Utility and treatment decisions: 15 clinical cases in Japan

The purpose of this study was to investigate the applicability of utility concepts to treatment decision making in different clinical situations. In each of the 15 independent cases studied, subjective utility values were obtained directly from the patients before the treatment decisions were made. The optimal decision based on the utility values was then calculated. The actual treatment decisions were made without any input or influence by this study. The data were obtained at two large public hospitals and two privately owned multi-service hospitals in Kobe, Japan. Active participation by patients in treatment decision making seems particularly useful when two or more treatments are approximately equivalent in terms of outcome. A careful assessment of an individual patient's utilities can help the patient choose a treatment option meeting individual goals. Patient autonomy must be strengthened by giving the patients realistic and unbiased information of the alternatives available and the possible outcomes.