Joel Tsevat, MD, MPH; E. Francis Cook, ScD; Michael L. Green, MD, MS; David B. Matchar, MD; Neal V. Dawson, MD; Steven K. Broste, MS; Albert W. Wu, MD, MPH; Russell S. Phillips, MD; Robert K. Oye, MD; Lee Goldman, MD, MPH
Tsevat J, Cook EF, Green ML, Matchar DB, Dawson NV, Broste SK, et al. Health Values of the Seriously Ill. Ann Intern Med. 1995;122:514-520. doi: 10.7326/0003-4819-122-7-199504010-00007
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Published: Ann Intern Med. 1995;122(7):514-520.
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.
Prospective, longitudinal, multicenter study.
5 academic medical centers.
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.
Time-tradeoff utilities (reflecting preferences for a shorter but healthy life) and health ratings.
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).
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.
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Emergency Medicine, Hospital Medicine, Neurology, Pulmonary/Critical Care, Healthcare Delivery and Policy.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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