and possible future health states by patients with newly diagnosed prostate cancer and their clinicians. Implications of these results for substituted judgement, when clinicians advise their patients or recommend a treatment strategy, are discussed.

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