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Assessing patients' utilities. Can the ends justify the means?
1General Internal Medicine Unit, Massachusetts General Hospital, Boston 02114.
Medical Care
|March 1, 1989
Summary
Utility assessments are complex, with controversies arising from interdisciplinary approaches and diverse applications. Clarifying the purpose and focusing on disease-specific outcomes, like in prostatectomy decisions, is key to improving their use in healthcare.
Area of Science:
- Health economics
- Decision analysis
- Psychometrics
Background:
- Utility assessment strategies involve defining health states, identifying subjects, selecting scaling tasks, aggregating data, and ensuring reliability and validity.
- Controversies stem from the interdisciplinary nature of utility assessment and its varied applications in individual and population decision-making.
- Divergent conceptualizations of utility across disciplines influence methodological priorities and problem-solving approaches.
Purpose of the Study:
- To clarify issues in utility assessment by focusing on the purpose of the assessment and disease-specific outcomes for clinical decision-making.
- To examine the validity of utility assessment applications, including their ability to predict patient well-being and behavior.
- To explore how utility assessments can influence decision-making to enhance overall well-being.
Main Methods:
- The study reviews existing literature and conceptual frameworks related to utility assessment strategies.
- It uses the prostatectomy decision as a case example to illustrate the application and challenges of utility assessment.
- It proposes focusing on validating the *uses* of utility assessments, beyond measurement validity.
Main Results:
- Utility assessment elements are subject to controversy due to interdisciplinary perspectives and diverse applications.
- Focusing on the purpose and relevant disease-specific outcomes can clarify utility assessment issues, as demonstrated by the prostatectomy example.
- Further research is needed to validate the predictive and behavioral impact of utility assessments in clinical decision-making.
Conclusions:
- Clarifying the purpose of utility assessments and focusing on disease-specific outcomes is crucial for their effective application in clinical decision-making.
- More attention should be directed towards validating the practical uses of utility assessments, such as predicting patient well-being and behavior.
- Challenges such as changing utilities, decision-making biases, and responsibility effects complicate the use and interpretation of utility assessments.