Preference Reversals: Violations of Unidimensional Procedure Invariance

Preference reversals have usually been explained by weighted additive models, in which different tasks give rise to different importance weights for the stimulus attributes, resulting in contradictory trade-offs. This article presents a preference reversal of a more extreme nature. Let (10, 5 Migr) denote living 10 years with a migraine for 5 days per week. Many participants preferred (10, 5 Migr) to (20, 5 Migr). However, when asked to equate these two options with a shorter period of good health, they usually demanded more healthy life years for (20, 5 Migr) than for (10, 5 Migr). This preference reversal within a single dimension cannot be explained by different importance weights and suggests irrationalities at a more fundamental level. Most participants did not change their responses after being confronted with their inconsistencies

The Better than Dead Method: Feasibility and Interpretation of a Valuation Study

Background Traditionally, the valuation of health states worse than being dead suffers from two problems: [1] the use of different elicitation methods for positive and negative values, necessitating arbitrary transformations to map negative to positive values; and [2] the inability to quantify that values are time dependent. The Better than Dead (BTD) method is a health-state valuation method where states with a certain duration are compared with being dead. It has the potential to overcome these problems. Objectives To test the feasibility of the BTD method to estimate values for the EQ-5D system. Methods A representative sample of 291 Dutch respondents (aged 18-45 years) was recruited. In a web-based questionnaire, preferences were elicited for a selection of 50 different health states with six durations between 1 and 40 years. Random-effects models were used to estimate the effects of socio-demographic and experimental variables, and to estimate values for the EQ-5D. Test-retest reliability was assessed in 41 respondents. Results Important determinants for BTD were a religious life stance [odds ratio 4.09 (2.00-8.36)] and the educational level. The fastest respondents more often preferred health-state scenarios to being dead and had lower test-retest reliability (0.45 versus 0.77 and 0.84 for fast, medium and slow response times, respectively). The results showed a small number of so-called maximal endurable time states. Conclusion Valuating health states using the BTD method is feasible and reliable. Further research should explore how the experimental setting modifies how values depend on time

The effect of a multifaceted empowerment strategy on decision making about the number of embryos transferred in in vitro fertilisation: randomised controlled trial

Objective To evaluate the effects of a multifaceted empowerment strategy on the actual use of single embryo transfer after in vitro fertilisation

Balancing the presentation of information and options in patient decision aids: An updated review

Background: Standards for patient decision aids require that information and options be presented in a balanced manner; this requirement is based on the argument that balanced presentation is essential to foster informed decision making. If information is presented in an incomplete/non-neutral manner, it can stimulate cognitive biases that can unduly affect individuals' knowledge, perceptions of risks and benefits, and, ultimately, preferences. However, there is little clarity about what constitutes balance, and how it can be determined and enhanced. We conducted a literature review to examine the theoretical and empirical evidence related to balancing the presentation of information and options. Methods: A literature search related to patient decision aids and balance was conducted on Medline, using MeSH terms and PubMed; this search supplemented the 2011 Cochrane Collaboration's review of patient decision aids trials. Only English language articles relevant to patient decision making and addressing the balance of information and options were included. All members of the team independently screened clusters of articles; uncertainties were resolved by seeking review by another member. The team then worked in sub-groups to extract and synthesise data on theory, definitions, and evidence reported in these studies. Results: A total of 40 articles met the inclusion criteria. Of these, six explained the rationale for balancing the presentation of information and options. Twelve defined "balance"; the definition of "balance" that emerged is as follows: "The complete and unbiased presentation of the relevant options and the information about those options-in content and in format-in a way that enables individuals to process this information without bias". Ten of the 40 articles reported assessing the balance of the relevant decision aid. All 10 did so exclusively from the users' or patients' perspective, using a five-point Likert-type scale. Presenting information in a side-by-side display form was associated with more respondents (ranging from 70% to 96%) judging the information as "balanced". Conclusion: There is a need for comparative studies investigating different ways to improve and measure balance in the presentation of information and options in patient decision aids

Patient and general population values for luminal and perianal fistulising Crohn’s disease health states

Background In patients with Crohn’s disease (CD), luminal disease activity paralleled by perianal fstulas may seriously impair health-related quality of life (HRQoL). Health utility values are not available from patients with CD that refect the health loss associated with both luminal and perianal CD. Objective To generate utilities for luminal and concomitant perianal fstulising CD health states directly from patients and from members of the general public. Methods A cross-sectional survey was undertaken enrolling CD patients and a convenience sample of members of the general population. Respondents were asked to evaluate four common CD heath states [severe luminal disease (sCD), mild luminal disease (mCD), severe luminal disease with active perianal fstulas (sPFCD), and mild luminal disease with active perianal fstulas (mPFCD)] by 10-year time trade-of (TTO). In addition, patients assessed their current HRQoL by the TTO method. Results Responses of 206 patients (40.8% with perianal fstulas) and 221 members of the general population were analysed. Mean±SD utilities among patients for sPFCD, sCD, mPFCD and mCD states were 0.69±0.33, 0.73±0.31, 0.80±0.29 and 0.87±0.26. Corresponding values in the general public were: 0.59±0.31, 0.65±0.29, 0.80±0.26 and 0.88±0.25. Patients with active perianal fstulas, previous non-resection surgeries, and higher pain intensity scores valued their current health as worse (p<0.05). Conclusions TTO is a feasible method to assess HRQoL in patients with perianal fstulising disease, often not captured by health status questionnaires. Utilities from this study are intended to support the optimization of treatment-related decision making in patients with luminal disease paralleled by active perianal fstulas

Assessing the information desire of patients with advanced cancer by providing information with a decision aid, which is evaluated in a randomized trial: a study protocol

Contains fulltext : 95653.pdf (publisher's version ) (Open Access)BACKGROUND: There is a continuing debate on the desirability of informing patients with cancer and thereby involving them in treatment decisions. On the one hand, information uptake may be hampered, and additional stress could be inflicted by involving these patients. On the other hand, even patients with advanced cancer desire information on risks and prognosis. To settle the debate, a decision aid will be developed and presented to patients with advanced disease at the point of decision making. The aid is used to assess the amount of information desired. Factors related to information desire are explored, as well as the ability of the medical oncologist to judge the patient's information desire. The effects of the information on patient well-being are assessed by comparing the decision aid group with a usual care group. METHODS/DESIGN: This study is a randomized controlled trial of patients with advanced colorectal, breast, or ovarian cancer who have started treatment with first-line palliative chemotherapy. The trial will consist of 100 patients in the decision aid group and 70 patients in the usual care group. To collect complete data of 170 patients, 246 patients will be approached for the study. Patients will complete a baseline questionnaire on sociodemographic data, well-being measures, and psychological measures, believed to predict information desire. The medical oncologist will judge the patient's information desire. After disease progression is diagnosed, the medical oncologist offers the choice between second-line palliative chemotherapy plus best supportive care (BSC) and BSC alone. Randomization will take place to determine whether patients will receive usual care (n = 70) or usual care and the decision aid (n = 100). The aid offers information about the potential risks and benefits of both treatment options, in terms of adverse events, tumour response, and survival. Patients decide for each item whether they desire the information or not. Two follow-up questionnaires will evaluate the effect of the decision aid. DISCUSSION: This study attempts to settle the debate on the desirability of informing patients with cancer. In contrast to several earlier studies, we will actually deliver information on treatment options to patients at the point of decision making

The relationship between change in subjective outcome and change in disease: a potential paradox

Contains fulltext : 87756.pdf (publisher's version ) (Closed access)BACKGROUND: Response shift theory suggests that improvements in health lead patients to change their internal standards and re-assess former health states as worse than initially rated when using retrospective ratings via the then-test. The predictions of response shift theory can be illustrated using prospect theory, whereby a change in current health causes a change in reference frame. Therefore, if health deteriorates, the former health state will receive a better rating, whereas if it improves, the former health state will receive a worse rating. OBJECTIVE: To explore the predictions of response shift and prospect theory by relating subjective change to objective change. METHODS: Baseline and 3-month follow-up data from a cohort of rheumatoid arthritis patients (N = 197) starting on TNFalpha-blocking agents were used. Objective disease change was classified according to a disease-specific clinical outcome measure (DAS28). Visual analogue scales (VAS) for general health (GH) and pain were used as self-reported measures. Three months after starting on anti-TNFalpha, patients used the then-test to re-rate their baseline health with regard to general health and pain. Differences between then-test value and baseline values were calculated and tested between improved, non-improved and deteriorated patients by the Student t-test. RESULTS: At 3 months, 51 (25.9%) patients had good improvement in health, 83 (42.1%) had moderate improvement, and 63 (32.0%) had no improvement or deteriorated in health. All patients no matter whether they improved, did not improve, or even became worse rated their health as worse retrospectively. The difference between the then-test rating and the baseline value was similarly sized in all groups. CONCLUSION: More positive ratings of retrospective health are independent of disease change. This suggests that patients do not necessarily change their standards in line with their disease change, and therefore it is inappropriate to use the then-test to correct for such a change. If a then-test is used to correct for shifts in internal standards, it might lead to the paradoxical result that patients who do not improve or even deteriorate increase significantly on self-reported health and pain. An alternative explanation for differences in retrospective and prospective ratings of health is the implicit theory of change which is more successful in explaining our results than prospect theory.1 september 201

The validity of time trade-off values in calculating QALYs: constant proportional time trade-off versus the proportional heuristic

In order to calculate quality adjusted life years (QALYs) from time trade-off (TTO) responses, individual preferences are required to satisfy the constant proportional time trade-off (CPTTO) assumption. Respondents who use a simple proportional heuristic may appear to satisfy CPTTO but will in fact generate preference reversals for states that are associated with a maximal endurable time (MET). Using data from 91 respondents, the study reported here examines the extent to which valuations satisfy the CPTTO assumption and the extent to which they might be generated by the proportional heuristic. The results suggest that respondents are using a proportional heuristic that casts doubt on the validity of using the TTO method to calculate QALYs for health states that are associated with MET preferences