Being There Is Important, but Getting There Matters Too: The Role of Path in the Valuation Process
| Autor: | Julie H. Goldberg |
|---|---|
| Rok vydání: | 2006 |
| Předmět: |
Natural course
business.industry 030503 health policy & services Health Policy Regression analysis Disease medicine.disease 03 medical and health sciences Prostate cancer 0302 clinical medicine Erectile dysfunction Medicine Operations management 030212 general & internal medicine Patient behavior Personal experience 0305 other medical science business Clinical psychology Valuation (finance) |
| Zdroj: | Medical Decision Making. 26:323-337 |
| ISSN: | 1552-681X 0272-989X |
| DOI: | 10.1177/0272989x06291680 |
| Popis: | Purpose. Traditional decision-analytic models presume that utilities are invariant to context. The influence of 2 types of context on patients' utility assessments was examined here the path by which one reaches a health state and personal experience with a health state. Methods. Three groups of patients were interviewed: men older than age 49 years with prostate cancer but no diabetes (CaP), diabetes but no prostate cancer (DM), and neither disease (ND). The utility of erectile dysfunction (ED) was assessed using a standard gamble (SG). Each subject completed 2 SGs: 1) a no-context version that gave no explanation for the cause of ED and 2) a contextualized version in which prostate cancer treatment, the failure to manage diabetes, or the natural course of aging was said to be the cause. Results. Patients with disease assigned higher utilities to ED in a matching context than in discrepant contexts. Regression models found that the valuation process was also sensitive to the match between disease path in the utility assessment and patients' personal experiences. Conclusions. These findings lend insight into why acontextual utility assessments typically used in decision analyses have not been able to predict patient behavior as well as expected. The valuation process appears to change systematically when context is specified, suggesting that unspecified contexts rather than random error may lead to fluctuations in the values assigned to identical health states. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
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