Sorum P C, Muñoz Sastre M T, Mullet E, Gamelin A
Departments of Medicine and Pediatrics, Albany Medical College, Albany, NY, USA.
Resuscitation. 2001 Mar;48(3):265-73. doi: 10.1016/s0300-9572(00)00260-4.
in helping patients decide about treatments, such as whether to authorize cardiopulmonary resuscitation (CPR), physicians typically present information about the possible outcomes and their likelihoods. The aim of this study was to elicit patient disutilities for the adverse outcomes of cardiopulmonary resuscitation (CPR) using the methodology of NH Anderson's functional theory of cognition and to determine how patients integrate the disutility and the likelihood of an outcome.
77 French adults rated scenarios of possible outcomes of CPR on a linear scale with anchors "what would be the best (or worst) for me." In 25 of the 27 scenarios, the result would be either total recovery or one of five adverse outcomes (chest injury, mild reversible brain damage, severe irreversible brain damage, death after intensive care, immediate death) with one of five likelihoods (one to five chances out of ten). In the other two, the only possible result was either total recovery or immediate death.
the mean disutilities relative to 0 for chest injury and 100 for severe brain damage were 13 for mild brain injury, 68 for death after intensive care, and 69 for immediate death. The graphs of the ratings of each adverse outcome in relation to its frequency were fan-shaped, showing that participants integrated this information multiplicatively.
the functional theory of cognition provides an alternate method of eliciting patient utilities for the outcomes of CPR and supports clinicians' assumption that people combine utility and likelihood multiplicatively.
在帮助患者决定治疗方案，比如是否授权进行心肺复苏（CPR）时，医生通常会提供有关可能结果及其可能性的信息。本研究的目的是使用NH·安德森的认知功能理论方法，得出患者对心肺复苏（CPR）不良后果的负效用，并确定患者如何综合负效用和结果的可能性。
77名法国成年人用“对我来说最好（或最坏）的情况”作为锚点，在线性量表上对心肺复苏可能的结果进行评分。在27个场景中的25个中，结果要么是完全康复，要么是五个不良后果之一（胸部受伤、轻度可逆性脑损伤、重度不可逆性脑损伤、重症监护后死亡、立即死亡），可能性为五分之一（十分之一次到五次）。在另外两个场景中，唯一可能的结果要么是完全康复，要么是立即死亡。
相对于胸部受伤为0、重度脑损伤为100，轻度脑损伤的平均负效用为13，重症监护后死亡为68，立即死亡为69。每个不良后果的评分与其发生频率的关系图呈扇形，表明参与者以乘法方式综合了这些信息。
认知功能理论提供了一种得出患者对心肺复苏结果的效用的替代方法，并支持临床医生的假设，即人们以乘法方式综合效用和可能性。
